Pills alone are not the cure for depression

A Wave reader in Ocean View writes:

Dear Dr. Hurd:

I have been down and depressed for a while now. My doctor prescribed medication for the problem, and says my depression is a disease. But I feel that I have an emotional problem, not a medical one. I’m confused. Is depression physical or mental?


Dear Reader:

Depression is a condition usually characterized by some combination of the following symptoms: low energy, low self-worth, a pervasive sense of hopelessness, sleep disruption, increased or decreased appetite, physical lethargy, and just plain negative thinking.

Although some of the signs of depression can be physical, it is impossible to apply the label “depression” without the presence of negative feelings within the person suffering from it. Depressed people feel depressed, regardless of what causes the feelings.

These negative feelings are not always the result of mistaken ideas or an overactive imagination. For example, a parent whose child dies in a terrible accident will experience symptoms of depression, clearly derived from the observation and experience of objective reality.

A depressed person is not ‘crazy;’ he just feels more despondent than there’s reason to feel. Depressed people tend to jump to conclusions and form negative outlooks about people and situations around them. For example, a man might hastily conclude that an argument with his wife means they are no longer in love and that they will break up in the near future. Or, an adolescent might overgeneralize a rejection by a potential romantic interest to mean that he is never going to find a girlfriend. In some individuals, poor thinking habits, such as hasty conclusions or unfounded generalizations can, over time, lead to disorders such as clinical depression.

In more serious cases, depression signifies the psychological consequence of thinking and acting in self-defeating ways, day after day, year after year, decade after decade. The most common example, in my experience, is the mistaken notion that we should sacrifice our personal happiness and well-being for the sake of others. For example, a young woman caught up in such thinking might sense (perhaps correctly) that her parents are having marital problems that get worse when she first goes away to college. Torn between her long-time goal of pursuing an academic career, and her need to emotionally support her parents, she drops out of school to be with them. After several weeks of this, she is, not surprisingly, listless, resentful, and depressed. And no wonder! She sacrificed her happiness and, quite possibly, her future success, for the sake of her parents—when they should be solving their own problems.

A therapist or counselor who understands the impact that self-defeating thoughts have on behavior and emotions can help this young woman get better. Prescriptions and pills won’t change the basis for her outlook or her behaviors. Other than dulling her perceptions and sensations, no amount of medical treatment, not even state-of-the-art antidepressant medications, can permanently, by themselves, relieve the causes of this young woman’s depression. To really change and get well, she must come to understand the futility and self-destructiveness of what she’s doing.

Although depression always involves a psychological, as opposed to a physiological (medical) component, considerable evidence does exist to suggest that antidepressant medications such as Prozac, Paxil and all the others can bring a certain degree of relief to depressed persons—as long as they continue to take the drug. In my own practice, I typically do not refer individuals for antidepressant medication unless: (a) their problem is so prolonged and severe that psychotherapy alone will not be enough, and, (b) they clearly understand that antidepressant medication will not solve their cognitive problems for them. (‘Cognitive’ refers to the process of reasoning, memory, judgment and comprehension, as opposed to purely emotional processes.) Self-generated, therapeutic work, both in and out of the therapy office, remains an absolute requirement for improvement. I tell them, metaphorically, that if the antidepressant works, they will be swimming with the current instead of against the current, but, either way, they still need to swim, on their own, with the therapist as their coach.

Philosophically, man is, at the same time, both mind and body. Cognitive psychotherapists help people figure out where they went wrong in their thinking and actions, and how they can become less self-defeating and more positive in their outlooks. But it is also reasonable to assume, especially with today’s expanding knowledge of brain function, that certain physical conditions can coexist and interact with the psychological state of depression.

Unless a person’s condition is so debilitating that they cannot even get out of bed or leave the house, I suggest trying therapy and behavioral change first. Get a therapist to help you and coach you along. Though the great majority of medical doctors are, no doubt, genuine in their desire to solve your problems, medication should not be the knee-jerk reaction to the symptoms of depression. It should be the last resort.