1. Most people have not done their homework to understand the science involved. For example, many still believe antidepressants are addictive!
2. A strong cultural bias along with stories of botched cases fuel the cruel judgmentalism so prevalent in society.
3. People who negatively stereotype the medicines and the people who take them have never experienced the shift from being moderately to severely depressed into feeling the miraculous relief of remission (freedom from the pain and limitations of depression).
4. Many women are still being treated with antidepressants when their symptoms are caused by a progesterone deficiency (PMS, perimenopause and menopause), not a serotonin and/or norepinephrine deficiency!
5. Most failed cases (the ones you hear about the most) are caused by inadequately trained general practitioners. (See below, regarding who should be practicing this speciality).
First, its ultimately a personal decision, just as it is a personal decision whether or not to choose better health practices. Just remember here that your personal decision affects those around you, especially those who care about you the most.
There are many forms of depression and no diagnostic test yet to tell when an antidepressant is absolutely necessary. But there are a number of basic clues (and a lot of more complicated indicators that we don't need to detail here). For example, how well are you functioning? Perhaps someone close to you has died or you've lost your job and are very sad about it. But if you still get up each day, do what needs to be done, eat and sleep appropriately, take responsibility for your (emotional) impact on others, you may not benefit from an antidepressant. Mild to moderate depression such as this often responds well to counseling (psychotherapy) alone. But even in these cases, you may want to try medication if you and your (qualified) doctor believe that you could benefit.
With more severe depression - for example, you are not eating or sleeping or you are not getting out of bed or the house - it's usually more clear-cut that you need medicine to raise your neurotransmitter levels. Also, if you have a family history of depression...have been depressed a number of times before......or if depression first started when you were an adolescent or younger, this indicates that your depression is biochemical in nature; that is, there may be a shortage of certain mood-regulating neurotransmitters or a dysfunction in how neurons respond to them. With biochemical depression, medication is typically an important part of treatment.
What are the best alternatives to antidepressant?
Psychotherapy helps. Just be sure to choose one of the types shown to work for depression, such as cognitive behavioral therapy (which tries to change habits of self-destructive thinking and behavior) or interpersonal psychotherapy (which addresses patterns in your relationships that promote depression).
In my practice, I have seen brief help in a few mild cases from the following list of "natural antidepressants": St. John's Wort (herb), omega-3 fatty acids, SAMe, methylfolate.
Above all, do not let depression go untreated, and be ready (informed) to reconsider antidepressants if other methods don't work or your symptoms worsen within 4 to 6 weeks.
For a person who is depressed, is an antidepressant sufficient treatment?
Even if an antidepressant corrects biochemistry, lifestyle adjustments and sometimes psychotherapy are critical for recovery. Lifestyle changes help alleviate symptoms as they do for other medical conditions such as heart disease.
Regular exercise is also important. It can be as effective as antidepressants for some people with mild depression. In addition, take time out for activities you enjoy, reach out to friends (real friends, not the "friends" who hurtfully judge you to be weak and defective). Get enough sleep, manage stress, eat properly and if you drink alcohol, do so only in moderation. Excess alcohol depletes happy hormones from the brain.
Does your family doctor have the expertise to prescribe an antidepressant effectively, or should you see a psychiatrist or other mental health specialist?
Most antidepressant prescriptions are written by primary care physicians (such as a family doctor, internist, pediatrician or ob-gyn), and there is nothing wrong with this if she/he has stayed up-to-date on the use of these medications through extensive study of medical literature and/or taking classes.
But not all doctors, competent as they may be in other areas, are expert in diagnosing, knowing when to prescribe, how to deal with possible side effects, and when to adjust the dose, switch or add complementary medicines. Far too often, non-specialists are familiar with only 3 or 4 antidepressants, among the roughly 50 that are available, making it difficult to get the best one for you.
Besides psychiatrists, certain clinical nurse practitioners have advanced training in psychiatry and can help many people.
Can taking an antidepressant damage your brain over time?
There has been no evidence of long-term bad effects on the brain. But issues with some medications have come to light only after many years of use.
On the other hand, we do know that untreated depression can damage the brain. Imaging studies show that areas such as the hippocampus actually shrink, which can cause severe memory and thinking problems. The more severe your depression and the longer it goes untreated, the worse and more lasting these harmful changes are likely to be. So the goal should be to take an antidepressant as long as necessary - but no longer.
How do you know whether it is time to stop taking an antidepressant?
Generally, 6 to 12 months of medication are sufficient for a first episode of depression. If this is your second episode, longer may be better. After three or more episodes, research shows that it may be advisable to stay on an antidepressant indefinitely.
In any case, you should not stop until you are no longer depressed (the more residual symptoms you have, the more likely it is that depression will come back), your physical health is good (or any chronic medical condtiion is being controlled), and you are maintaining a healthy lifestyle.
Some people have trouble stopping antidepressants. Is this like narotics withdrawal?
"Discontinuation syndrome" bothers about 20% of people when they stop antidepressants due to a rapid drop in the neurotransmitter serotonin or norepinephrine. It is not true withdrawal, because your body is not dependent on these medications as it might be with narcotics and other drugs that can be abused.
Discontinuation problems include flu-like symptoms, fatigue, unusual sensations (like pins and needles in hands or feet) or anxiety. In most people, they are relatively mild and go away within a week, but they could last up to a month or two.
To minimize discontinuation problems, taper the dose slowly under the guidance of your specialist. If you are particularly sensitive, the process may take up to six weeks.
These are the facts that I want my patients to understand.
For this article, I wish to thank Michael Banov, M.D., Medical Director of Northwest Behavior Medicine and Northwest Behavioral Research Center, both in Atlanta. He is the author of Taking Antidepressants: Your Comprehensive Guide to Starting, Staying On and Safely Quitting.