Considering Meds for Depression?

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. Anti-depressant drugs are often seen as the first-line treatment for clinical depression, but there are some very good reasons to think twice before signing up for the happy pills. Recent studies have shown anti-depressants are not effective except in cases of severe depression.

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.

A quarter of American adults live alone. Direct emotional contact with friends happens a lot less than it used to. 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 have increased our sense of isolation from one another. We’re each on our islands, feeling a sense of isolation and meaninglessness that only connection can solve.

Recognizing 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 tend to isolate themselves, experience fits of anger and turn to substances or sex for comfort. Isolation doesn’t help matters. Energy levels plummet, you can’t bring yourself to eat and 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 your condition.

In the rest of this article, I’ll be considering the implications around the use of anti-depressants on mild and moderate depression.

The Stats

The Center for Disease Control (CDC) reports that 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 psychiatric training in depression, anxiety and ADHD yet are the main prescribers of medications to treat these conditions. 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 often don’t record a diagnosis of clinical depression when prescribing anti-depressants.

Americans tend to have trouble staying the course with their medications, and some drop out as soon as they start to feel a little better or a little worse. Side-effects of anti-depressants can range from dizziness, drowsiness, upset stomachs and loss of sexual appetite. It’s no surprise that many don’t want to stay on their meds.

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 that antidepressants continue to be used as the first line treatment for depression. And it’s the unspecialized primary care MDs who are handing out these pills.

Chemical Imbalance

From a medical perspective, the practice of treating depression with a pill came out of the chemical imbalance theory. This is the idea that chemical imbalances in the brain give rise to mental illness.

This assumption is outdated by modern research but a lot of pill prescribers don’t seem to have caught up. Most of the time, it is not faulty brain 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. It can also lead to the emergence of psychotic symptoms in some patients, who are then given mood stabilizers and diagnosed with bipolar II disorder.

How about a little exercise?

Exercise is one of the best ways to help with depression in mild and moderate cases. It can be difficult for people who are depressed to get motivated to exercise.

Fast walking for an hour a day has been been shown to be more effective than anti-depressants and leads to lower recurrence rates for depression. Other forms of cardio exercise are also helpful.

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 like yoga also help by providing a sense of group membership, which can be very reassuring to people who would otherwise feel isolated.

Therapy for Depression

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

Group therapy, couples counseling and relational psychotherapy all tend to be more effective than anti-depressants and have lower relapse rates.

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.

Bruce Hearn is a Psychotherapist in private practice in the San Francisco Financial District. He works with couples, men and women. He welcomes people who struggle with depression in his practice.

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