BRIAN E. LEONARD,
Sir, - Dr Terry Lynch raised a number of important issues in his letter of January 3rd. He is correct to argue that the uncritical prescription of (any) medication without a detailed explanation of the patients's symptoms is poor medical practice. However, I disagree with him regarding the nature and treatment of depression.
He is incorrect when he refers to the "common though unproven medical explanation that the medication will correct chemical brain abnormalities". A cursory glance at any textbook of neuropharmacology should convince a sceptical clinician that (a) there are substantial changes in several neurotransmitters in the brain of the depressed patient which correlate with the major symptoms of the disorder and (b) following the administration of an antidepressant these changes return to normal only when the symptoms of depression remit.
Regarding the analogy between diabetes and depression, it can be reasoned that many patients with depression will be reliant on antidepressants in order to keep well, which is analogous to the long-term use of insulin to keep the diabetic well. Both types of drug help to correct biochemical imbalances in the patient which in many cases are permanent and therefore require chemical replacement.
Antidepressants are not drugs that "merely anaesthetise the patients from emotional pain and distress", but, when appropriately prescribed, can transform the life of a miserable, often suicidal, depressed patient to normality.
With so much stigma attached to mental illness in this country, it is important to emphasise that depression is not due to a character weakness or self-imposed disability but is often due to a genetic vulnerability which can be activated by adverse environmental or psychological events. Drug treatments for mental illnesses have revolutionised the practice of psychiatry in the past 30 years and played a major role in helping unfortunate patients to have fuller and happier lives.
Getting away from the "brain is a black box about which we know little" mentality by giving basic information about how the brain functions must help to de-stigmatise mental illness. - Yours, etc.,
BRIAN E. LEONARD,
Emeritus Professor
of Pharmacology,
National University of Ireland,
Galway.