Would You Rather Take The Pills Or Learn Some Skills?


Depressed? Psychotherapy teaches skills for living that last a lifetime.

In a society that embraces the use of pills for everything from oppositional childhood behavior to weight loss, it should come as no surprise that a recent study reveals that depression is overdiagnosed and overtreated with medication. The study, conducted at Johns Hopkins, finds that many people are taking antidepressant medication even though they do not meet the criteria for Major Depressive Disorder, the condition for which medication is most often appropriate.

To put this in context, let's say your child refuses to go to bed or hits her brother. I'm guessing your first line of attack is not to go to your doctor and ask for medication. Let's say you look in the mirror one day and recognize that you really need to lose 40 pounds or so. Is medication your first thought? Consider the losses we all experience living in this world: getting fired from a job, the death of a loved one, or divorce, just to name a few. Each of these, and a host of other life stresses, may result in depressed mood, difficulty sleeping, feeling hopeless and a drop in interest in pleasurable activities, all symptoms of what we would call an Adjustment Disorder with Depressed Mood.  Is a pill going to solve these life problems?

Most people are savvy about childhood behavior problems and weight loss. They know there are many ways to tackle behavior problems and they will often try quite a few before seeking medical help. In order to make a lasting change in your weight, you know you're going to have to make difficult changes in your relationship with the food and exercise. When all else fails, you ask your doctor.

It's very much the same with depression. I am not talking about people with lifelong depression, with family histories of depression and suicide, who may be thinking of suicide themselves; the relatively small number of people falling into this group are the most likely to benefit from medication. Most people who experience mild depression do not fall in this group. When they notice the symptoms they read about the problem, ask friends for suggestions or support, and try various solutions. People attempt to improve depressed mood with exercise, good sleep hygiene, a healthy diet, spending time doing positive things with friends, and pushing themselves to do important things despite feeling lethargic. It usually works. If you feel your efforts haven't resulted in improvement, or you just want to talk things out with someone, talking to your doctor certainly makes sense. But which doctor?

If you ask your primary care doc, your internist, your gyno or any of your other MD docs about your depression, chances are they will prescribe an antidepressant medication. They may also refer you for psychotherapy. On the other hand, if you ask your psychologist about your depression, chances are they will offer psychotherapy. They'll tell you that if your symptoms don't improve in 6-8 weeks, medication might be worth considering, the generally accepted approach for mild depression. At that point, if you're improving, you may continue with therapy. When you leave therapy you will walk away with improved coping skills. If you're not improving after 6-8 weeks or so, you might decide to discuss medication with your primary care doc.

The mere fact that pills are available for behavior problems, weight loss, mood issues, and other garden-variety-life-problems, presents a great temptation. Taking a pill is so easy. Many of my clients come to me after taking antidepressant medication which they've stopped taking: it wasn't working, they didn't like the side effects, or they didn't want to keep taking medication. Sometimes they felt better, and then after stopping the meds they didn't. Often they were following the advice of a physician, and their preference was really not to take medication to begin with.

I am not saying that medication is never helpful or necessary. If your medication is helping you, by all means, continue taking it and don't discontinue it except on the advice of your prescriber. In moderate to severe depression, or persistent mild depression, medication can be a great adjunct to therapy. I say adjunct because we know that you don't learn anything from taking pills. If you want to cope better with the next loss, do better in your next job, or figure out how to recover from your divorce, you can look into my crystal ball. It will give you the same answer that you get from a pill. Or you can see a psychotherapist and work on learning some new skills for living. It is work, but it's the good kind; the kind that helps you grow.