The dangers of not treating depression are so great that any responsible physician will err on the side of caution and prescribe antidepressants.
As a psychopharmacologist who treats patients, I feel Sharon Begley does a disservice to those who live with depression. She bases her argument largely on two meta-analyses by Irving Kirsch and Guy Sapirstein. The psychiatric community understands that meta-analyses, which combine different medications and methodologies (as in Kirsch and Sapirstein's research), or which handpick studies and exclude others (as did, in my view, the recent JAMApaper published by Jay C. Fournier of the University of Pennsylvania and his colleagues), are susceptible to biased interpretations. The research that practitioners use to determine how to treat their patients is based on analyses that require statistically proven effectiveness. Those of us who treat patients on a daily basis understand that medications are not magic pills, and that treatment combining antidepressant medication with psychotherapy offers patients the best chance of recovery.
Julie Hatterer, M.D.,
American Psychiatric Association Council on Communications, New York, N.Y.
Antidepressants do work when administered to patients who really suffer from depression. The problem is that many people who are not clinically depressed are being administered medication. That's because Big Pharma dominates medical education and aggressively targets the public through advertisements, as if medication were candy.
Stergios Kaprinis, M.D.,
As a psychiatrist who has spent more of the last 35 years taking patients off antidepressants than putting patients on them, I was gratified by your article. Nonetheless, placebo-driven or not, these drugs can still be a valuable tool in our therapeutic armory. The key is to precisely determine which individuals are the right fit. In the struggle with emotional duress, it is always better to have more arrows in the quiver than fewer.
Isaac Steven Herschkopf, M.D.,
NYU School of Medicine, New York, N.Y.
I have suffered from severe depression for years. The combination of antidepressants and therapy has saved my life.
Jessica Knowles, Bethesda, Md.
'A Doctor Disagrees'
As a clinical social worker, I'm generally supportive of Robert Klitzman's disagreement with your article about SSRIs. However, his comment that psychologists and social workers fear having patients medicated because it will "rob them of clients" is libelous. My colleagues and I all have collaborative relationships with M.D.s to arrange medications for patients. Our goal is to help people improve their lives, not to unethically collect fees without a proper treatment plan.
Stephen Rosenbaum, Highland Park, Ill.
'Follow the Leader'
As a Massachusetts voter, I was aghast at the outcome of our recent vote, but I completely agree with Anna Quindlen when she says it was "neither specific nor illuminating." This, too, will pass. Indeed, it will be interesting to see what Massachusetts voters—even those who voted for Scott Brown—do at the next election.
Patricia Warner, Belchertown, Mass.