A couple of weeks ago, Richard Friedman, a Columbia Medical School psychiatrist wrote an op-ed for the New York Times in which he put forward anti-depressant drugs as the treatment of choice for depressed and suicidal college students who felt themselves under “toxic social pressure.” I was troubled by the article and the authority that appearing in the pages of The Times gave it and wrote a Letter to the Editor. The Times didn’t print it, but I wanted to share it with you. I’d suggest you read Dr. Friedman’s article first and then my letter. I would welcome your sharing your thoughts about the issues raised with others and also with me. This is an important topic. The distress and dilemmas these young people face require a solution that is far more integrative and compassionate than the one they are ordinarily offered.
To the Editor:
Richard Friedman’s plea (Teenagers, Medication and Suicide, August 3, 2015), for mental health services for depressed and potentially suicidal adolescents is appropriate and well intentioned. His focus on psychopharmacological treatment is, however, dangerously narrow and based on a selective reading of the science. Nor does it recognize and respect the great capacity that all of us, including young people, have to understand and help ourselves.
Comprehensive reviews of the evidence (unpublished as well as published) on antidepressants in The New England Journal of Medicine, The Journal of the American Medical Association, and PLoS Medicine tell a story quite different from Dr. Friedman’s. They reveal that antidepressant drugs, which are burdened with such depressing side effects as weight gain and sexual dysfunction are, at best, only marginally more effective for mild to moderate depression than placebos. Moreover, the FDA data that Dr. Friedman cites clearly indicates that, though the rate of suicidal thinking and behavior was low, it was twice as high in people taking antidepressants as in those receiving placebos (4% vs. 2%).
Even more important, Dr. Friedman completely neglects the various forms of psychotherapy, including cognitive behavioral therapy and interpersonal therapy which appear to work as well as anti-depressants and also make young people active partners in their own care. He also ignores meditation, exercise, and other powerful, evidence-based self-care tools for reducing stress—a primary cause of depression– as well as the small group interventions that may be critical to transforming “toxic social pressure” into life giving social support.
James S. Gordon, a psychiatrist who has worked with adolescents for 45 years, is the author of Unstuck: Your Guide to the Seven-Stage Journey Out of Depression.