Читать книгу Well-Being Therapy - G.A. Fava - Страница 12

I became more and more skeptical of the long-term effectiveness of antidepressant drugs to the point that in 1994 I introduced in the literature the hypothesis that these medications could be a cause for chronicity [8]. I was inspired by the ‘antibiotic paradox’: the best agents for treating bacterial infections are also the best agents for selecting and propagating resistant strains, which persist in the environment even when exposure to the drug is stopped [9]. On the basis of some data that were available, I postulated that long-term use of antidepressant drugs may worsen the long-term outcome and symptomatic expression of illness, decreasing both the likelihood of subsequent response to pharmacological treatment and duration of symptom-free periods [8]. Two decades later the evidence supporting this hypothesis is quite impressive [10], but in those days swimming against the tide of pharmaceutical propaganda was not easy. In Albuquerque, under the guidance of Robert Kellner, I had learned to practice cognitive behavior therapy (CBT). I used it with my depressed patients, whether associated with antidepressant drugs or not, but it did not seem to affect their long-term outcome, as also reported in the literature [7]. This was in striking contrast to the use of CBT in anxiety disorders, where positive and lasting effects could be observed [8].

Meanwhile, more and more studies were pointing to the fact that pharmacological treatment of depression was not solving all the problems and, despite substantial improvement, important residual symptoms were present [11]. Such symptoms included anxiety and irritability in particular, and were associated with impaired functional capacity. Most residual symptoms also occurred in the prodromal phase of illness and might progress to become prodromal symptoms of relapse [11]. As a result, the concept of recovery could not be limited to the abatement of certain symptoms [12]. As Engel indicated [2, 3], health is not simply the absence of disease, but also requires the presence of wellness. We knew how to bring people out of the negative functioning, but regaining psychological well-being was quite different and we did not have a clue about how to achieve it.