Would you like to give advice to psychiatrists?

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It is interesting to me to see you mention depression, as it seems to me to be a topic that is overemphasized. This is from the point of view of someone with a long history of depression and a formal diagnosis of depression and other co-morbid disorders.

I'm not saying that depression is over-diagnosed, nor am I saying that it is not an important topic. I do feel that there is a disturbing trend in the medical establishment to treat depression as an end in itself. This is especially prevalent among primary care practitioners who often take the view that they can simply treat depression by giving people anti-depressants. It seems to be a popular view that it is possible to simply treat depression, without considering that depression may actually be a consequence of some other psychiatric condition.

I realize that this is far from the topic of your current column, but should you choose to discuss this topic in a later column, I hope that you will consider asking for the opinions of members of WrongPlanet. Depression is far from rare in this community.

(YOU HAVE A PERMISSION TO USE THIS IN YOUR ANY AND ALL OF YOUR COLUMNS)

Ironically enough, that might be the reason why he SHOULD write a column on depression. In particular, he might attempt to discuss the issues that you were talking about in the rest of your reply. Namly, that doctors shouldn't be too focused on prescribing antidepressants and attempt to pay attention to surrounding issues that might have caused the depression to begin with.

By the way I agree with your stand point. I am against meds in general, whether it be depression, OCD or even schizophrenia. I mean the meds can't teach anyone new skills. What they can do is "block" the "undesired" function (stick to the end of the neuron and block its interaction with some kinds of neurotransmitters). In other words, taking the meds is the same thing as hitting computer with a hammer whenever it writes 2+2=5, so that it can't write anything at all, including the "undesired" information.

I know this is an extreme exageration, but still, meds are not "smart", and neither are neurotransmitters. There is no such thing as ONLY blocking undesired functions without blocking the desired one.

Now I realize that if the underlying problem is chemical then you need chemical means of alliveating it. But in this case, the "chemical trigger" of depression has nothing to do with "lack of prozac in the blood", since prozac is not something that body produces to begin with. So, the logical thing to do is to supply the body with what it DOES in fact lack, which would be something a lot more natural. In other words, probably natural supplements in combination with good nutrition and psychotherapy is the way to go.

Now, if you give a patient prozac, what happens is that his body is still "abnormal" in terms of whatever imbalance it had that caused the patient to be depressed to begin with, but then you introduce additional abnormality, which is prozac in their blood which most humans don't have. The two abnormalities work in the opposite directions as far as the person's mood is concerned, so the person now has normal mood. But still, as they say, two wrongs don't make it up to right. That is why I don't like the concept of antidepressant "making up" for something that is completely different to begin with.

Also another thing to talk about in depression column is ECT. I hate this concept even more than meds. I mean, to me it feels like the way ECT works is by ruining a person's brain so that a person "has no energy" to be depressed, or to halucinate or whatever it is. Now if the person's brain is ruined who cares if they are depressed or not! Why would life worth anything anyway for someone with ruined brain? Instead of ruining their brain through ECT, we have to find some PRODUCTIVE ways of curing depression that works through a series of improvements, not a series of ruins.

I'm not sure if I will get a reply, but this is an open question. Did you learn anything here that will effect the way you practice psychiatry, or were we all just helping you write your column. I am very happy to help. Also did you share this information with your residents since you are an attending physican.

Someone could write entire books on each of those topics! It must be hard to write such a brief overview. It would actually be easier to write a lot more.

I've just sent the article to the newsletter editor, who may ask for changes. When it comes out, I will scan it and post it to this thread.

Thanks so much to all of you for your comments. Taken together, this thread is a wonderful guide for psychiatrists working with people on the spectrum. I've shared the thread with my current residents and medical students, and discussed it in our team meetings and seminars. I've learned from your posts. As a concrete example of that learning, I will be giving more emphasis to the autism specturm than I had previously planned in writing task, a 2500 wd encyclopedia article on "Neuropsychiatry."

If you are interested in continueing to give input to the medical community, take a look at AASPIRE dot org
The Academic Autistic Spectrum Partnership In Research and Education (AASPIRE)

I will no longer be monitoring this thread.

Thanks and best wishes.

William H. Wilson, MD
Professor of Psychiatry
Oregon Health & Science University