" Celeb" M.D.?

" Celeb" M.D.?

By Kathryn Berlá, Ed.D

Dear Dr. Berlá,

I recently saw one of my very favorite actors on a talk show saying some things against antidepressants. I have been on that kind of medication for a few years. Is there anything I should be worried about?

T.C., Louisville

Dear T.C.,

Ah, actors! Actors give us many things besides mere celluloid fantasies in our celebrity-worshipping culture. They tell us which charity causes are worthy of our attention while simultaneously giving us fashion dos and don''ts. They provide some really compelling programming on Court TV and solid consumer feedback on drug rehab facilities. They establish new benchmarks for the eating disordered and set trends among new parents with baby names such as "Apple" and "Satchel." Now, as a bonus, they are providing us with medical advice without the pesky encumbrance of an actual medical degree. To think, my colleagues and I could have skipped all that wasted time on graduate school and just gotten our SAG cards instead!

Recently there has been a lot of media attention on a certain few celebrities and their views on methods of mental health treatment, specifically psychotropic medications. Some of the assertions include that psychiatry is a "pseudo-science," that there is no such thing as a chemical imbalance and that all that is needed for good mental health are vitamins and exercise. Let''s discuss.

First, in all of medicine, there is no greater mystery than the human brain. At best, we have only a partial understanding of how it works. However, there is a big difference between an incomplete science and a pseudo -science. Countless studies - reliable studies - have demonstrated the effectiveness of a variety of psychotropic medications. For example, a recent UCLA study examining the interaction of antidepressants and suicide examined data on the subject going back to the 1960s. Among the findings was that suicide rates in the United States climbed steadily from the 60s until the introduction of a new class of antidepressants, called SSRIs, in 1988. At that point, suicide rates began dropping. The study also found that areas of the country that have higher antidepressant prescription rates have lower suicide rates.

Now, by no means are these medications perfect. There are a host of side effects, some of which can be quite serious for certain individuals. However, statistically speaking, the benefits of antidepressants far outweigh the risks. Untreated depression is far more deadly than antidepressant medication.

When people refer to a "chemical imbalance," they typically are using shorthand to describe a state where chemical transmitters in the brain are not functioning properly or effectively. We know that certain chemicals in the brain, by their presence or absence, affect or control things like mood, appetite or even one''s basic sense of reality. By supplementing or inhibiting the action of these brain chemicals, or neurotransmitters, we can reduce or correct serious psychological symptoms. Not every individual will respond in the same way to every medication, which is why there is often a period of trial, error and adjustment to these kinds of interventions. However, there are similarities across disease states in our brain chemistry. Here''s an interesting example: most of the medications for attention deficit hyperactivity disorder (ADHD) are actually stimulants. If taken by someone who does not have ADHD, the medications will likely cause that person to become more hyperactive. For some reason, there is what we call a paradoxical, or opposite, effect on a person who truly has ADHD. The medication that would normally rev up most people actually has a calming effect on a person with ADHD. We may not call that person "chemically imbalanced," but it would be difficult to assert reasonably that they do not have chemical differences in their brain.

I am a huge proponent of the positive role that diet and exercise play in mental health. In fact, I know of no mental health professional on the planet who would not support the idea that a healthy, balanced diet and a reasonable amount of exercise are good for their patients. It would go against the standards of practice, however, to suggest that diet and exercise are sufficient for treating moderate-to-severe mental health problems. Some patients will respond just fine to psychotherapy and may never need medication. Others, however, will not experience significant relief unless they are treated with a combination of therapy and medication.

Remember Andrea Yates, the woman in Texas who drowned her children one by one in the bathtub? It would be beyond irresponsible to suggest that a regimen of exercise and vitamins could have prevented her from succumbing to her delusions and engaging in that tragic act. While the percentage of the mentally ill who will act out in such a way is very small, I use that case as a dramatic example of just what the price can be for mishandling or underestimating the need for proper mental health intervention.

Some may argue that even responding to the recent media hype is lending credence to an issue not worthy of a response in the first place, and is allowing a fringe opinion to set the mainstream discourse. The problem is that mental health issues and mental health treatment still carry a great deal of stigma for a lot of people. Patients suffering from serious depressive or psychotic disorders may be highly suggestible; that is, they may be more vulnerable than the rest of us to believing things that are distortions of reality. A non-medically trained celebrity issuing medical advice to the mentally ill is not only irresponsible - it''s dangerous.

If you have a question that you would like for our psychologist to answer, please write to: Family Matters Column , KHF, P.O. Box 436387 , Louisville , KY 40253-6387 . You can e-mail questions to: bdaykhf@aol.com or you can fax your questions to: 502-245-4098. Due to the volume of submissions, inquiries may not receive direct responses.

Kathryn Berlá, Ed.D. is a licensed psychologist in private practice in Louisville . She may be reached at 502-412-2226

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