Resistance to Antidepressant Treatment
It may come as a surprise to anyone who’s read my writing to hear that I was reluctant to start antidepressant treatment for my depression. While I would not call myself "pro" medication, my life has been changed by antidepressants, and I know quite a few other people who feel the same way.
However, my initial reaction to my psychiatrist’s suggestion that I start antidepressants was a firm "no." Or, that is, as firm as I was about anything at that time. I was in the middle of the third, and worst, major depressive episode of my life. Most of the time I was either numb or crying. I had made an appointment for a mental health evaluation after reading William Styron’s "Darkness Visible" and realizing that in all likelihood I was suffering from clinical depression.
My psychiatrist’s confirmation that I did have clinical depression was a huge relief to me. I think he was somewhat surprised; I’m sure some of his patients were resistant to the diagnosis. I was just relieved that what I was going through had a name and that my symptoms were part of a medical condition. I wasn’t, however, ready to treat it with medication.
From the perspective of twenty years, I’m not sure why I refused. It’s possible that my resistance was due to my experience with medication for headaches I had suffered as a teenager. After months of all-day headaches, my parents took me to a neurologist, who ordered all the appropriate tests. Since these all came back clean, the neurologist apparently decided to treat the pain without knowing what caused it, and prescribed something called Bellergal, which is partly a barbiturate. That’s certainly the effect it had on me during the three or four years I took it. While it did eliminate my headaches, it also made me very spaced out. I started cutting the daily dose in half, and then half again until I had a manageable balance between pain relief and alertness. In college I stopped taking them altogether, and was relieved to find that I no longer had the headaches.
So it’s possible that my knee-jerk reaction to the psychiatrist’s suggestion may have been because of that experience. Or I may have refused to start antidepressant treatment due to my lack of knowledge about antidepressants. At that time, I didn’t know much about depression, and knew nothing about its treatment.
Whatever the reason, I declined the antidepressants and instead chose to embark on talk therapy. Ultimately the therapy was very effective in terms of helping me break some unhealthy patterns, but it didn’t treat the major depression I was suffering through. Finally, after six months, I told the psychiatrist I was willing to try antidepressant treatment.
What a difference Not only did it treat my major depressive episode, but for the first time in as long as I could remember, I was happy instead of just existing. After six months the doctor suggested discontinuing the medication, which is standard practice. Unfortunately, my depression came back in full force. We tried again at one year and a year and a half, with the same results. When I was told it was likely I would be on antidepressant treatment the rest of my life, I said, "No problem!" I never wanted to go back to just existing (barely).
Now, antidepressant treatment is not always the best treatment for depression. Sometimes therapy alone is enough, especially in mild to moderate depression. But if you dismiss the idea of antidepressant treatment immediately like I did, you need to ask yourself why, especially if you respect the opinion of the doctor suggesting it.
Make sure that you are not reluctant to try antidepressant treatment because of misconceptions about antidepressant treatment. Do you think it will turn you into a zombie or a Stepford person? Do some homework to ensure that your decision is well-informed.
If you’re concerned about side effects, remember that there are a few different "families" or types, of antidepressants. Even if one gives you uncomfortable side effects, chances are that there is another kind that will not.
Bottom line is, if your first reaction is to dismiss the idea, ask yourself why.
Deborah Gray wrote about depression as a Patient Expert for HealthCentral. She lived with undiagnosed clinical depression, both major episodes and dysthymia, from childhood through young adulthood. She was finally diagnosed at age 27, and since that time, her depression has been successfully managed with medication and psychotherapy.