No need to fear antidepressants if patients, doctors team up on diagnosis, treatment
"Is the antidepressant I'm taking safe?" I am hearing this question from my patients more and more. The reason? The media has recently reported that among antidepressant users, some develop increased feelings of hostility or anxiety, and have even committed sudden acts of violence against others.
The Ministry of Health, Labor and Welfare has investigated the side-effects of antidepressants and has decided to revise the warnings on the medication, stating, "There are cases where we cannot rule out a causal relationship with the medication."
When patients taking antidepressants hear news like this, it's little wonder they feel uneasy and think things like, "I guess there are some harsh side-effects," or, "Will I end up like that, too?"
However, the fact is that the overwhelming majority of those taking antidepressants for depression are recovering. Should people arbitrarily decide without sufficient data that antidepressants are unsafe, there is a real danger that those in need will stop treatment.
On the other hand, I cannot deny that there is a trend to prescribe especially new antidepressants on a wider scale than is needed. Above all, it is not desirable to prescribe antidepressants to patients who seem at first glance to be depressed but who in fact are mildly manic-depressive. In such cases, the hitherto hidden manic condition will show its face, and may lead to irritation or even violence. In cases of manic-depression, the patient must be prescribed a completely different type of mood-regulating drug.
To say that being able to tell the difference between depressives and mild manic-depressives is the test of a psychiatrist's true skill is no exaggeration.
Should a trusted psychiatrist diagnose a patient with "genuine depression" and prescribe antidepressants, it would be safe to say that the medication will not have the sorts of negative side-effects that have been reported. If a patient balks, saying "medication is scary," then treatment will simply be delayed at no benefit to the person in question.
On the other hand, no matter how renowned the doctor, there are some cases where a definitive diagnosis cannot be made after just one visit. In such cases, though it may be troublesome, patients should pay regular visits to the doctor every few days.
With a patient making visits to the doctor whenever possible, doctors can make careful diagnoses and treatment with medication can continue. Should doctors and patients follow such a cooperative routine, then incidents of patients beset with terrible side-effects from antidepressants would not occur.
I hope people will not simply assume that medication is something to be scared of, and search for a route to recovery through medication suitable for their condition. (By Rika Kayama, psychiatrist)
(Mainichi Japan) May 21, 2009