Lecture attempts to answer whether treatment of depression has resulted in over-prescription of SSRIs

By Miranda Senft

(Judith Gibson-Okunieff/ Daily Collegian)

Steven Hollon of Vanderbilt University gave a lecture titled, “Is Cognitive Behavioral Therapy Enduring or are Antidepressant Medications Iatrogenic?” at the Commonwealth Honors College on Monday night.

According to Psychology Today, cognitive behavioral therapy is a goal-oriented psychotherapy that is supposed to treat mental health problems by boosting happiness and modifying dysfunctional behaviors, thoughts and emotions. The dictionary defines “iatrogenic” as a medical disorder that is caused by the diagnosis, manner or treatment by a physician.

In his lecture, Hollon investigated whether the treatment of clinical depression with cognitive therapy had more long-lasting effects and fewer negative side effects than other common antidepressant medications.

Hollon began by “disclosing” his finances, joking that “it pains” him to have no financial conflicts to declare. Hollon made it clear that he does not receive any money from pharmaceutical companies.

He continued by talking about big pharma, specifically Purdue pharma, a pharmaceutical company that he says is widely believed to have played a crucial role in starting the opioid epidemic through their aggressive advertising and over-prescription of OxyContin.

“Pharmaceutical companies are not in business to do good,” Hollon said. “They’re in business to do well.”

Throughout his lecture, Hollon proposed questions that he and other scientists have tried to solve about depression.

Some of the major conclusions Hollon came to was that depression appears to be temporal, and that cognitive therapy is at least as efficacious as antidepressant medication. He says this type of therapy can hold its own with medications in the treatment of more severe depressions if adequately implemented.

Hollon also said that patients responded differently to different treatments, and that selecting the best treatment for a given patient can improve the efficiency of the healthcare system.

His data concluded that the causal mechanisms that underlie the response and eventual prevention of depression are different based on the types of treatment. The brainstem and limbic systems respond to medications, while the cerebral cortex responds to cognitive therapy.

“We use antidepressants a lot more than any other country in the world, and that started with the SSRIs [selective serotonin reuptake inhibitors]…about 20 or 25 years ago,” said Hollon.

“Around two-thirds of folks who met the criteria for depression were treated with psychosocial intervention, and about one-third with medication — which is totally flipped around since the advent of the SSRIs,” Hollon continued. “The reason for this is that general practitioners are overprescribing.”

Hollon said that after Psychiatrist David Healey uncovered suppressed evidence about drug companies, it showed that SSRIs increased violence, homicide rates and suicide rates in adolescents.

“They put a black box warning on the drugs, and the suicide rates went up — the reason is that these SSRIs increase the propensity for violence, but the odds of that are lower than if the depression is left untreated,” said Hollon. “I do think we rely too heavily on medication but we undertreat depression.”

When comparing antidepressant medication and cognitive behavioral therapy, Hollon said, “We’re more likely to get folks back to work with cognitive behavioral therapy [CBT] than with medication…because some of the skills you learn in CBT help you get jobs…and improve the quality of your relationships, so psychosocial interventions do [other] things in addition to helping you not feel depressed.”

Maureen Perry-Jenkins, a faculty director for the Center for Research on Families, helped organize the lecture. She started off the talk containing a bit of background on the lecture series before passing it off to Kalpana Poudel-Tandukar, an assistant professor in the College of Nursing at the University of Massachusetts who is a current family research scholar at the Center for Research on Families.

Poudel-Tandukar said she has more than 20 years of experience working with Bhutanese immigrants, first as a clinician and then as a researcher. Poudel-Tandukar introduced Hollon by commending him on his dedication, his publications and his overall research.

Poudel-Tandukar says that in working with immigrants, she finds that while many say they were happy to come to the United States, they are often screened as clinically depressed.

“Once they have the disease, they can go to the clinic and have counseling and there are medicines, but what is lacking is that the community does not have any preventative program or any strategy,” said Poudel-Tandukar.

“So, once they have the disease, they go to the doctor, and they start taking medicine,” Poudel-Tandukar continued. “That’s the cycle that’s going on in that community. My intention is to break that cycle and I want to prevent them from having this disease, so they don’t have to go through that cycle again.”

Poudel-Tandukar stressed the importance of understanding the cultural community that is being treated. She is starting a program that helps Bhutanese immigrants integrate better into society by giving them a skillset so there is less stress, resulting in fewer people needing to be on medication.

Poudel-Tandukar elaborated on a prevention program that would bring family members together so they can talk about what their problems are and what their strengths are to solve problems and to identify what extra help they need.

“Through this approach, I’m planning to help them solve their problems by themselves,” said Poudel-Tandukar.

Hollon had advice for people who are not educated but feel depressed. He said that for less severe cases of depression, you should “start out with something that’s minimally invasive,” suggesting low-intensity therapy or self-help books.

For more severe cases of depression, Hollon and Poudel-Tandukar agree that you should start with psychological clinical treatment before you go on medication, and specifically start with behavioral alteration or cognitive therapy.

Miranda Senft can be reached at [email protected].