What? Me, Take Medicine?

Christopher Lukas Health Guide

    It is not uncommon for people to tell me that using antidepressants is against their better judgment.

    "I'm not that depressed."

    "They don't do any good."

    "I'll lose my sex drive!"

    "I don't want to become dependent."

    "I've tried one; it didn't work."

    "I've read that they're really harmful. I take herbal medicine instead."

    Let me take each of these arguments one at a time:

    1. "I'm not that depressed."

    Anti-depressant medicines are not just for people with clinical (major) depression. In fact, millions of people with dysthymia (chronic, but moderate depression) get benefits from one or another of the SSRIs or other kinds of antidepressants. The point isn't how depressed you are: the question is whether or not your depression interferes with your quality of life, your relationship with others, and your enjoyment of work and family.

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    2. "They don't do any good."
    There are studies that show that some antidepressants by themselves are not much better than placebos. There are studies that show that some antidepressants seem to work better when you're also in psychotherapy. There are studies that show that some antidepressants do work better than placebos. The field is not evenly split between believers and non-believers, but there is disagreement. I have personally found that a small dose of Effexor at bedtime works for me. Would a placebo work as well? Would other antidepressants work as well? I don't know and, frankly, after six years I don't care. This medicine seems to work for me.


    3. "I'll lose my sex drive!"
    There are two answers to this, one in the form of a question: Would you rather be depressed and have lower sex drive or be less depressed and have lower sex drive?

    The second answer: Oh, I see what you mean.


    4. "I don't want to become dependent."

    From my point of view, this is a valid concern. No one wants to become dependent on a medicine, unable to stop using it if side effects are unpleasant or harmful. And there are always some side effects. And there is always some doubt as to the potential long-term harm of the medications. However, dependency is something that can be dealt with in two ways. The first is to differentiate between being "hooked" on a medication and being "dependent." Hooked implies the impossibility of getting off the meds without emotional and/or physiological pain. Dependent, on the other hand, implies that you have become used to the meds and must either increase the dosage or find a way of slowly withdrawing from usage. But what is the problem with mere dependency (as opposed to painful or harmful side effects)? Isn't it more a belief that you should be able to "cure" yourself of depression without medication? Isn't it more a a so-called moral question? For instance, if I tell you that insulin is necessary for the rest of your life, you don't worry about dependency because diabetes isn't under your control. However, you may believe that depression is a matter of will power; that you should be able to rid yourself of your own mental state. The question is one that a good psychotherapist can help you deal with. But, from my point of view, it's simple: depression is unpleasant. Taking a few pills a day is easy.


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    5. "I've tried one; it didn't work."
    Yes. You tried one kind. Was it prescribed by a physician or by someone skilled in psychopharmacology? Was the dosage strong enough? Was it the right kind of antidepressant for you? Until you've tried a variety of these little pills, you really won't know if the doctor was the right prescriber, the medicine works for you, or the side effects are just too upsetting to put yourself through these trial and errors.


    6. "I hear they're harmful; I take herbal medication instead."
    There is some indication that long-term use of some anti-depressants can be harmful. You need to discuss this issue carefully with your psychiatrist or psychopharmacologist and make your own decision.

    However, what about those herbal medications? Are you talking about St. Johns Wort? That's a very popular herbal that is touted on the Internet as the solution to depression. It's used in Germany a lot, prescribed by physicians. It seems to work in some cases, though not in major depression. Again, this is a discussion you need to have with a physician or psychiatrist. The warning? Herbal medicine can also have side effects and may, at times, fight other meds you might be taking.

    In short, nothing is certain in this world of ours.

    Where have I left you, on balance?

    Only with my opinions and experience.

    The rest is up to you and your psychiatrist, physician, or psychopharmacologist.




Published On: August 07, 2008