Guest Column: Rebuttal to Gatekeepers to Pharmaceuticals

Jane H. Feldman, MD

In This Article


Recently, in both the lay press and the professional literature, there has been a great deal of attention paid to the potential of some contemporary antidepressants precipitating suicidal ideation in some patients. While it remains equivocal as to whether this is a direct drug effect of specific compounds in some depressed patients, it has been noted by clinicians for a long time that as patients begin their recovery from depression during a medication trial, their risk of suicide increases transiently as they enter a phase where they are more energized and more capable but still relatively despondent. While this is certainly not a ubiquitous phenomenon, it has been noted and written about enough that it alone should give us, as a profession, considerable pause before we would even consider open access to these medications. The mental health system is certainly troubled and troubling. We need to think of new ways of providing care but, if anything, we need to be more involved with our patients, not less.


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