In Defense of Happy Pills

Why talk to a shrink if Prozac or Zoloft will do the trick?

Maia Szalavitz from the October 2005 issue

(Page 5 of 5)

While this phenomenon might be unsettling if, as in the movie Eternal Sunshine of the Spotless Mind, drugs made these changes by erasing the memories that make us who we are, there's no evidence that antidepressants do that. And those who argue that we should be able to impulsively act out our prickly, irritable, depressive characteristics to provide human variety are not usually the ones who have to live with those who do so.

One final argument for preferring talk to drugs is fear of dependence. Some antidepressant drugs do produce painful withdrawal symptoms, and it is unconscionable that some patients are given these medications without appropriate warnings and without first having tried other, less problematic treatments. But there's also no doubt that some talk therapies create dependence every bit as worrisome. Therapy cults aside, just think of those analysands who have therapy four hours a week and never make a decision without first consulting their shrinks.

While it's always better to have fewer needs, physical dependence on medication, in and of itself, needn't be a problem if the drug is readily available and safe. If the drug improves one's ability to work and love, who is being hurt? We're all dependent on air, food, and water, and maintenance medications will become a fact of life for most of us as we outlive the ages which our bodies evolved to reach. Whether the medication treats high blood pressure, pain, or depression shouldn't matter.

Suffering Is Not All It's Cracked Up to Be

This is not to say we have anything close to perfect medications--and for many people, the tradeoff between side effects, risks, and benefits weighs against taking those currently available. In this connection, full disclosure of the data on current drugs and more research and openness on those in development is critical.

Nor do I believe there is never lingering emotional distress that needs to be understood and conquered, or that there is no role for talk therapy or self-help. Many studies, including a 2002 review in the American Journal of Psychiatry and a more recent head-to-head trial published this year in the same journal, have found that certain talk therapies are just as effective as drugs. A 2003 study published in the Proceedings of the National Academy of Sciences even found that for people with childhood trauma, one such therapy was more effective.

But evidence-based therapy is hard to find outside university research studies. The therapy that helped the childhood trauma victims more than drugs, for example, was a cognitive-behavioral treatment that focused on dealing with current problems, not searching for their roots in the past. It wasn't the kind of "depth" treatment talk therapy proponents usually advocate.

Few patients outside of studies get therapy based on what the research finds effective; most practitioners ignore the data and do what their "clinical experience" suggests. Recognizing this gap, government agencies such as the Substance Abuse and Mental Health Services Administration have distributed literature and sponsored initiatives aimed at bringing "research into practice." But while the situation is far better than it was 10 or even five years ago, both researchers and patients say there's a long way to go. For talk therapy to be a genuine alternative or supplement to medication, the methods covered by insurers should be proven safe and effective, just as the Food and Drug Administration requires for drugs. Mental health advocates have long called for "parity" between coverage of mental and physical illnesses, but it makes no sense to cover talk unless therapists practice proven treatments.

In addition to insisting on evidence of effectiveness, mental health professionals need to understand that suffering isn't necessarily good for the soul. My own experience has shown me that therapy, self-help, and medication all have value. It has also shown me the pitfalls of each. Both depression and addiction have biological, sociological, and psychological dimensions that vary in importance depending upon the individual and his or her situation. This complexity means that no one solution will work in all cases and that the right approach for any given person may change over time.

I can say this: Painful talk therapy isn't morally superior to medication or to therapy that doesn't go "deep." Pleasure can be just as important for emotional recovery and growth as pain, if not more so. That's why drugs sometimes are the better fix.�