All the Things They Taught Us That Were Wrong

Thomas A. M. Kramer, MD

Disclosures
In This Article

Introduction

One of the many wonderful things I learned in medical school is that my parents were probably wrong about not letting me go swimming after I ate. Actually, making me wait an hour probably made it more likely that I would have a cramp in the water. When it comes to debunking myths, I believe there are two kinds of people : those who think it is wonderful and those who think it is horrible My response is firmly in the former category. I see the dispelling of supposed truths as progress -- as evidence that we are moving forward, constantly questioning and continuously learning. I very much enjoyed the recent programs by the television journalist John Stossel in which he demonstrated that many accepted truisms are false. With this column, I would like to indulge in some myth-busting for psychopharmacology, and hopefully my colleagues who also enjoy questioning authority will enjoy and perhaps even contribute to this discussion.

Antidepressants treat depression, right? Not when I was a resident in the 1980s (OK, in the early 1980s). I was taught that antidepressants were only effective for those depressions that had the physical symptoms associated with the diagnosis of major depression, such as a sleep disturbance, an eating disturbance, diurnal variation, etc. These were then referred to as endogenous depressions, and these were the only depressions that required medication Other depressions that were a result of some grief-provoking event or of coping with some form of tragedy were referred to as reactive depressions and could only be treated with psychotherapy. I have discussed the distinction between endogenous vs reactive depression in a previous column ("Endogenous Versus Exogenous: Still Not the Issue"), and although I have no desire to revisit that discussion here, I present this to you as the first in a series of truisms about the psychopharmacologic treatment of depression that our profession embraced and then discarded.

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