I remember, before trying medication, I was terrified of it. I had the same misconceptions that many people do:
- Medication is for weak people
- Antidepressants are just “happy drugs” designed for people who can’t handle life
- Medication will ruin your brain
- Doctors give out antidepressants like candy whether you need them or not
As it turns out, none of these things are true, but they sure seemed true at the time.
So I get fear of antidepressants and other medication. Psych medication is scary stuff.
But sometimes you have to face that fear in order to get better.
Antidepressants Don’t Work
There seems to be two fears among people who are considering antidepressants: antidepressants don’t do anything or antidepressants do too much. I understand both fears.
First of all, yes, antidepressants do work to treat depression, particularly moderate-to-severe depression. While many people will not be successfully treated by their first antidepressant the vast majority of people will be helped by a following antidepressant. So if the first one doesn’t work, don’t give up hope.
And as far as efficacy goes, there was a recent meta-analysis that indicates that antidepressants are about as effective as other medication used for internal medicine.
Antidepressants Harm You
I can understand this fear. Many people speak of psychiatric medication in very negative terms but it doesn’t have to be this way. In fact, most people use psychiatric medication for a time, and then get off of it and never say a thing about it because they don’t want anyone to know. That is the common experience – nothing of great interest to report.
Because properly used, antidepressants can be effective with minimal side effects. Yes, some people are harder to treat than others and those patients who are harder to treat may require more medication and that ups the side effects, but most aren’t in that group. Many people can take one medication, in a normal dosage range, and get better.
And, to the best of my knowledge, there is no side effect of antidepressants that continues after you stop taking the drug. In other words, if a side effect develops with which you can’t live, you can always reduce the dose or get off the drug entirely.
[Update: one reader reminded me that there are additional risks, including mania, associated with treating people with bipolar disorder with antidepressants. Not all doctors agree on this but I have written about the controversy here. See about the dangers of misdiagnosis here.]
Black Box Warning
One commenter mentioned the black box warning on antidepressants and I wanted to briefly address it. A black box warning is the most strong warning that the Food and Drug Administration (FDA) can place on a product and they did so because there were reports of people, possibly, getting increased symptoms on antidepressants and reports of people taking their own lives. The FDA, rightly, did not want to wait for all the data to come in on this situation and so they placed a warning on all antidepressants.
I can say that some have found the data does not support the fact that there is an increased risk of suicide in adults when compared to those who have not been treated and their risk of suicide. That being said, antidepressants can cause side effects in people that may agitate them or worsen their condition and the final result may be suicide so it’s important when starting antidepressants to be closely monitored by a healthcare professional.
(It’s important to note this warning is especially important for those under the age of 18.)
All that being said, it still takes a leap of faith to try something new, especially something scary like putting a medication into your body, so it’s all about the pros and cons. Are the possible pros of taking the medication work the possible cons? How sick are you today? Have you tried other treatments? Are you in therapy? Have you attempted suicide? What will happen if you choose not to get treatment?
And one of the best ways I know to combat these worries is to have a doctor you trust with whom to discuss you fears. You absolutely have a right to be scared and it’s a reasonable thing to feel but sooner or later you’re going to have to make a decision and I would recommend that you let facts guide that decision and not fear.
[As an aside, regardless as to whether you feel antidepressants are for you, every person with depression should try therapy, particularly cognitive behavioural therapy, as that can help many people.]