Do You Really Need that Antidepressant?

Sleep Drugs as Hypnotists

Depression Hurts

Lots of my friends ask me whether I think it’s a good idea to take an antidepressant. They ask because I’ve been prescribing these drugs for over 20 years…I’ve pretty much seen it all. You might wonder if I give my good friend’s advice that is different from what I tell my patients, kind of like the psychiatric equivalent of insider trading. I decided to write this article as if I were talking to a close friend about whether or not they should take an antidepressant.

Number 1: The first few questions I would ask are:

  • Have you tried taking a good, hard look at your life?
  • Are there things you’re doing you don’t want to be doing?
  • Are you working at a job you hate?
  • Are you in relationships that are causing distress?
  • Are you being clear about what you want and what you don’t want?

You might think these are obvious questions but think about it. Antidepressants are not going to fix those things you hate about your life—only positive behavioral changes can do that. When I was first learning to prescribe, a supervisor once told me, “A pill won’t talk to you.” Sounds simple enough, but you’ll be surprised by the number of times I’ve seen people disappointed because their primary care doctor prescribed an antidepressant and their life didn’t get any better.

Number 2: Maybe you’ve decided that your life is okay but you’re still depressed. Or that your life does in fact suck, but an antidepressant is what you need to fix it. In that case, the next question becomes: “What should I expect the medication to do for me?

It may be helpful to know what you can expect and what you shouldn’t expect from an antidepressant. So let’s start with what you can expect. Antidepressants typically work on the biological symptoms of depression. These symptoms typically include: difficulty with sleep (too much or too little). Decreased energy…often people with depression complain about easy fatigue, poor concentration, and it’s brother, problems with memory. Eating problems with depression are tricky because while most will lose their appetite, some will “pig out” as a sign of depression.Women typically have more trouble with overeating than under-eating when depressed. This is referred to as an “atypical” type of depression. Because there can be so many variations to the diagnosis of depression, it’s important to look at all of the symptoms instead of just one or two complaints.

Another thing that oftentimes improves with an antidepressant, is the symptom of irritability. People are surprised to discover that they have a great deal more patience after they start taking the medicine. This can open up a new world of relationships, where conflict is met with patience instead of anger. The best case example of this was with a patient of mine. He had alienated his son because he always got angry when he helped him with homework. His son had stopped asking for help out of fear, and my patient always felt guilty for losing his temper. I can’t tell you how many times he came to me promising that he would do better the next time. I started him on an SSRI, and he discovered he had the patience of a saint. It opened up a new relationship for him and his son. It even helped his marriage because his wife wasn’t on pins and needles anymore. She trusted his judgment more and her love for him grew. It was one of the most gratifying prescriptions I’d ever written.

Now let’s talk about the things you shouldn’t expect from an antidepressant. As I already said, “it won’t talk to you”. You are going to need a friend or a therapist who can help guide you. For example, if you tend to isolate yourself from others because you have trouble communicating or because of low self-esteem, the pill will not make you a better communicator. It won’t raise your self-image, unless you’re like my patient whose irritability made him hard to get along with, resulting in a type of self-hate. In his case, taking the pill did make him feel better about himself as a father, a husband, and a person. The irritability was one facet of his depression but even more so, it was a symptom of his anxiety. He worried about everything. When he saw his son failing at math, it brought up all sorts of worries about his son’s future. By the way, SSRIs are often just as helpful with anxiety as they are with depression.

Number 3: What’s the worst thing that can happen from taking an antidepressant? I’m referring to the most common class, known as SSRIs—drugs like Prozac, Zoloft, Celexa, Lexapro, and Paxil). I won’t turn ‘Drug Company” on you and start listing a bunch of possible side effects. You’ll get plenty of that that from commercials, so you don’t need to hear it from me. I’m just going to talk about two possible downsides here. The most common complaints I’ve heard with these drugs, have had to do with sexual dysfunction. For men, it can mean erectile dysfunction and for both men and women, it can take longer to orgasm. For some men, taking longer is not a bad thing. Not only that, it can be a godsend for the women they are with! But in all honesty, the men I’ve treated with SSRIs sometimes say that it’s “too much of a good thing” and when it comes time to finally let go, they can’t. That turns out to be a pretty frustrating experience.

Some people complain that they can’t feel any strong emotion, good or bad. It’s known as affective blunting. While you may be happy to feel less angry or sad, you probably won’t be jumping for joy, because the medicine can affect the degree of happiness or excitement you feel. Unless you “switch” to mania, in which case, you’ll feel plenty of emotion. But that’s not a common side effect so let’s not go there.

Number 4: The last, and perhaps most important question my friends will ask is: “Would you take an antidepressant?” It’s a legitimate question.
My answer: First I would need to know that I had tried to correct the problem by practicing what I preach. That means I would have asked myself the hard questions:

  1. Have I taken a hard look at my life and what needs to change about my thoughts, beliefs and behaviors?
  2. Have I asked the people who are closest to me what they see when I spend time with them and if they can picture alternative solutions?
  3. Am I working out and using the benefits of exercise to improve my mood?
  4. Am I eating the right foods to improve my energy and to stop the cycle of lethargy and fatigue?

If I’d done all these things and still felt sad, down or in a slump for a long time, then the answer would be clear. I would take the antidepressant and deal with the side effects, or switch drugs until the side effects were negligible. I would keep taking them so long as they helped me to feel better and live a happier life. 

If or when your time comes to choose an antidepressant, I hope this article helps you. This website is dedicated to the people who want to make the best decisions about living a happy and productive life. Let us hear your thoughts, and especially your concerns about the role that antidepressants play in your own life.
I guarantee I will answer each and every one of your comments. One of the best treatments is knowing you’re not alone.

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