I very much want to encourage anyone with severe depression to try medication. It can be a real help, sometimes a dramatic change, sometimes a lifesaver. I have seen this happen many times with my patients, and I routinely refer people with severe depression or depression compounded by anxiety to a psychiatrist. People with depression often resist medication treatment for years and years, self-destructively, because they are afraid of change. I feel, and people around me confirm, that medication has helped me greatly when I have been at my lowest. It’s very frustrating for me when my patients won’t try it out of fear and ignorance. I don’t want to add any ammunition to this resistance.
But—and it’s very big but—medication, especially over the last 15 years, has been vastly oversold, overpromised, and overprescribed. Scientific research has been compromised and distorted. Respected academics have published results favoring certain meds because they’ve been bribed. Greedy researchers, secretly in the pay of Big Pharma, have created epidemics like childhood bipolar disorder by playing on parents’ fears and confusion. The side effects of medication have been swept under the rug. The way the drugs achieve their effect, as we will describe, carries with it a lot of unintended negative consequences.
All that must be balanced against the fact that unremitting depression is also damaging, usually much more so than medication treatment. Most dramatically, depression can cause brain damage. But it can also destroy your confidence and self-esteem so that you miss out on the opportunities of life. It can destroy relationships and make you unemployable. The longer it lasts, the more damage it causes. Adequate, prompt treatment for a first episode reduces the odds that you’ll get depressed again. Up against all that, the problems with medication seem pretty small. In fact, there’s evidence that medication treatment reverses some of the brain damage done by depression.[i]
The drawbacks of medication are not small at all, though, if you’re merely looking to be happier. Antidepressants are immensely overprescribed to the “worried well”—people who are facing a minor or temporary life upset and hope for a pill as a cure, when they really need to take action. If you rely on medication, you don’t grow in skills or self-esteem as you would if you toughed it out or solved the problem yourself (or with a therapist). Adolescents and children whose behavior is worrying or upsetting for parents and teachers need to learn new skills, not be medicated so they will be more compliant. Seniors—almost all of them—in group living situations are prescribed antidepressants to enable them to put up with dehumanizing conditions.
You see how I bounce back and forth in the last four paragraphs: one minute an advocate for meds, the next minute an alarm bell. I regret that this must be confusing for the reader, but I think confused is the appropriate way to feel about medications for depression at this time.
The bottom line: if you’re really depressed—if you meet the criteria for major depression or bipolar disorder, you can’t get out of bed or can’t manage the normal tasks of everyday life, you have suicidal thoughts, you can’t stop crying or control your anger, you’re in great pain from guilt or shame, your negative thought processes keep running away with you—you should give medication a serious try. Make an appointment with a good psychiatrist. But you should be in therapy as well, with someone you trust and respect, and your therapist should agree with the decision to try meds. At the same time, do everything you can to start exercising regularly, and add fish oil to your diet. If you’re not so seriously depressed but are unhappy, grieving, stuck, low energy, and rarely feel good—find a therapist first. Of course, you should also try the advice on this website and in my book that fits you— seek a more mindful attitude toward your life, address life’s problems more effectively, and become more aware of opportunities for happiness.
[i] Goldapple, et al., op. cit.
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