Depression really sucks. Everybody has times where they feel down, when they are sad, or feel bummed out about something that happened. That’s not the kind of depression that I’m talking about. I’m talking about full-on clinical depression. People who have not experienced what clinical depression feels like don’t understand. Psychology as a field did a really stupid thing by calling it depression. Using the word depression to describe the clinical state just makes it confusing and hard for other people to know how to best support you.
Clinical depression is not something that you have any kind of control over, something you can snap out of. Clinical depression is caused by an imbalance of the chemicals in your brain, neurotransmitters. Therapy can help by teaching you coping skills to deal with what you’re experiencing, but often it’s not enough. That’s where medications come in. I am not pro-medication, but I’m also not anti-medication. There are times that people get misdiagnosed and end up on meds (see PTSD tab), but there are times when people need to be on meds because their depression is actually a physical disease. Not treating clinical depression with medication is like not treating diabetes with insulin.
I think of it like you’ve fallen into a deep, deep hole and no matter what you do, how hard you try, you can’t get out. Medications used properly raise the bottom of the hole so that you can get your shoulders out and pull yourself up the rest of the way. They are an important and sometimes necessary adjunct to psychotherapy.
Once medications are started, it is critical that they be taken as directed and for as long as is recommended by the prescribing doctor. I tell my clients they should be stable for 6 months before they begin to think of going off of the meds. The good news is that by following directions and being willing to give the medications time to work, often the medications can be discontinued without there being a loss of benefit.
When people start medications they usually feel better after a few weeks. What commonly happens is that once they start to feel better, they decide they didn’t need the medications after all, and stop taking them. Just like it takes time for medications to build up in the system, it takes time for the medications to fully leave the system. Their experience is they stop the medications and then feel fine, which continues for a while. And when their symptoms do return, they’re faced with waiting for the meds to kick in again to feel better. By not staying on the medications until they get stable, the experience becomes like a roller coaster that sucks emotionally and can really screw up your brain.
Sometimes people don’t follow through with medications because of side effects. Most side effects from psychiatric medications go away within the first 2 to 3 weeks. Sometimes they’re just not tolerable and that is when they must return to their prescribing doctor and work with them until the balance is right. As a therapist I cannot prescribe medications myself. If together we decide medications are necessary, I will help you find the right doctor.