Considering Meds for Depression?

Published September 21, 2016 · Reviewed July 11, 2026

If you feel 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 antidepressants when they get into this state. Antidepressant drugs are often seen as a first-line treatment for clinical depression, but there are some good reasons to think carefully before starting them. Research suggests that the average benefit over placebo tends to be more modest in less severe depression, while people with more severe symptoms may see greater benefit.

When you lose your job, it’s normal to feel sad, discouraged and anxious. When a loved one dies, you can feel a lot of very intense emotions.

Many American adults live alone. Direct emotional contact with friends can be hard to come by. One of the most painful forms of isolation is to live with a partner to whom you don’t feel connected. Many people are affected.

Social changes enabled by technology may have increased our sense of isolation from one another. We’re each on our islands, feeling a sense of isolation and meaninglessness for which connection can be an important answer.

Recognizing Depression

Depression can be recognized partly by how much it impairs normal functioning. It may become increasingly clear to friends, colleagues and family that something is wrong, though people can show it differently. Some isolate themselves, experience fits of anger, or turn to substances or sex for comfort. Isolation doesn’t help matters. Energy levels can plummet, appetite may change, and you can lose the sense of pleasure in the things you used to enjoy. Suicidal thoughts can turn towards planning.

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 the condition. A clinician can also consider medical conditions, medications, or substances that may be contributing.

If you are having thoughts of suicide or are worried about someone else, call or text the 988 Suicide & Crisis Lifeline at 988. If there is immediate danger, call 911 or go to the nearest emergency department.

In the rest of this article, I’ll be considering the implications around the use of antidepressants for mild and moderate depression.

The Stats

Antidepressants are widely prescribed, and primary care doctors are responsible for much of this prescribing. Primary care clinicians can assess and treat depression, but office visits tend to be brief, which can make it difficult to explore the emotional, relational, and situational context in much depth.

Few people wish to identify themselves as having a mental illness, and some don’t feel at ease starting to take a drug. Others welcome medication as a potentially useful form of relief. Either response deserves a thoughtful conversation about likely benefits, side effects, alternatives, and what follow-up will look like.

People sometimes stop taking antidepressants when they start to feel a little better or a little worse. Side effects can include dizziness, drowsiness, upset stomachs, sleep changes, agitation, and loss of sexual appetite. It is not surprising that some people have trouble staying on their medication.

Studies of antidepressants show an average benefit over placebo, but the size of that benefit varies. For mild depression it may be modest, and non-medication options may be reasonable places to begin. For moderate or severe depression, medication may have a more substantial role, sometimes together with psychotherapy. This makes shared decision-making more useful than either reflexively prescribing a pill or reflexively rejecting one.

Chemical Imbalance

From a medical perspective, the practice of treating depression with a pill became associated with the chemical imbalance theory: the idea that an imbalance of brain chemicals gives rise to depression.

That explanation has not held up as a complete account of depression. Current understanding is more complex, involving some mixture of biological vulnerability, isolation, loss, difficult life circumstances, relationship problems, and patterns of thought and action. The mixture differs from one person to another.

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 does not directly address every cognitive, emotional, relational, or practical process involved in that cycle. It may, however, reduce symptoms enough to help someone sleep, think, connect with others, exercise, or make better use of therapy.

Antidepressants also carry risks that should be discussed with a prescriber. They can occasionally activate mania or hypomania in people with a vulnerability to bipolar disorder. Children, adolescents, and young adults need monitoring for new or worsening suicidal thoughts when starting treatment or changing a dose. People already taking an antidepressant should not stop abruptly; withdrawal symptoms can occur, and tapering should be discussed with the prescribing clinician.

How about a little exercise?

Exercise can help with depression in mild and moderate cases. It can also be very difficult for people who are depressed to get motivated to exercise.

Exercise can easily become an all-or-nothing proposition. If you cannot get to the gym five times a week, run several miles, or complete a full class, it can feel as though there is no point in doing anything. But every bit of movement helps. A ten-minute walk is still a walk, and it is more likely to become a habit if the first step is small enough to repeat. Once the habit starts to take hold, you can add to it without having to rely on a heroic burst of motivation each time.

Brisk walking and other forms of cardiovascular exercise have been associated with reductions in depressive symptoms. There is no single prescription that works for everyone, and exercise should not be treated as a moral test or a substitute for an assessment when symptoms are severe.

Studies of yoga practice also suggest benefits for symptoms of depression and anxiety. Group activities like yoga may help by providing a sense of group membership, which can be reassuring to people who would otherwise feel isolated.

Therapy for Depression

Even if you’re exercising a lot or taking medication, you might still have a lot on your mind that could benefit from thinking and feeling more deeply into.

Psychotherapy is an established treatment for depression. Cognitive behavioral therapy and interpersonal therapy have particularly strong evidence, while group therapy, couples counseling, and relational psychotherapy may be useful depending on the person and the problems involved. Therapy can be used on its own in some cases or alongside medication.

Couples counseling can promote supportive emotional bonds between partners, so that you potentially lead a life reassured that your partner has your back. It may be especially relevant when depression and relationship distress are feeding each other.

Groups can offer a valuable sense of community and the sense that you’re not alone, that others face difficult issues of their 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.

Bruce Hearn is a psychotherapist in private practice in San Francisco. He works with individuals and couples and welcomes people who struggle with depression in his practice. This article provides general information and is not a substitute for medical advice, diagnosis, or treatment.