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Letters to the Editor
November 2001

Ethical Dilemmas in Prescribing Antidepressants

Arch Gen Psychiatry. 2001;58(11):1085-1086. doi:

In his thoughtful article, Nesse1 provides a persuasive argument that depression has adaptive functions for some patients. But this paradigm leads to an additional question. If depression is adaptive, could its treatment be maladaptive? With the wide array of effective and relatively benign pharmacological treatments for depression, it has become almost a "knee-jerk" reaction among health care practitioners to prescribe antidepressant medication when patients have symptoms of severe depression. Given the distressing and disabling nature of depressive illness, many patients clearly benefit from this strategy. However, on those occasions when severe depression is serving an adaptive purpose for the patient, improvement in depressive symptoms results in overall net harm. The practitioner is then faced with the ethical dilemma of considering stopping the medication in the face of patient opposition. The following cases illustrate these points.

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