If you have felt down, discouraged, isolated, lack motivation, or no longer enjoy work or personal relationships as you used to, you might be clinically depressed. Many people consider antidepressant drugs when they feel this way. It can be an easy step to take, though many have reservations. Today, anti-depressant drugs are viewed as the first-line treatment for clinical depression, but there are good reasons to think twice before signing up for the pills, which experts agree are not effective except in cases of severe depression.
When you lose employment, it’s normal to feel sad, discouraged and anxious. Experiencing the loss of a loved one can be very intense and complex, overlapping with symptoms of depression. Modern life has many people living physically isolated from one another, with one quarter of American adults living alone, and even when the isolation is not geographical it can be emotional; the lack of direct emotional contact with others is an increasing social phenomenon. One of the most painful forms of isolation can be the experience of living with a partner with whom you do not feel connected.
The impact of loss and isolation and the technology-mediated societal changes we are living through today do not directly signify an increase in psychiatric disorders. Yet feelings of meaninglessness can easily infiltrate the sunniest of dispositions. People are often quite resilient and recover from losses on their own or perhaps with a little help from a spiritual counselor, family member, friend or therapist. Sometimes, normal sadness turns into a more serious depression. Depression can be recognized because of how much it impairs normal functioning. It becomes increasingly clear to friends, colleagues and family that something is wrong, though men and women may show it differently; men can isolate themselves, experience increased fits of anger and turn to substances or sex for comfort. Isolation doesn’t help matters. Suicidal thoughts can turn towards planning, energy levels plummet, you can’t bring yourself to eat and lose the sense of pleasure in the things you used to enjoy. If you, or someone you know fits this description, it can be cause for alarm, and it becomes important to visit a doctor or therapist to assess your condition. Sometimes symptoms of depression may be caused by physiological issues, so it’s important to get a full physical to rule this out. In the rest of this article, I’ll be considering the implications around the use of anti-depressants on mild and moderate depression.
To get a sense of the state of medication in the US, here are some numbers: the Center for Disease Control (CDC) reports that a full eleven percent of Americans over twelve years old take an anti-depressant. Primary care doctors are responsible for the majority of this prescribing. Most primary care doctors lack specialized psychiatric training in depression, anxiety and ADHD yet are the main prescribers of medications to treat these conditions, and physician office visits tend to be quite brief.
Few people wish to identify themselves as having a mental illness and don’t feel at ease in starting to take a drug. This may partly explain why doctors usually don’t diagnose people with clinical depression even when prescribing anti-depressants. People often have trouble consistently taking their medications, and some drop out as soon as they start to feel a little better, or perhaps a little worse. Side-effects of anti-depressants can range from dizziness, drowsiness, upset stomachs and loss of sexual appetite.
Consider that after hundreds of studies, we now know that anti-depressants are only marginally more effective than a placebo in clinical trials for mild to moderate depression. This is a shocking finding given how antidepressant medications are considered the first line treatment for depression.
The Chemical Imbalance Theory
From a medical perspective, the practice of treating depression with a pill comes from the chemical imbalance theory, the view that chemical imbalances in the brain give rise to mental illness. The assumption behind this traditional view of depression is outdated by modern research. Most of the time, it is not faulty wiring, but the effects of one’s isolation, of common sadness and self-defeating thoughts arising from difficult life circumstances or transitions that can lead someone to depression. Many people who suffer from depression experience constrained thoughts that seem to be stuck in a loop. When feelings of sadness and isolation lead to negative self-evaluations and unhelpful actions or inactions, a vicious cycle can be set into motion. Taking a drug like an SSRI to alleviate depression does not directly address the cognitive or emotional processes that gave rise to the imbalance. At best, in cases of severe depression, chemical treatment can help the brain to break away from the vicious cycle of depression. At worst, prescribed for mild depression, it can cause severe side-effects or even lead to the emergence of psychotic symptoms, hence the importance of regular checkups.
Non-Medical Interventions for Depression
It is commonly known that exercise helps with depression in mild and moderate cases, but it can be difficult for people who are depressed to get motivated to exercise. One study reported by the Harvard Medical School Health Publications showed that to gain a benefit from fast walking, it must be done for 35 minutes a day 5 days a week, or for 60 minutes 3 days a week. This sort of exercise has been shown to be ultimately more effective than anti-depressants as it leads to lower recurrence rates for depression. Studies of Yoga practice have shown similar results, with two 90-minute sessions of Hatha Yoga classes each week leading to significantly reduced depression, anxiety and pain. Group activities such as yoga can also help by providing a sense of belonging to a group, which people who otherwise feel isolated often can find very reassuring.
Therapy for Depression
Of the treatment options that seem to work well, group therapy, couples counseling and relationally and emotionally-focused individual psychotherapy have all been shown in studies to be comparable or more effective than anti-depressants around relapse. Couples counseling promotes supportive emotional bonds between couples that shield individuals against adverse conditions, so that you potentially lead a life reassured that your partner has your back. Groups can offer a valuable sense of community and the sense that you’re not alone, that others face issues as bad or worse than your own. The interpersonal connection of individual psychotherapy can allow people to develop internally, reshape their relationships and develop new perspectives on the world. When therapy provides the space to talk through difficult feelings and foster greater self-awareness, depression may gradually yield, allowing for a more honest accounting of one’s life and prospects.