Antidepressants not for every case of the blues

Hera Diani, The Jakarta Post, Jakarta

It was still six in the morning when Tria, bleary from sleep, sensed someone was in her room.

The intruder was her 61-year-old father; his hands trembling, he asked her for a couple of hundred thousand rupiah.

"His medicine had run out and he can't function without it. He can't sleep, he can't eat or do daily activities," said Tria, 25, a public relations officer.

Her father suffered from depression for the past year and had sought help from a well-known psychiatrist. To Tria's dismay, the doctor's remedy was to stuff her father with antidepressants and coax him into buying his books.

"Later, my father become sort of addicted to the medicine. And he lost interest in everything, only sitting there with a blank expression and doing nothing," she said.

Except, of course, when his medicine ran out.

Depression can be triggered by biological, social-cultural or cognitive factors. Without any external reasons, a person can suffer from depression if there are biological or chemical changes in the brain.

Deficient production of one or both of two neurotransmitters -- norepinephrine (noradrenaline) and serotonin -- is believed to cause depression.

Antidepressant drugs increase the production of the neurotransmitters. There are many types of antidepressants available today, with prescriptions undergoing a three-fold increase in the past decade and Prozac becoming a household name.

Antidepressants, also known as selective serotonin reuptake inhibitors, are aimed to enhance ones' mood and include Prozac and Zoloft.

The drugs do help some people in dealing with feelings of sadness and depression, such as during bereavement, but there is increasing acknowledgement that they are not wonder drugs. Like any drugs, they have side effects.

Sometimes intolerable withdrawal symptoms can make it difficult to stop taking antidepressants, as described in an article by a London-based medical expert in this newspaper on Nov. 29.

For some patients, severe and depressing side effects from going off the drugs include substantial weight gain, loss of libido and mood changes, to name a few.

This, according to the writer, is fostering a looming antidepressant crisis which, on the Richter scale of drug disasters, appears to range between 7 and 11. He compared the widespread use of antidepressants today to the massive prescriptions for the addictive tranquilizer Valium in the late 1970s.

Psychiatrist Irmansyah from the University of Indonesia's School of Medicine said some complaints linked increasingly suicidal behavior to use of antidepressant drugs, but they were not fully substantiated.

"It's a concern for us. However, the latest research still shows that antidepressants still very much help," he told The Jakarta Post in a phone interview.

Irmansyah also argued that there was not overprescription of the drugs here.

"It's not like in America, or Europe, as we see in their films where they often mention Prozac ..." said Irmansyah, who also works at Cipto Mangunkusumo General Hospital (RSCM).

But in this country, where rules are easily bent for a few extra rupiah, the drugs can still be obtained without prescription from some drugstores or on the black market.

With the prevalence of depression believed to be quite high, around 7 percent to 15 percent according to Irmansyah, there is the risk of people self-medicating and popping a few pills to deal with a simple case of the blues.

Irmansyah's colleague from RSCM, Martina Wiwie, believes the incidence of depression may be higher because awareness of mental illness is still low among the Indonesian public.

"People with depression are still considered as just being in a bad mood. Those seeking help from a psychiatrist are still few because it's not considered a life-threatening disease."

Drugs are not the only way to cure depression, she added, as the approach may also include psychotherapy and counseling.

However, as with Tria's father and his psychiatrist who offloaded his books on him, some complain that doctors are too quick to prescribe drugs.

"Barry" sought out help from a psychiatrist last year when he felt unhappy about his life.

"Basically, I was looking for counseling. We ended up discussing my feelings, which was fine, but then he floored me by prescribing two types of antidepressants."

Barry was told he should try Prozac, and then Zoloft, with the explanation that the former was popular in the U.S., the latter in Europe.

"It was like, 'let's mix and match'. I filled the prescription for Zoloft, for Rp 300,000, but then never ended up using it, because I thought once I start, when would it stop."

Irmansyah countered that doctors here were circumspect in their prescriptions, and tend to give lower dosages than listed in the medical literature.

"The dosage is based on the doctor's judgment. It's just like other illnesses, like hypertension. Sometimes doctors don't give medicine right away, but advise the patients to eat well and exercise."

Irmansyah said that doctors use their best judgment.

"Well, should we have to wait until it gets worse?"

Irmansyah said antidepressants must be consumed continuously for at least six months to work effectively.

Even if the doctors say there is no antidepressant crisis looming on our immediate horizon, perhaps it's better to err on the side of caution. And that must also include the government and its related agencies clamping down on the abuse of prescriptions and the drug black market.