“Does depression medicine make any f%#%ing difference at all?”
Michelle asked me this question as she sat in my office explaining how she needed help. Her boyfriend just left her. “He said he wanted out of the relationship because I was a crazy witch!” Michelle’s boyfriend couldn’t put up with her mood swings anymore. I diagnosed Michelle as having borderline personality disorder and severe anxiety. She’s habitually afraid of being abandoned, and now her worst fear came true. Her boyfriend walked away. It makes sense for her to ask the question about antidepressants since she’s been on all kinds of medications since she was 16 and now she’s 32. Michelle has had many doctors, but none of them have told her some important facts about her antidepressant medications.
Secret #1. Antidepressants don’t work much better than sugar pills.
I know this is an outrageous statement, but check out any study that actively compares an antidepressant to placebo (sugar pill). You’ll find that the active medicine is usually no more than 20-30 percent better, even in the best of circumstances. But before you go trashing your antidepressants, remember that placebos can have some pretty big effects which means that believing something is going to make you feel better is half the battle. Having faith in the power of a medicine is known to have observable effects, just like believing in healing rituals help many people to feel restored after visiting faith healers. Or how believing that caffeine works seconds after drinking coffee makes people feel more energized an hour before the effect actually kicks in.
Secret #2. Antidepressants are no more effective than practicing new behaviors for depression.
So why do doctors prescribe mind-altering drugs when they know there’s such little difference between popping a pill and taking walks in the park or practicing new ways of thinking? Well, there are at least 4 obvious reasons:
Reason 1. Most people don’t feel motivated or have as much faith (remember the placebo effect) about the effects of behavior change. They get stuck in their feelings, “I’m too tired to exercise.” “I don’t want to go out of the house.”
Reason 2. Patient’s expect their doctor to make a high impact difference in the shortest period possible. Doesn’t it make sense that a drug is the easiest way to do that? It requires very little behavior change, and it can help to increase motivation and energy. So for your doctor, it’s a simple solution. You leave the office with hope and he feels good because he’s done something to get you feeling better as quickly and effortlessly as possible. It’s a win/win. At least until the medicine stops working.
In cases of really severe depression both medicines and lifestyle changes are necessary; either alone won’t usually be enough.
Reason 3. There are those impressive cases of patients who take an antidepressant and feel completely renewed and happy with life. For these individuals, it’s like the clouds fade away and the sunshine beams into their life. These are the patients that make us glad to have these tools in our kit and happy to use them again and again. But even these successes will tend to lose effect if the patient doesn’t add lifestyle changes ASAP.
Reason 4. Another reason doctors prescribe pills before behavior change is– the patient. When they schedule a visit with their doctor they expect to get something tangible for that effort. Doctors only have a limited time to spend with each patient, and they feel a pressure to prescribe.
I had one patient complain to my hospital administrator because I wouldn’t prescribe medicine to help him feel less anxious about his girlfriend cheating on him. You might say that it’s the doctor’s fault for giving in to the patient’s insistence on medicine, and you may be right. But doctors are people just like you. They don’t like to disappoint someone who comes to see them for help. They may even lose faith themselves after seeing how often their patients lose the struggle with the work of establishing new behaviors.
Isn’t it just quicker to press the “EZ” button? Sometimes, doctors will even prescribe a medicine at a dose that is lower than recommended. They see it as a safer way to give into the patient’s wish to take something to feel better without facing more serious side effects. This has been characterized as a type of placebo treatment. The patient leaves with a prescription and the doctor feels less worried about prescribing a potentially harmful drug.
Secret #3. Your relationship with your doctor is more important than which antidepressant they prescribe
Research in both psychology and psychiatry agree: the therapeutic relationship has the greatest impact on recovery. It makes sense no matter how you slice it. If you like and trust your doctor, you’re more likely to follow his/her instructions. You’re also more likely to continue your therapy and to let him/her know when something isn’t working for you.
Jim’s Hard Life:
Jim is a 20 year-old college student. His doctor has prescribed Zoloft for his depressed mood. After taking it for a few days, he notices he has a painful erection that lasts two hours but eventually goes away. He doesn’t feel comfortable talking to his doctor about it even though she advised him this could happen and he should tell her about it immediately. He stops the medicine and doesn’t go back for more treatment. He’s seen commercials about priapism and decides its not worth taking the risk. He’ll “just deal with it” on his own. Jim can’t be helped by his doctor anymore. The question of which medicine is best is over. If the doctor calls Jim to ask how things are going but the trust isn’t there, he still won’t tell her.
There are many other ways the relationship affects the way people respond to medicine. If they believe their doctor really wants the best for them, they’ll stick it out even when they hate the side effects-even if the medicine DOESNT WORK AT ALL. If a trusted doctor says, “I’ve prescribed this medicine ‘X’ your asking for but it’s not as good as medicine ‘Y'”, the patient is more likely to take medicine Y. The bottom line is that the relationship is at the heart of every treatment.
These are just a few of the things you probably won’t hear from your doctor when starting an antidepressant. And that’s not all. There are other drug facts you might not learn about until it’s too late, like the Sneaky Anxiety Drugs that Enslave You and The Menopause: A Breakthrough Treatment or Just Hype?
Have you discovered any other antidepressant secrets? Share, share, that’s fair.