Antidepressants are helpful—even lifesaving—for people with severe depression, but they are ineffective for other patients and overprescribed for many. Too many doctors routinely recommend antidepressants for patients who are feeling blue or have little energy. These drugs may seem to offer a simple solution for these patients, but no studies have convincingly shown that medications relieve milder depression.
You may think, Well, why not take them—they can only help. The problem is that all antidepressants have side effects. Even Prozac and other selective serotonin reuptake inhibitors (SSRIs), which were originally touted as being easier to tolerate than older drugs, have side effects. These include weight gain, loss of libido and emotional “blunting” or loss of empathy—which can be quite troublesome and should not be taken lightly.
Most people with mild-to-moderate depression can be treated effectively with psychotherapy…and patients whose depression is serious enough to warrant medication are likely to do better if drugs are accompanied by some form of talk therapy so that the root emotional problem can be identified and resolved.
Before writing you a prescription for an antidepressant, your doctor should have a thorough discussion with you and perform a physical examination to determine if there is a physical cause for your problem. Some diseases mimic symptoms of depression or are accompanied by depression. Examples: Thyroid problems can cause loss of energy and difficulty concentrating. So can anemia. Undiagnosed heart disease may show up first as depression. Stroke patients, too, may develop depression.
To help determine the appropriate treatment, your doctor should ask…
How is your job…marriage…relationship with your children? If your low mood is connected with a change in any of these areas or if you are under stress for other reasons, such as from financial problems, you might benefit most from talking to a professional who specializes in these issues. A career counselor, financial planner, debt counselor, interpersonal therapist or marriage and family counselor can help you gain skills and take action on these problems.
Have you increased your use of alcohol or other drugs? Alcohol and marijuana are depressants—and depression often accompanies dependence on drugs or alcohol. You should address this dependence (whether through counseling or a 12-step program) as well as the depression.
Are you taking medications, prescription or nonprescription? Antihistamines and painkillers can cause lethargy and fatigue, common symptoms of depression.
Do you exercise? Studies show that exercising three times a week improves mood as much as taking antidepressants, and continuing to exercise reduces the likelihood of future depressive episodes.
During your visit, ask your doctor the following questions…
How severe is my depression? Depression is characterized by persistent sad mood and/or loss of interest in previously pleasurable activities that lasts for at least two weeks. To be diagnosed as major depression, these symptoms also should be accompanied by at least four of the following…
How much experience do you have in treating depression? And what strategy do you generally use in treating it? Prescribing antidepressants is an art, and a doctor with extensive knowledge and understanding of the available drugs and their side effects will be better able to help you. If antidepressants are appropriate for you, it may take some trial and error to find the most effective dose or combination of drugs.
Can you refer me to a specialist in talk therapy? If you go to your general practitioner first, he/she should be able to provide several names of mental health professionals. Most kinds of talk therapy work equally well, so choose a style—and a therapist—you are comfortable with. Talk therapies include…
Cognitive behavioral therapy, which helps identify and change the faulty thinking that leads to negative feelings.
Mindfulness-based cognitive therapy, which includes training in meditation to place thoughts in a healthier perspective and interrupt the habit of ruminating.
Psychodynamic therapy, which is focused on uncovering and coming to terms with early trauma that has continued to cause pain.
Important: If you are experiencing persistent sadness or other troubling or debilitating feelings, do talk to your doctor or a mental health professional. Depression is treatable, and the sooner you get treatment, the more likely you are to prevent a future recurrence, especially if this is your first episode.
