Medicine & Nursing Mental Health & Counseling

When to Medicate Depression

February 19, 2022

One of the more common queries that we receive concerns depression. Depression is real, raw, and miserable. To people suffering from depression, life can appear like a meaningless black hole, a hopeless endeavor, and in extreme forms, no longer worth living. Depression, like so many mental health maladies, operates on a continuum—this means the illness can range from mild transient types all the way to chronic and dangerous forms. 

Depression, according to one definition, is a medical condition that affects how you feel, the way you think, and how you act. Depression can cause feelings of sadness and produce a loss of interest in activities you once enjoyed. It often produces something called anhedonia, which is a loss of pleasure in everyday things. 

A requirement to effective treatment often requires an attempt to isolate the type of depression, which in turn helps to determine the disease course and better informs treatment. There are numerous forms of depression: one is major depressive disorder, sometimes known as clinical depression; another is persistent or chronic depression, sometimes called dysthymia. Other common types are post-partum depression, situational and circumstantial depression, seasonal affective disorder, and the profound cyclic depression associated with bipolar disorders. 

Those who have suffered from depression know that there is usually no easy fix for most types; they also know that treatment can be frustrating and time consuming. I run the risk of oversimplifying this complex subject, but in trying to assess the chances of medication helping you, I posit a few thoughts. 

When assessing a person suffering from depression with no immediate definable cause (such as a recent death in the family or obvious pathological issues from the past, for example) the following questions may help direct therapy and care. 

  1. Do you have an intact social structure that provides meaning? Do you have close family ties and multiple friend relationships?
  2. Is your religious structure intact; that is, do you find your spiritual life fulfilling and inspiring, giving room for life’s ups and downs?
  3. Do you have a meaningful career or work that you enjoy and find fulfilling? 
  4. Do you have any hobbies or useful things you enjoy doing in your spare time?

At the risk of overgeneralizing and simplifying a serious malady, these are fair questions to ask. In general, if any of these structures are dysfunctional, lacking, or absent, medication may not be as effective or may not help at all. In this case, begin to reach out beyond yourself to correct and repair the gaps in social structure. Recognize where the void is in your life and actively seek insight into your angst. Then assess its relationship to your depression from a holistic perspective, that is, spiritually, socially and personally. 

Another set of simple questions can further clarify the cause and type of depression. 

  1. What comprises your usual diet? 
  2. Are you sleeping well and getting enough of it? 
  3. Do you follow an exercise regimen? 

A recent case in point. A young lady in her mid 20s presented to us, saying she feels depressed and discouraged with life in general. She’s also had a focal headache for the last three weeks and is worried. Her primary care doctor has suggested an increased dose of antidepressants, blood work, and an MRI of her brain. These may all be appropriate interventions but a deeper look into her life produced the following information: the girl has not eaten properly in months and has subsisted on crackers and soda. She has no job. Her sleep patterns can only be described as scattershot, sleeping during the day, with screen time until early hours of the morning. She has no real intimate friendships and is living in an unstable relationship that has no future. Any semblance of spiritual life is nonexistent. 

The case study above may be somewhat extreme, but with this lifestyle, I would be surprised if she wasn’tdepressed. Now, if she has a clinical depression, there is a chance an increased dose of antidepressants would perhaps give her the energy and will to find a job. Ultimately however, in order to climb out of this hole, she will have to develop life habits that tend towards health instead of away from it and seek meaning through stable relationships and a career. For lasting effect, somewhere in this picture she will also need to connect with God. We are spiritual beings and ultimately healing and progress will require addressing this need. 

But back to individuals who have all these structures and aspects in place and are still depressed. For them an antidepressant may be just the thing. It’s worth a shot—take two or three months out of your life to give it a chance. The brain is extremely complex and functions through the complicated interplay of billions of neurons emitting neurotransmitters that control and direct our being. Not to mention the physiological fundamentals of oxygen and blood delivery. To say this can never go wrong is ludicrous. It’s actually more amazing that it works as well as it does! 

Once again, depression can be a serious malady. Sometimes the treatment is simpler than we think (simple does not mean easy). A brisk walk, adequate water intake, and healthy food may be just the ticket. Other times and in the right circumstances, medications can work wonders. 

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