Resolution, Not Conflict

The guide to problem-solving.

The Blues Is Depression. Should You Treat It With Pills?

Here's the downsides of meds, and good news about alternative treatments.
Allen Frances, M.D.
This post is a response to Antidepressant Use Skyrockets by Allen J. Frances, M.D.

Anti-depressant medications risk creating more problems.
Anti-depressant medications risk creating more problems.
What people refer to as the blues is usually depression.  Depression, or the blues, is an unpleasant emotional state characterized by what therapists refer to as "the negative cognitive triad."  That's 1) negative thoughts about oneself, 2) negative t houghts about others and 3) negative thoughts about the future. 

Some people describe the blues, and also depression, as feeling like there's a dark cloud over you.  Others refer to depression as seeing the world through dark glasses.  Feelings of hopelessness and helplessness are another indicator.  

Why do people take antidepressant medications? 

There's four main reasons why people who may be distressed by something in their lives end up defining their depression as an illness and then taking medication instead of addressing the life problem that triggered their depressed feelings.  

First and foremost, depression is a terrible feeling that sufferers sorely want to get rid of. 

Second, most folks have not been fully informed of the medications' downsides. I'll elaborate on drug dependency below.  In addition, these medications can cause serious weight gain, a significant drop in libido (ability to enjoy sex), hazy thinking, and a general emotional numbness that blocks feelings of joy in addition to feelings of depression.

Third, people who take the medications may not have been informed of their relatively low rate of effectiveness.  They can be effective if they work, but they only work for something like about 60% of people who use them. 

Lastly, most people who take anti-depressant medications have not been informed by their doctor about alternative treatment options.  To a man with a hammer the world is a nail.  Physicians know about illness and proscribe medications.  Yet, as psychologist Martin Seligman has explained, depression is a relatively  normal, if quite unpleasant and often self-defeating, response of giving up in response to a challenging life circumstance. 

What are the downsides of assuming that depression is an illness and therefore needs pills? 

Two particularly negative side effects of medication that doctors generally do not sufficiently explain include potential weight gain and decreases in ability to experience sexual arousal. Doctors may mention them but often do not clarify that both extra pounds and decreased interest in sex can have strongly negative impacts on personal self-esteem, on attracting a mate and on sustaining a marriage.

The other significant risk that doctors may or not fully explain is that users will have a hard time getting off these medications.  When a drug company says that their anti-depressant medication is not addictive, strictly speaking they are telling the truth.  A strict clinical definition of an addictive substance or activity is one that induces both dependency and craving.  Antidepressants do not induce craving.  Over time they definitely do, however, make users drug dependent.

Craving is a familiar feeling to anyone who has fallen in love.  The intense sexual desire that drives someone in love to find every way possible to be near the object of their desire is a craving.  Someone who craves alcohol similarly may wake up in the morning already urgently wanting a drink.

What does "drug dependent" mean?   Drug dependency is the state a body goes into when it has adapted to the presence of a chemical to the point that the body requires steady doses of the substance in order to maintain normal functioning. 

Our society for instance is highway-dependent.  Many of us have become accustomed to having highways that enable us to drive to work from the suburbs.  Having bought a house in the suburts on the assumption that we can take the highway to work, we have become highway dependent.  It's unlikely that anyone has a craving for highways.  Many of us though have become highway dependent.

If you for some time have been taking an antidepressant medication, odds are that your body has become drug dependent.  That means that if you should decide today that as of tomorrow you will no longer take the medication, starting tomorrow you are likely to discover that without the pills you normally take your body will plunge into a serious depressive state. 

Does this depression mean that you really need after all to stay on your meds because the pills are all that have stood between you and the depths of despair?   Not at all.  To the contrary, this depression means that your body has become dependent on the antidepressant pills.  Is this addiction?  No, but it definitely is drug dependency.

I am not saying that no one should ever take antidepressant medication.  They do help some people, and sometimes with relatively few negative side effects.  My point is just that if you are considering taking these medications, or have for some time been using them, you deserve accurate information about the factors to take into account in your decision.

Here's six vital points to consider.

1) There are other excellent alternatives to medication for working your way out of depression, including various kinds of talk therapies, energy therapies such as Bradley Nelson's Emotion Code and Body Code, acupuncture, exercise, the visualization you can download for free from my website, or read about how to do on one of my other blogposts, couples therapy, and more.

2) Depression is generally induced by a situation in which you have experienced insufficient power. If you close your eyes and picture whom or what you may feel angry at, you will generally see an image of the trigger person or situation. Fix that situation and your depression will be likely to go away. (See my book From Conflict to Resolution  or my audio Depression, A Disorder of Power for a full explanation of this theory of depressive reactions).

3) If your doctor is recommending medication as a short term fix, use the pills until you feel better. Use your renewed energy to address the power-loss situation. Then begin the medication-weaning process asap.

4) Wean slowly. Consult your prescribing doctor for an appropriate weaning schedule for the particular medication that you are taking.

5) Be aware that research has shown that the most powerful way to overcome depression and keep it far from you in the long run is the combination of therapy and medication. Medication alone and psychotherapy alone have very similar effectiveness rates, but medication has an impact more quickly, and psychotherapy tends to have more longer-lasting impacts. 

6) There is a visualization exercise that you can do with a therapist, a friend, or on your own that may help you conquor the depression in just a few minutes.  See my posting on A New Treatment for Depression.

6) In my clinical experience I find that most depression is a response to relationship problems. Look into marriage education, couples counseling, or a combination of both to upgrade your relationship. These treatment routes can make you a double winner.  You can both end the depression and simultaneously gain a vastly more gratifying marriage or romantic partnership.


Susan Heitler, PhD, a Denver Clinical psychologist, is author of multiple publications including From Conflict to Resolution for therapists and The Power of Two  for couples.  A graduate of Harvard and NYU, Dr. Heitler's most recent project is a fun interactive website that teaches the skills for marriage success,



Susan Heitler, Ph.D., is the author of many books, including From Conflict to Resolution and The Power of Two. She is a graduate of Harvard University and New York University.


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