By Ellen McGrath, published on April 1, 2002 - last reviewed on November 5, 2014
The need for antidepressant medication is widely misunderstood, not only by depressed people but by many around them. As a result, patients often fail to comply with the very regimen of drug treatment prescribed to relieve their suffering.
One reason for this very peculiar state of affairs is that taking medication for depression means defying centuries of cultural conditioning. Although depression appears to be a disorder of nerve signal transmission in the brain, the symptoms of the disorder are such that they have long been misread as a weakness of will.
Slipping on a straitjacket of simplistic logic, we come to believe that the disorder must, or at the very least should, be overcome by an application of willpower. To do otherwise is to acknowledge that you are defective.
In addition, we all harbor the core fantasy that we can handle things by ourselves. That includes even mastering mental illness. The sooner you can give up that fantasy around depression, the sooner a cure can occur.
In order to reap the benefits of drug treatment, patients have to do a major cognitive reframe—that is, they have to shift their own perspective. And that requires more knowledge of brain chemistry than most people have been exposed to. Here's what you need to do.
Update your data bank on what the antidepressant medications can and should do. Recognize why it is so hard to look neutrally at these drugs—they fly in the face of cultural conditioning.
If you understand what antidepressant medications do, you would understand the need to take them as prescribed. What the drugs essentially do is replenish brain chemicals depleted by stress or by genes, so that you have enough mood energy to take action.
Recognize when medication is appropriate. There are good general guidelines for considering the use of antidepressant drugs.
If you are undergoing psychotherapy, you should see significant improvement in your ability to function in about eight to 12 weeks. If you don't feel much improved in that time, consider a medical consultation to explore the possibility of adding drug treatment.
Consider medication immediately if you are unable to function in some area of living; for example, if you are unable to work or to sleep. Also consider medication immediately if you are thinking or talking about suicide, or if you are engaging in self-destructive behavior, like cutting yourself.
Antidepressant medication is also indicated if you have experienced a truly traumatic event and after one month you are not able to move along. Similarly, if you are in long-term counseling for any reason and after six months you still feel significantly burdened—even if the therapy is progressing—the therapy will go much faster if your psychic energy is supported with antidepressant agents.
And lastly, medication may be needed if you have had some major physical procedure like surgery, and especially open-heart surgery. It is a kind of severe physical trauma, and it has an impact on the brain. Depression is a common consequence of cardiac procedures.
Become the CEO of your own healthcare. After all, you know your body better than anyone. Being active in taking core responsibility for yourself is an important thrust towards recovery in depression.
You need to become a true participant in your medical care. You have to enter into a strategic partnership with your healthcare provider.
If you start having questions about drug side effects or dosage, don't hesitate to call your doctor. And don't stop until you reach the doctor.
You also need to handle your medications like a CEO. Among other things, that means evaluating them in terms of costs and benefits. You definitely need to educate yourself about the product(s) prescribed.
On the cost side, figure in the actual dollar cost of medication, the psychological stress of admitting vulnerability, the drug side effects, the cognitive challenge of taking the drug, and the memory task to remember to take it. On the plus side are improvements in mood, increased efficiency in work, improved ability to sleep, better control of appetite, and the dispelling of despair.
One aspect of being in charge of your own healthcare is to make sure that your doctors talk to one another. Check to see that the psychiatrist talks to the family doctor and to the psychotherapist.
Forge a partnership with a physician who trained in psychotherapeutic approaches. Don't just rely on a psychiatrist to talk unless he or she has been extensively trained in psychotherapy. Fixing depression long-term is a two-part strategy of medication and therapy.
Be aware that the medication used to treat depression can lose effectiveness over time. Your doctor can't predict how or why burnout occurs.
If suddenly you are finding that it is more difficult to get things done, or you are questioning yourself and your life, or despair creeps back, drug effects may be fading. In that case you need to go back into the system for a consultation.
Despite their imperfections, antidepressant drugs are 21st century miracles whichever way you look at them.