Is it Time to Start An Antidepressant?
… or maybe it's just January … ? ❄️
ICYMI 👉
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Patients ask me this question a lot. They want to know whether or not their symptoms of depression (e.g., low moods or fatigue, for example) would improve with medication or if they should stick with more conservative measures such as regular exercise and psychotherapy.
When I was in medical school, I asked my own doctor this question when I felt sad for a prolonged period of time. Was I down as a result of the wintertime chill plus long hours in the library? Was it from the recent death of a family friend? Or was this sadness something bigger and more permanent—and not just a temporary dark cloud that would soon blow over and away?
It turns out that my depression symptoms stemmed from all of these things at once. The combination of genetics, hormonal changes, life circumstances, winter weather, social isolation, and poor sleep had conspired to make me feel hopeless and joyless for weeks on end.
Therapy alone had provided temporary relief, but it did nothing to lift the weight of despair that came over me every morning. Two weeks after I started taking Prozac, however, I felt my internal reserves coming back. It was still January—and I was still a stressed-out medical student—but I was able to think about the day ahead without dread. The muscles in my face were no longer slack. I was able to curl my mouth into a faint smile when someone greeted me.
Perhaps the most hopeful sign for me was my newfound ability to use psychotherapy not only as a place to dump any negative emotions but as a gymnasium to (re)train my brain. I learned firsthand that depression makes insight-gathering a nearly impossible task—by definition, depression hijacks our rational brain, hindering the healing process—but with Prozac on board, I had the wherewithal to explore my interior life and challenge my negative self-talk.
My advice if you are feeling depressed?
#1 - See your doctor
Depression is a medical condition. It’s not a personality flaw or character weakness. It is also not the same as the normal dips in mood that can accompany grief, loss, a breakup, or a bad day. That said, distinguishing between depression and “normal” blues can be difficult. This is where your doctor or mental health professional can help.
The symptoms of depression are on a continuum and vary widely from person to person. The symptoms can be emotional (e.g., feeling sad, hopeless, disinterested in normal activities), cognitive (e.g., difficulty concentrating or making decisions; thoughts about self-harm); physical (e.g., fatigue, insomnia, weight gain or loss); behavioral (e.g., substance overuse, binge or restrictive eating, social isolation)—or some combination of all four.
To be diagnosed with major depressive disorder, a person typically needs to experience at least five of these symptoms during the same two-week period, and these symptoms should represent a change from the person’s previous functioning. Additionally, the symptoms should cause significant distress or impairment in social, occupational, familial, or other important areas of day-to-day life. I sometimes call depression the “brain flu.” It can rob a person’s sense of self. It is not something to ignore or suppress.
#2 - Consider treatment options
Treatment depends entirely on the patient—the nature, severity, and duration of symptoms; the impact on their health and daily functioning; their existing coping tools; their behaviors and habits; their support structure; and environmental factors. For some patients, depression symptoms can abate after removing a chemical trigger such as alcohol or other sedatives. For other patients, leaving a toxic personal relationship or establishing better boundaries with family can improve mood and hope for the future. For many patients, therapy alone can be helpful.
Similarly, changing existing habits and routines by adding exercise and journaling, and reducing social media inputs can be enough to improve mood in some patients. For my restrictive eaters, the process of re-nourishment is often enough to turn the internal pilot light back on. And for others, a combination of exercise and psychotherapy can put these patients back in control of their thoughts—instead of the other way around.
What about pharmacotherapy?
Medications like Prozac, Lexapro, and Zoloft are tools in the toolbox to treat depression. Even though it’s been established that depression and anxiety aren’t due to low serotonin levels in the brain doesn’t mean that SSRI medications that increase serotonin shouldn’t be part of the solution.
Of course, medication isn’t a cure-all. There’s no pill for insight, no elixir for behavioral modification, no quick fix for uncomfortable parts of lives. But when they are used as one part of a holistic plan to manage a patient’s mental health, medication can make all the difference.
I recently put a healthy, 40-something-year-old new mom on a small dose of Zoloft for postpartum depression—something she had resisted for months, blaming her low moods on wintertime “blues” and working to feel better by walking outside and socializing more. She even tried 6 weeks of psychotherapy, but none of these efforts had worked. After two weeks on the medication, she reported feeling like herself again. She was no longer tearful all day. She started sleeping again. She was able to bond with her baby and feel hopeful about the future.
“Am I crazy?” she asked me. “Nope,” I said. “You’re human.”
The need for pharmacotherapy doesn’t mean you’re broken. It simply means you need added support. Just like we treat high blood pressure with medication when lifestyle changes alone aren’t enough, treating a patient’s depression with meds isn’t a treatment failure; it means we’re meeting the patient’s biological, genetic, and behavioral reality where it is.
Depression is multifaceted. The answers for depression have to be as well.
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Disclaimer: The views expressed here are entirely my own. They do not reflect those of my employer, nor are they a substitute for advice from your personal physician.
Can you please talk about how you get off an anti-depressant successfully? I've read and seen many stories by people that wish they never started them because of how difficult or impossible it was to come off them. Bc of this, I don't really see antidepressants as an option although I really like that you said you were then able to use psychotherapy to retrain your brain...that sounds amazing.
👏🏻👏🏻👏🏻