Cognitive side effects also wouldn't be of such concern if they were short-lived. But many patients go on these drugs for years, even decades. "If, as was once done, you merely give antidepressants for, say, a few weeks, to interrupt an episode of depression," says Peter Kramer, "you do not hear complaints about loss of libido or ambition—only reports of gratitude for the remission of symptoms." But doctors now know more about the gravity of depression—that it often recurs and causes serious damage to both brain and body. As a result, he says, "these medications are given longer and in fuller doses than in the past."
There are currently no definitive guidelines for when depression should clear up after a patient starts on medication, but several doctors mentioned four to six weeks as average for seeing significant improvement. Once the disorder remits, the American Psychiatric Association recommends continuing treatment for a minimum of 16 to 20 weeks to prevent relapse. Experts agree that long-term medication is not necessarily appropriate after a single bout of depression, which means patients kept on antidepressants for years should be questioning why. And anyone whose drug cocktail includes antianxiety meds may get a double whammy: Benzodiazepines like Ativan and Xanax list "memory impairment" as a possible adverse reaction on their package inserts.
Many in the field would like to see much more emphasis on psychotherapy, in particular short-term cognitive behavioral therapy, which studies have shown to be very effective. Originally, the idea of medication, says Glenmullen, "was to improve the patient's emotional state to the point where he or she could begin to initiate changes in his or her life, often with the help of psychotherapy. Somehow that thought was lost, replaced with the idea that the drugs alone can do the job."
Also lost, experts argue, is the idea that patients should be monitored for as long as they're on antidepressants. "I think of using these medications as turning dials on the control panels of the brain," says Prey. "There is the need for constant and very precise tuning, because people don't stay the same." Richard Friedman, MD, director of psychopharmacology at Weill Cornell Medical Center, stresses, "It's not necessary to choose between feeling emotionally well and living with cognitive side effects, or stopping the drugs and getting depressed. That's a false choice. A good clinician asks about side effects and tries to adjust the medication. Sometimes that means lowering the dose; sometimes it means switching to a different drug."
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