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I am writing to address a currently politically incorrect issue in psychiatry. I am becoming increasingly concerned that we are often overmedicating our patients with antidepressants. I am not blind to the necessity of aggressively medicating patients suffering from depression, even masked and subtle depression. I am simply stating that in addition to the widely publicized discussions in psychiatric circles of under-medicating patients with depression, there has been little written about the possibility of overmedicating depressed patients.
There are at least two issues I would like to raise. The first occurred in a session prior to writing this letter. It was only my second visit with the patient, and I had prescribed Paxil to treat her for major depressive symptoms of over a year's duration. In her second session, she revealed that she had not yet taken the medication because of anxiety regarding its side effects and also that for the last 14 years her husband has not been interested in sex. She stated that she has never told anyone her "secret" and felt tremendous relief after disclosing it. It is not yet clear to me whether the patient will in fact require antidepressant medication, but we both agreed that given the relief she felt after our discussion, it would be best to wait at least a week.
The other issue is that of patients with long-standing depression. We are routinely recommending, based on current research, that these patients stay on medication for the rest of their lives. I continue to encounter patients who have used medication episodically and do not seem to need medication continuously.
To identify subgroups of patients correctly and separate them from the vast majority who clearly require maintenance antidepressants takes more time and work--a microscopic focus on their lives. I realize that this is an anathema to the managed care ethos.
Emanuel H. Rosen, M.D.
La Jolla, Calif.