Now, it is tempting to write these individuals off as fear-mongering cranks, possessed of only the faintest scientific knowledge. A handful certainly fit that description—the ones, for example, who insist that antidepressants are destroying the brains of millions; causing thousands of suicides; and turning scores of once-placid accountants into knife-wielding, psychotic killers. Oh, yes—and causing permanent sexual dysfunction in thousands of patients. (The actual prevalence of this last phenomenon is not known, though, to my knowledge, there are fewer than 30 such cases in the published literature—see references 15 and 16.) These individuals will probably never be persuaded, no matter the evidence, that antidepressants are usually effective and well-tolerated when properly prescribed and monitored.

And yet, dismissing all critics of psychiatric treatment as querulous crackpots would be a serious mistake. Some of those who wrote to me were both knowledgeable about psychiatric medications, and sophisticated in their grasp of medical research. Some spoke from painful personal experience with psychiatric medications—whether antidepressants, antipsychotics, or mood stabilizers. They spoke, for example, of becoming agitated or manic while taking antidepressants, and feeling depressed or “doped up” while taking mood stabilizers. They spoke of painful “withdrawal symptoms” lasting many months, after their antidepressant was stopped. They spoke of lethargy, blunted creativity, or impaired cognition while taking antidepressants or mood stabilizers. Perhaps most disheartening, they spoke of how little they felt understood, “listened to,” or respected by their physicians. http://www.psychiatrictimes.com/prin...printable=true

So what is next? We need to improve access to psychiatric care, so that patients who need antidepressants are seen by those best trained and most knowledgeable in their use. We need to work more closely with our colleagues in primary care, so that they become more proficient in the diagnosis and treatment of depression. We need to investigate carefully even the very rare side effects of antidepressants, so that we do not lose the confidence of the general public. We need to avoid even the appearance of conflicts of interest, related to “Big Pharma.” And perhaps most important, we need to listen attentively and respectfully when our patients tell us they are not happy with their treatment.