Depression Medication
Know the Costs and Limitations

About mental health medications

The following reflects my conservative opinion regarding the use of depression, anxiety, and other health medications, particularly for those experiencing mild to moderate symptoms.

This page is not a professional opinion about any individual's mental or emotional condition, and is for informational purposes only. This information is not intended to replace formal examination by a licensed health care professional.

While I respectfully validate client choices for their own treatment, and recognize that some find drug therapy useful (see below for discussion on who might be helped), it’s important to be informed on the overall effectiveness, and other issues involved.

But this information on effectiveness is buried beneath a lot of hype. Marketing techniques and confusing science surround the use of pharmaceuticals for mental health symptom management, many of us are taken in by the idea of a “quick fix” that a pill promises.

Depression medication is the most common mental health drug prescribed. But using drugs routinely to solve human problems renames unhappiness (the symptoms) to “illnesses” and what follows are impersonal, pharmaceutical interventions. The medical model says mental health symptoms (i.e. unhappiness) are caused by a "chemical imbalance." The suffering caused by human problems in living then becomes a vague biological issue. This creates a disconnect between unhappiness and the human problems that cause it.

Unhappiness, even in its extreme forms, often stems from real issues like difficult relationships, past trauma, troubled children, loss of love or health, poverty, racism, leading an isolated life, being sedentary, lack of community, unsatisfying work, lack of joyful activities, and poor dietary and health habits. Do these problems lead to a chemical imbalance? It's hard to know for sure. There isn't a test to measure these chemicals!

We have the option to pick up a prescription of the latest wonder pill to “manage symptoms,” shooting the messenger, while the actual problems continue.

Symptoms are the force our minds and bodies use to push us to find solutions to our problems. Symptoms are messengers. Real wellness is removing the problem that causes the symptoms, not removing the symptoms and letting the problems continue. A pill is not going to remove the communication problems or unconscious defenses that keep someone alone or stuck in conflicted life patterns.

When patients are struggling with a problem and desperate for change, pills seem to take the effort and fear out of finding the personal, interpersonal, community and even political solutions to our human problems of living.

Resolution of difficult problems requires creating meaningful connections with others, like collaborating with a therapist and others, finding resources both within the self and in the community, changing attitudes, increasing awareness of our inner life, and making an effort to act in different and better ways.

Also, and not surprising in this environment of the quick fix and focus on symptoms rather than problems, is the tendency to avoid the fine print of the drug studies, their confusing language, troubled findings, unknown long term efficacy, and their short and long term side effects.

Limits of medication effectiveness

The most prevalent depression medication research studies focus on antidepressant medications, but similar problems exist for other mental health drugs. When you take a close look there are problems with research design, weak findings, and researcher financial ties to drug companies.

It appears that most persons who are experiencing mild to moderate symptoms may not be gaining anything (except costs and side effects) when they take medication.

Antidepressants exceed placebo effect in only 18% of cases. Even this result may be due to the medication side effects unblinding the study. In other words, those patients in the study who were taking the real medication as opposed to the placebo pill, could tell they were taking the medication due to the side effects. This unblinds the study and leads to the placebo effect.

Does Medication Work for Severe Symptoms?

However, the combination of therapy and medication may offer benefits for some people, especially those with severe, recurrent symptoms.

Why is this? The two therapies may work on different aspects of the issue. Antidepressant medications (and others) may help some people with short term problems like sleep, appetite and a change in mood, while therapy helps with wider issues, such as interest in solving problems, teaching skills, creative problem solving, minimizing suicidal thinking, managing moods, work, and uncovering unconscious thoughts and feelings that can drive behavior.

Additionally, drug therapy alone may be better than nothing for people who refuse or fail to respond to other therapies.

The most helpful approach

The best approach is to include therapy as a primary treatment, whether medication are used or not, and connect with the idea that most people can and do find solutions to their darkest dilemmas given time and the proper encouragement and support.

Clients must have a voice in every decision that affects their health, and being given the truth about the limitations and side effects of medications, and the ability to reject inadequate treatments, is a necessary part of having that voice.

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