In the Age of Prozac, Are Meds All You Need?

 I’ve always tended to “see the glass as half-empty,” but I’ve come to realize that, in the past year, I’ve really become quite depressed. It’s gotten to the point where I drag myself to the office, and I have missed filing deadlines on my clients’ behalf because I just can’t concentrate. I asked my primary care doctor for a referral to a psychotherapist or counselor, but he told me that now, in the age of Prozac, talking therapy is unnecessary. Is that indeed the state of the art?

It’s not the state of the art, but it may reflect the state of medicine and of managed care. There have been conflicting and confusing research findings for year as to the effectiveness of both psychotherapy and antidepressant medications, but the preponderance of evidence and clinical experience is that both are usually (and about equally) helpful. Clearly, some individuals do better with one than the other, and most (if clinically depressed) get maximal benefit from a combination of the two. Medication treatment appeals to managed care and others because it may be faster and less labor intensive (i.e., less epensive). Proponents of “talking therapy” note that its benefits go beyond symptom reduction, and that its results continue after treatment ends, often not the case for medication. In some cases, managed care organizations have rewarded primary care physicians who keep costs down by minimizing referrals to specialists. This may be a short-sighted solution, since people with untreated or inadequately treated depression, stress, anxiety, etc. tend to develop somatic symptoms and drive up other medical costs.
At Lawyers Concerned for Lawyers, we often see the impact of depression on practice, particularly in neglectful or sloppy handling of cases. We wish that more attorneys would talk to us when the problem first appears, and before it spawns negative consequences. We usually recommend a comprehensive plan of attack, often including both psychotherapy/counseling and medication evaluation, as well as addressing environmental, family, or work related factors contributing to the lawyer’s mood. We can also provide a consultation for those who would like a second opinion.

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