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    Thinking About Anti-Depressants

    By Tom Moon, MFT–

    Q: I’ve been depressed for at least a year and a half, and I’m doing my best to get over it. But my doctor is leaning on me to take anti-depressants. I don’t want to do that. I don’t believe that depression is some kind of brain disorder that needs medication! I’m sure that I’m depressed because of what has been going on in my life, and that’s what I need to be focusing on. I want to cure it on my own, and not have to depend on pills to make me feel better. Am I making sense? I’d appreciate any feedback that you might have for me.

    A: It is your absolute right to decide what you are going to put into your body, and if you don’t want to take anti-depressants, whatever your reasons, then you are right not to let anyone else pressure you into doing it. But having said that, I also think it’s important that you base your decisions on accurate information and clear thinking. To that end, I have a few comments on what you wrote.

    First of all, I don’t know any mental health professionals who believe depression is a “brain disorder.” It’s far more complicated than that. Virtually all of us these days are proponents of what’s called the “biopsychosocial model” of the illness, which sees it as the result of multiple factors—biochemical, psychological, environmental, social, etc. The mix of factors varies from person to person, meaning that each case requires an individually tailored treatment response. It may be true that some people are more biologically susceptible to depression than others, but that’s a long way from the claim that depression is completely the result of physical causes. We know, for one thing, that the incidence of depression in the United States has increased tenfold since the end of World War II. Presumably, our biology hasn’t changed in that time, which strongly suggests that the psychological and social changes that have occurred in American life are responsible for the increase.

    But while I agree that your depression is probably the result of circumstances in your life and not a brain malfunction, that doesn’t mean that anti-depressant medications can’t still be useful in treating it. In fact, the standard of care for moderate to severe depression is generally considered to be a combination of anti-depressants and psychotherapy. Depression typically includes apathy and feelings of hopelessness that can leave people feeling too immobilized to participate in therapy or to make important changes in their lives. In many cases, a course of anti-depressants can pull people out of the “black hole” enough to enable them to get moving again, and to begin to take actions to improve their life circumstances.

    The final reason you gave for not wanting to use anti-depressants is one I’ve heard often over the years, but have never understood. You say you want to cure your depression through your own efforts, and not have to “depend on pills” to make you feel better. I am sorry if this sounds sarcastic, but it sounds almost as if you see taking medication for depression as a form of cheating. What if they work? Is it that you don’t get all your points unless you can believe that your improved well-being is due to actions you personally take, rather than medication?

    I wonder what you would think if someone told you, “I want to manage my diabetes on my own. I don’t want to have to take insulin to make me feel better.” Many people who will not hesitate to take medication for other illnesses feel that doing the same for emotional illnesses is somehow shameful.

    To take appropriate treatment for depression doesn’t make you a defective human being. Depression is a serious, sometimes debilitating, illness. I think the wisest thing to do in deciding how to respond to it is to think of it as a practical problem, a question of what works, and to leave your pride and ego out of it. Keep an open mind and be willing to do whatever works to relieve your suffering. Anti-depressants aren’t a panacea; they don’t work for everyone. They should not be the only response to depression, but they definitely have their place in our treatment arsenal.

    Tom Moon is a psychotherapist in San Francisco. For more information, please visit his website http://tommoon.net/