Sir, - Dr Terry Lynch (December 20th) presents a "cursory examination of the facts" around the approach of mainstream medicine to the treatment of depression and suggests it is "based on faith rather than science". This "cursory" examination does not do justice to the wealth of evidence regarding the biology and treatment of depressive disorders.
Are we to take it that because, as Dr Lynch incorrectly asserts, "no biochemical abnormality has been identified for any psychiatric condition" that mental disorders do not exist? Would he have us return to the asylum-based management of mental illness that characterised the pre-antidepressant era? Our understanding of the biology of depression is incomplete but this does not lessen the reality of the condition or the effectiveness of antidepressants in relieving the often profound suffering caused by it.
The pathology of depression is not characterised as clearly as that of diabetes because depression is a complex condition and, thankfully for homo sapiens, the human brain is infinitely more complex than the pancreas! Dr Lynch describes mainstream approaches to the treatment of depression as "woolly" and less than fully scientific. A balanced appraisal of the substantial body of available scientific evidence clearly indicates that, although antidepressants are no panacea, they are the most potent treatment available for depression. Drug and non-drug treatments should be seen as complementary. To approach the treatment of mental disorder exclusively by a single means would be sub-optimal and narrow-minded - sentiments that should apply equally to those who advocate exclusively non-drug treatment.
The greatest enemy of depressives is the under-treatment that results from a reduced ability to seek help. One of the cruellest aspects of depression is its impact on one's attitude to self, so that a depressed person often feels less worthy and he or she is weak, or deserves to be ill. These symptoms, and the stigma that surrounds mental illness, can inhibit help-seeking - with tragic consequences, including suicide. It is important that views about medical treatments are expressed in a responsible way that encourages sufferers to seek the best available help. The implication that the widespread use of antidepressants is not a valid approach to the treatment of depression is unacceptable from both scientific and humane perspectives.
The characterisation of antidepressants as merely mood-altering compounds does not do justice to their impact on the wider range of depressive symptoms, including disturbances of sleep, appetite, motivation, etc. It is unfortunate that many patients with depression are treated with Valium-like drugs due to misdiagnosis of their condition as anxiety or "stress". One might interpret from Dr Lynch's comments that antidepressants are addictive - a common misconception among patients that is not borne out by scientific evidence but does discourage patients from seeking appropriate treatment.
Increasingly carers, providers and sufferers of mental illness are working together to advocate more comprehensive services and the appropriate resources to further study the biology and treatment of mental illness. The development of mental health will be best furthered through such collaborative efforts. Mental health services are under-resourced and imperfect, but a "public inquiry" would create the type of hysteria that rarely benefits mental health services and sufferers from mental illness. The views expressed by Dr Lynch may boost sales of his book, but are poorly informed, divisive and unlikely to advance the cause of those who suffer from depressive illness. - Yours, etc.,
Dr David Meagher MD, MRC Psych., MSc. (Neuroscience), Consultant Psychiatrist, Limerick.