4 Comments to
Consumer Reports on Antidepressants

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  1. Hear, hear.
    I have some concerns about the subject matter.
    1. First, unlike most of the products Consumer Reports evaluates, medications vary drastically in their effectiveness depending on each person’s individual body chemistry, which is one reason there are so many options and also one reason it sometimes takes some trial and error to get the choice of meds and doses right for each person. It’s not like a Toyota, say, which is going to have the same strengths and weaknesses no matter who drives it.
    2. Second, as noted by Dr. Grohol, a prescription of an antidepressant without psychotherapy is a bad idea – not least because the effectiveness of an antidepressant often starts dropping off after several months, leaving the patient who has not learned cognitive coping skills back at square one.
    3. I’d go further, also, and say that an MD or DO without experience in psychiatry should refer patients who appear to have mood disorders to a psychiatrist; too often the general practitioner quickly prescribes psych meds and doesn’t involve the appropriate specialist; one major reason is that the general practitioner is unlikely to have the skills at differential diagnosis needed, and that can be dangerous. In one of the most common situations, a person who is depressed at the moment, but actually has bipolar disorder rather than major depressive disorder or dysthymia, can’t safely take an antidepressant without pairing it with a mood stabilizer. The antidepressant taken alone is likely to trigger severe mania which can have disastrous consequences.
    4. Finally, this doesn’t mention the benefits of other strategies including moderate exercise, sleep hygiene, dietary improvements, and some supplements such as fish oil or other sources of omega-3 fatty acids. There are also plenty of books for people suffering from depression, along with support groups like the 12-step program Emotions Anonymous.

  2. For someone who has suffered from depression for over forty years (like me) therapy seems pointless. I been to four therapists over the years with little success. Their advice would just scratch the surface while my depression has embedded itself inside of me and it’s going to take something more aggressive to get relief. I’ve taken many different antidepressants and now on cymbalta. It’s fairly effective but seems to be pooping out. I would love to exercise but with depression I have absolutely no energy to do anything. I will always keep looking for the right treatment though hope for a “normal” life seem very distant.

  3. Hi doc.,

    I have pondered the question “how do we get AD’s to the people who really need them and restrain from having them prescribed to people who either won’t benefit from their use, or are undiagnosed bipolar and the prescription might be a dangerous if not deadly course of action.”

    Despite what the mental health community believes, SSRI’s and SNRI’s are being doled out like Halloween candy by GP’s. I believe I had a front row seat to a manic episode incited by Prozac. It caused me much distress and the impending divorce saw me fall into a fit of depression. I went to my GP after loosing a lot of weight very fast. I spent 20 min. explaining how I believed AD’s had ruined my marriage. At the beginning of the description he even interrupted and said, “It sounds like (my wife) might be bipolar”. So he was aware of the risks. At the end of the appointment, do you know he tried to prescribe me an AD? I said, “Doc, how do you know that I am not bipolar? Are you planning one monitoring my behavioral changes over the next couple of month or keep in contact with my family as the FDA protocol requires?”

    His answer was that “the new SSRI’s are better and more mild then the old.”

    The solution to the problem seems simple. I can’t get cancer treated by a GP, so why can i get depression treated by one? The reality is when the patient walks out the doctor’s office, who is going to come back and tell this GP about a manic episode?

  4. Only budeprion was found to be not as effective as brandname Wellbutrin for some people because the administration of the medication is slightly different. Bupropion is fine. Furthermore, Wellbutrin is very expensive (insurance usually won’t cover a brandname if a generic is available) and often not stocked anymore. And if you’ve only ever been on a generic version of the med then it doesn’t really matter does it? The issue is when a patient is switched from generic to generic or brand to generic because which may have slightly different amounts of medication. But again, this is not likely to cause a problem.

    There was a great NY times article about this.



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