Pills for Depression Send the Wrong Signal

A recent study, funded by the National Institute of Mental Health, has reached the striking conclusion that Prozac is not only better than a placebo in treating teenage depression but that it is significantly better than talk therapy.

This is the latest battle in a controversy that’s been going on for the last few decades in the world of psychiatry over whether drugs can replace conventional therapy. In recent years, psychopharmacologists have developed powerful drugs to treat not only depression but anxiety and shyness and compulsive hand-washing and almost everything else you can think of. More and more, psychiatrists are moving toward prescribing medications to their patients and not providing therapy at all. Why waste time with years of psychoanalysis or therapy if you can shoo your problems away with a pill?

For one, the reports out of this most recent study might be wrong. They are preliminary -- only 12 weeks of a yearlong study have been analyzed. The findings may not be borne out when the full results are considered.

But there’s another issue as well, more subtle but as important: The way you choose to deal with your unhappiness may have consequences for the way you think about it. To treat your misery with a pill is to imply that it’s something in your body, like a cold. You can imagine that you are no more responsible for it than you are for your winter flu and that what you can do about it is to treat it with medicine -- rather than to think about the messed-up relationships or crazy-making workload that upset you in the first place. Neither you nor anyone else is the author of your misery, but neither are you the captain of your fate.

On the other hand, to treat your misery with psychotherapy is to imply that you’re unhappy because of something you’ve done with your life -- the way you put relationships together, the way you deal with your parents or your boss, the way you choose to spend your afternoons. To think about unhappiness that way makes you feel responsible for the ways in which you might have contributed to your difficulties, and makes you feel that you have choices to make. You are in charge of your destiny, and you can learn to live life differently. But then you have to accept that you, or someone close to you, helped to create the unhappiness in the first place.

We know now that both models of illness have a good deal of truth to them. Some people have bad genes. Some have bad parents. Some have both, some neither. Almost always, the real story of mental illness is a gumbo of body, family, society and culture. But in choosing the way you treat your distress, you are also choosing something about the environment in which your future self will grow, the way you imagine what it is to be a person, to be a soul.

And it could be argued that particularly when you are dealing with teenagers, with young people who are just forging their sense of how to be effective in the world, you should help them to think of themselves as being in charge of their lives, capable of learning the emotional skills they need to cope.

Depressed teenagers may well respond to antidepressant medication. But it would be a shame to leave them with the lesson that their despair is bigger than they are. If they also learn there are ways of thinking, feeling and relating that they can master and that can help them, so much the better.

Even this NIMH study found, as have previous studies, that drugs and talk together do better than either alone. Prozac alone was better than talk alone, but talk and Prozac together were better still.

Given that these new antidepressants might actually cause suicide in a small number of patients, the common-sense conclusion for a worried parent might be that antidepressant medication could be helpful, but that the child should be watched like a hawk and preferably be in therapy at the same time with someone familiar with these medications and their risks.