Antidepressants ?

Q.I have a question about indications for various antidepressants. I know that Prozac (despite its purported problems) is a very common antidepressant. From my research, I have found that it not useful in treating major depression which involves suicidal feelings. I have found that it is useful in treating non-major depression (from my reading). However, I know someone who has major depression and is suicidal, and has been presribed prozac. Is this an appropriate use for this drug, or would tricyclides be more appropriate.

A.While I'm not denying the value of adding a cognitive or behavioral therapy to a treatment program for depression, for just the reasons you state above, I do have to wonder about how you've come to such a certain theoretical position on a subject that has been scrutinized by many for a number of years with what I interpret as results contradicting your theory. For example, serotonin reuptake inhibitors given to non-depressed individuals do not seem to make them 'feel good' as your theory would appear to predict, it only helps clinically depressed patients normallize their mood (as far as I am aware). That would seem to imply to me that it was not just masking the depression, but somehow influencing its underlying mechanisms. Second, the fact that other 'feel good' chemicals, like narcotics, do not effectively alleviate the clinical symptoms of depression to the same extent (as far as I am aware) ? Certainly not with as little extraneous behavioral effects. Third, given the well established findings of a hereditary link for depression, we also have the finding (I believe, though I don't have the twins study with me) that clinical depression appears to follow identical twins raised in different environments, more than it does fraternal twins or adopted children raised in the same environment. If this is true, how would their cognitive thought patterns follow their genes, in your theory, better than they follow early experience, upbringing, and so on ? Seems a neurochemical predisposition is more likely and if so, that neurochemicals like SRUIs might possibly positively influence the underlying cause in addition to whatever cognitive retraining might help prevent recurrances of severe depression.

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