A 52-year-old patient came to see me about two years ago for a severe depressive episode that was triggered by a marital crisis. He had a textbook case of major depression: sad mood, lack of pleasure, loss of appetite and libido, relentless pessimism and insomnia. I started him on Zoloft and saw him weekly in supportive therapy. Within six months, his depression had completely resolved, although his marriage was still rocky.
Psychiatrists, like all physicians, are trained to diagnose medical problems and then do everything they can to treat them into remission. We’re experts at prescribing medication but not so good “de-prescribing” drugs.De-prescribing is the critical art of knowing when a drug or other treatment has served its purpose and can be safely stopped. This is due, in large part, to the fact that many illnesses, like depression, tend to be chronic, so the assumption is that lifelong therapy is required.
These are fast-acting, highly effective drugs that can be helpful in treating various types of anxiety, but they can be habit forming and have serious potential adverse effects over time. To be clear, there is a strong empirical basis for using multiple medications in “augmentation treatment” for various psychiatric disorders. But there is a lot of irrational polypharmacy that results from failing to decide at every step along the way whether a previous treatment was helpful. If it wasn’t, that drug should be stopped before starting another.