Antidepressants -- a Last Resort

Some fundamental insight was omitted from your "wonder drug" article on the use of Prozac for depression {Cover, Aug. 28}. It is now well-known that drugs do not cure emotional problems and any suggestion to the contrary is misleading information.

At best, antidepressant medication is a reluctant, temporary compromise (or resignation) to social problems that have become entrenched by neglect and avoidance.

Though we might wish for a wonder drug, we would do better to realize that drugs cannot replace health that is gained from humane understanding and learned self-reliance.

It should be made clear that antidepressant medication is used with reservation and concern, and then only until better support methods can become effective. Harold M. Graves III Chevy Chase Shock Therapy's Other Side

Dr. Keith Russell Ablow's thinly disguised plug for shock treatment {Mental Health, Sept. 4} is filled with doubtful statements. He says that the patient's arm "is the only part of the body that moves" during shock treatment today.

If this is true, then why is the patient in the photo shown wearing a mouthguard? The July 6 issue of Psychiatric News features an ad for a double-thickness mouthguard to avoid the "tooth fractures" so common during ECT (electro- convulsive therapy).

The comment that "ECT is not profitable to industry" also gives a misleading impression. It is hugely profitable for the psychiatric profession.

As the history of electroshock treatment accompanying the article noted, the standard series of treatments for a single ECT patient "costs about $5,000." If "about 100,000 people annually undergo ECT," as the article claimed, ECT is a $500-million-a-year industry. Arne Steinberg Silver Spring

In response to the article on electroshock therapy, I'd like to express my point of view. Having studied ECT, I have strong apprehensions on the subject.

ECT creates immediate results, but they are only temporary. This poses the question of its validity. Does ECT actually treat depression or, rather, act as an environmentally induced defense mechanism that helps one to suppress undesirable or unwanted memories?

One of the known side effects is temporary amnesia. Could it be that when the "forgotten" thoughts are recaptured, the depression resurfaces?

Another consideration is the physiological effects that long-term electroconvulsive therapy has on the brain. At least anti-psychotic medication effects can be measured and controlled, whereas the damage done by prolonged usage of electrical currents cannot be repaired. Lori Hiser Oxon Hill How Many Hospitals Are Left?

Your graphic on hospital closures {Vital Statistics, Sept. 4} was a disappointment. The statistics presented were a classic example of the 1954 book "How to Lie With Statistics."

My students reading the article assumed that if 698 hospitals closed between 1980 and 1989, we would find 698 fewer hospitals listed in the American Hospital Association guidebook in 1989 than in 1980.

In fact, there are only 107 fewer hospitals, because hospitals don't close -- they restructure or merge and come back with a different name. Counting only the "closings" and not the new facilities that began operation is confusing. For example, in 1988, 80 hospitals closed by 45 hospitals opened.

Some additional hospitals will have to close. People should vote with their feet to avoid low-quality, low-productivity hospitals. Do we have an excess supply of hospital beds? Yes, if you consider that on an average day there are 318,000 empty beds and on the peak-census day in l989 there were 179,000 empty beds.

The government should do something to relieve a $13 billion indigent care burden on our hospitals, but these institutions should be better managed. Productivity breeds better financial standing. The results would represent good economics and good medicine. Steven R. Easthaugh, ScD Professor of health economics and finance School of Business and Public Management George Washington University Cholera's Toll in Europe

My grandfather wrote in his memoirs about a cholera epidemic that occurred during the hot summer of 1892 in Hamburg, Germany, where he had his first job as a customs official. The disease was thought to have come into Hamburg by way of floods of Eastern European immigrants -- many on their way to America --

and spread through the primitive water supply -- untreated water from the Elbe River.

During the worst period in August, about 500 people died daily, he wrote. By the time it was over in November, 9,000 had died and more than 30,000 had been ill. The city was quarantined, at great economic loss, and the dead were picked up off the street and buried in mass graves.

The only precaution was to boil everything, even water to wash with, avoid raw foods, he recorded, and "thank God from the bottom of our hearts when we woke up healthy each morning." Almuth F. Payne Fairfax Letters intended for publication must be signed and include the writer's home address and home and business telephone numbers. Letters may be edited. Although we are unable to acknowledge all letters, we appreciate the time and value the viewpoints of those who write. Send letters to Health Section, The Washington Post, 1150 15th St. NW, Washington, D.C. 20071.