Monday, August 18, 2008

If Meds Don’t Work…Add Another!

I was browsing the new TIME magazine when a bizarre advertisement caught my attention.

This is for Abilify, an antipsychotic from Bristol-Myers Squibb.

Here is the deal: if you are taking an antidepressant, and you still have “unresolved symptoms,” the physician should add Abilify.

Am I missing something here?

If your antidepressants aren’t working, maybe you should start talking to your physician about how to find a decent therapist. As in: talk therapy is an effective treatment for depression. “Behavioral Activation” is also a decent intervention: getting off the duff and getting active. Exercise is an effective intervention for depression. Any of these, with or without an antidepressant, will help improve things.

What people are increasingly figuring out is that the pills just really do not work. Not like we are lead to believe” You have this biological illness called depression. It is caused by some imbalance (or deficit) of serotonin. If you take these pills, the serotonin levels will be restored, and you will no longer be depressed.”

Right. If I had a dollar for every time A psychiatrist played out this tired story, I would be as rich as…as a pharmaceutical company.

So, apparently Bristol-Myers Squibb comes up with a great idea – antidepressants never work that well – so let’s figure out a drug to augment.

To figure out a bit more info, I found the website equivalent of the print ad:

Sure, if it helps some people, I guess that is what we want: less depression. But sad to see the reinforcement of pills as the answer, especially pills as the answer when pills don’t work. Is some pharmaceutical company out there currently studying a third category of pill for augmenting the antidepressant/antipsychotic combo if that leaves you with “unresolved” symptoms?

It doesn’t make sense. The ad, and much of this physician-directed and pharmaceutical-directed message fails to ever suggest: Try therapy when the meds fail ya.

Even scarier – the side effects of Abilify must be wicked. The disclaimers and cautions are very prominent on this ad. Seizures, anxiety, and more. Especially a shockingly clear statement about meds being associated with increased suicide risk, paired up with explicit direction to talk to the doc if you start thinking about hitting the gaspipe. All this, plus, very clear warnings that this pill is off-limits to the youngsters. Quite a scary ad, really.

Now consider the side effects of talk therapy: Increased confidence. Greater insight. Increased interpersonal effectiveness.

Take your pick: meds versus therapy.


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