As I said last month, research shows the best treatment for depression, in general, involves a combination of medication and psychotherapy. There are many therapy approaches, and I will address the most widely used ones in future posts. First though, it is important to address whether medication is a necessary part of treatment.
Some people require antidepressant medication to feel better, and some do not. In my experience as a psychologist, I’ve learned that depression symptoms fall on a continuum from mild to severe. Mild depression does not usually require medication. It tends to be related to situational factors, and talking through different ways to approach the situation usually helps. When depression is severe, the biological symptoms make it impossible to function normally, and medication is clearly required. The confusion comes when depression falls in the moderate range. At this point on the continuum people can function, but it takes effort. They sometimes go long periods of time without knowing how depressed they actually are.
Many people are reluctant to take these medicines for various reasons. Some are afraid of side effects. Some do not want to acknowledge they might need medication due to the stigma. Others simply feel they want to try other options before taking this step. It is important to know that these medications tend to have few side effects. There are many different options if any negative effects happen. It is relatively safe to give it a try.
The best way to know whether medication is needed is to try psychotherapy first, and/or to work on doing the things that would normally help depression…particularly exercise. If you are unable to motivate yourself to do things differently, or if you force yourself and it doesn’t help, there is a good chance you are biologically depressed enough that you will need medication to alleviate the symptoms.
On the continuum of depression symptoms, I think there is a threshold (somewhere between moderate and severe depression) at which no amount of psychotherapy, or exercise, or any other behavioral changes will help. At some point, people are biologically depressed enough that their brain just needs medication, at least for a while.
So, if you have many depression symptoms (see my May post) and are not sure if you are at that threshold where you need medication, listen to that nagging voice inside about what would make you feel better. Are you beating yourself up for not exercising or eating healthier? Are you letting things around the house go undone? Or are you avoiding activities or people you usually care about? Start trying to address these issues. If you can’t get motivated to do things different consistently, or if you do and still feel down, apathetic or unmotivated, consider talking to a psychotherapist. And, to your doctor about antidepressant medication!
Next month: Psychotherapy for Depression