On June 30, 2005, the FDA released a new warning for adults taking antidepressant medication, stating that they should be watched for increased suicidal thoughts and behavior, and ordered that warning labels be placed on medication.

There are several theories to explain the increase. The one I’m seeing most often in the press is the theory that starting drug therapy causes the cloud of lethargy to lift just enough to allow the patient take action on suicidal thoughts. That seems reasonable to me. But I think there’s another side to it.

In my experience, most people with severe depression don’t ask for help until they hit rock bottom and can’t go on for even one more day. If they’re lucky, their doctor responds to their need with compassion, but that’s not always the case. The first time I was broken enough to call my doctor, he told me to buck up and get over it. It took another 10 years for me to try again, with a different doctor.

Starting medication is a very vulnerable moment. You’ve just had to lay your “weakness” out there for evaluation and accept someone’s judgment about it, and by extension, you. One would think it would get easier after that, but a lot of times it doesn’t. Getting on drugs is trial and error, and far too often it takes several tries to find the right medication. But when you’re so deep in the well, it can be impossible to face those odds rationally. What often happens is that the first drug doesn’t work, even though you take it for 3 weeks to give it a “fair trial.” Someone who hasn’t been there can’t understand the utter despair of that realization. “Even drugs didn’t work. It’s never going to get any better … I’m going to feel like this forever.”

That’s enough to trigger suicidal thoughts, or even actions.

I agree with the FDA that there has to be more follow-up after a prescription is given. Family practitioners try, but sometimes are out of their depth in dealing with severe depression. In the best of cases, the patient is told to call the doctor if they don’t feel better before the next appointment, but that level of initiative is often next to impossible for some at the bottom of the well.

There also needs to be more awareness in the patient of how many different therapies there are, and how long it can take to find the right drug. When you’re trapped in depression it’s hard to remember how you felt before it hit, and it’s impossible to imagine feeling ok again. Each day becomes an eternity and a three week trial an unimaginable eon. Someone needs to hold up a lantern to cast a light at the end of the tunnel, whether it’s family, a friend or a health care professional. Even on medication, you can’t get better alone.