To the Editor of The New York Times:

Dr. Procci’s advice is for the depressed patient to identify the ethical caregiver. That is not so simple in a medical care system that denies access, limits complex consultation and rewards technology and procedures.

Questions about the efficacy of antidepressants are but one chapter in a larger moral and social tale without clear answers. Except perhaps one: the medical system we have today plainly does not work. What to do next is far more challenging than listening to Prozac.

RONNIE S. STANGLER, M.D.
New York Times July 16, 2011

Dr. Procci’s response:

I tend to agree with the skeptics who question the efficacy of antidepressants and condemn their prolific use.

Marcia Angell has long highlighted the ways in which the pharmaceutical industry, the psychiatric profession and academia have at times colluded to erode appropriate boundaries.

Another problem is the insurers’ control over access to practitioners and the kind of care they can render.

Kippi Fagerlund poignantly exemplifies how third-party payers relentlessly limit treatment options to those seen as quickly “cost effective,�? such as brief medication management visits rather than psychotherapeutic approaches.

Ronnie Stangler rightly sees this as a huge obstacle to quality care. I agree.

The hot crucible of the psychiatrist’s office is far removed from the cool sterility of research labs and academic offices. Patients in real-world settings often do find antidepressants singularly helpful. This doesn’t exonerate the excessive claims of the pharmaceutical industry. It only demonstrates the need for the individual practitioner to maintain his or her focus on the patient’s needs.

The bottom line: We doctors must push our professional organizations to disseminate only the highest quality data, free from conflicts of interest, to assist us in clinical decision making, and we must seek relief from obsessive cost-control management of patient care.

And those suffering from depression should insist on being given access to all available treatments and true information about their efficacy. It is unconscionable for patients to be held hostage to one form of treatment supported by such weak data.

WARREN R. PROCCI, M.D.