Depression
is a feeling of impending doom or hopelessness.
When multiple symptoms are found to persist for long periods of time,
one may be diagnosed with major depressive disorder. Other forms of depression
may be mild or temporary. Dr. J. Michael Bostwick, M.D., an expert in
Psychiatry at Cambridge Hospital, points out that mild depression occurs throughout
the normal course of life when, for example, someone experiences a death of a
family member, has trouble adjusting to a new environment, or suffers from
dysthymia (538). Antidepressants are usually the first line of defense used to
treat depression and are sometimes found to be necessary, but they have become
far too accessible. Antidepressants should not be considered the cure-all
solution for all forms of depression because there are many more beneficial
alternative forms of treatment with less unwanted side-effects.
Antidepressants
are medications used to reduce the effects of depression. Dr. Morgan Sammons,
PhD, who is currently the dean for the California School of Professional
Psychology at Alliant International University, observes that the rate of suicides
has decreased since antidepressant use has become widespread (327). In many
cases of major depressive disorder, changing the chemistry of the brain through
the use of medicine appears to be the best solution. George Sims, a journalist
from Countryside Magazine, swears
that antidepressants were the only solutions to his problems (101). Dr. Jeffrey
C. Danco, PsyD, a clinical psychologist, found that in 1998, over 60 million
prescriptions were written for Prozac, Zoloft and Paxil (10). More recent statistics
show that antidepressants have become the most popular pharmaceutical, with 118
million prescriptions in 2005 (Danco 10). There is undoubtedly great benefit
found in the use of antidepressants for the treatment of some forms of
depression.
There
are, however, many side-effects to using antidepressants including drowsiness,
dry mouth, nervousness, anxiety, insomnia, decreased appetite, nausea,
headaches, long-term weight gain, cognitive impairment and decreased ability to
function sexually (Bostwick 543). These side-effects fall into two basic
categories: short-term and long-term. Short-term effects can be felt during the
first few weeks of use and before the antidepressant starts to relieve the
depression, while long-term effects are felt later and once the depression
starts to subside.
With
most antidepressants, people may experience nausea or a dull headache during
the first few weeks (Bostwick 543). Bupropion can cause jitteriness and
fluoxetine can cause nervousness, anxiety, agitation, insomnia, low energy, and
fatigue (Bostwick 543). These early side-effects sometimes discourage the
continued use of antidepressants. Sleep may also become a problem and the
patient may be prescribed a benzodiazepine to assist, which can be very
addictive (Bostwick 544).
As the
antidepressant effects start to be felt, patients can lose control of their
sexual functioning; thus upsetting the patient and sometimes discouraging the
continued use of the antidepressant (Bostwick 453). Weight gain can later show
up as eating or exercise patterns change (Bostwick 453). Since the loss of
sexual function and weight gain can sometimes be the causes of depression
itself, these effects ironically act against the antidepressant. This may be
part of the reason that stopping the medication can become more difficult in
the future. Tiffany Kary, a journalist for Psychology
Today, explains how withdrawal from antidepressants is sometimes nearly
impossible, causing confusion, vomiting, and suicidal impulses (15).
Also,
one has to question the placebo effect of antidepressants in treating
depression. People suffering from depression usually feel that they are out of
control of their own life and that drugs will sometimes give them the sense of
control they are lacking (Danco 11). Sometimes people will start to feel better
before the first antidepressant has even been swallowed just because they think
they will feel better (Danco 13). Because the side-effects of antidepressants
are so great, patients can not doubt the power of the medication and that power
is sometimes mistaken to be treating the depression (Danco 13).
With
all the adverse effects of antidepressants, one would assume that prescribing
antidepressants would be handled with great care; however, caregivers will
often reflexively prescribe them at the first sign of any mild depression. Instead,
they should more accurately diagnose patients to be sure they are in need of
antidepressants. They should first consider alternative forms of treatment
including watchful waiting and psychotherapy. They should prescribe
antidepressants when they are absolutely sure that other forms of treatment
will not work.
Watchful
waiting simply involves frequent visits with face-to-face contact to assess
whether depression symptoms have resolved or more aggressive treatment is needed
(Bostwick 539). According to the article, “Watchful waiting just as effective, less costly than newer
antipsychotics for AD”, watchful waiting has been used effectively as a
method of treatment for other illnesses such as Alzheimer’s disease and certain
types of cancer (5). Watchful waiting is a very good solution if there is a
diagnosis of mild or temporary depression or if the diagnosis is unclear. The
patient should be carefully observed over a period of "4-to-8 weeks"
(Bostwick 539). If, however, the condition of the patient does not improve or
worsens, other forms of treatment should be considered.
Psychotherapy
should be considered as one of the first forms of treatment for depression.
During psychotherapy, a person suffering from depression will discuss the
factors that may be causing the depression with a trained mental health care
professional. The goal of psychotherapy is to uncover the root of the
depression and discuss it openly. If behaviors and emotions contributing to
depression are better understood, the chance for behavior modification or
problem solving is much greater. Therapy techniques include cognitive behavior
therapy, behavioral activation treatment, psychodynamic approaches,
problem-solving therapy, interpersonal psychotherapy, and social skills
training. Patients will learn, through therapy, to eventually cope with their
depression and in some cases remove the factors causing it.
One
study, conducted by Christopher F. Sharpley, PhD, shows that psychotherapy can
biologically rewire the brain (603). The reward section of the limbic system is
usually affected the most from depression (Sharpley 604). Some brain structure
differences tend to be common in patients suffering from depression (Sharpley
604). The amygdala, for example, usually appears to be larger in volume while
the hippocampus appears to be smaller. Psychotherapy has been found to
reestablish limbic circuitry balance and cause the same measurements seen in
those not suffering from depression (Sharpley 607).
However,
psychotherapy takes extra effort by both the patient and the caregiver. For it
to be of any benefit, the depressive patient must have an ability to work in a
relationship absent serious regression or withdrawal (Ahola et al. 357). Unfortunately,
depression is known for affective blunting that can seriously hamper the
development of a workable treatment relationship (Ahola et al. 357). By
starting with psychotherapy, patients are avoiding the unwanted side-effects of
antidepressants while the caregiver can monitor the depression. The mental
health professional can accurately diagnose the patient over time to determine
if other forms of treatment are required, including antidepressants.
Proper
diagnosis is extremely important in determining whether someone is in need of
antidepressants. In a sample of 100 patients, 10 patients with depression will
be correctly identified, 10 will be missed, and 15 patients who are not
depressed will be falsely given the diagnosis (Bostwick 540). One of the main
problems with diagnosis of depression is that primary care physicians are
responsible for more than 75% of them (Bostwick 540). Given that depression is
a mental illness, better diagnoses would come from referring depressed patients
to mental health professionals.
To be
diagnosed with major depressive disorder, a patient must exhibit a depressed
mood or depressed pleasure as well as a substantial social or occupational
impairment (Bostwick 539). Also, the patient must have four of the following
symptoms: weight loss or weight gain, insomnia or hypersomnia, psychomotor
agitation or retardation, fatigue or reduced energy, preoccupation with
feelings of worthlessness or guilt, poor concentration or indecisiveness, or
morbid or suicidal thoughts. These symptoms must last for at least two weeks
(Bostwick 539). Patients experiencing symptoms less than these may be diagnosed
with a mild depression and should not reflexively be prescribed an
antidepressant.
With
the right mix of medication, watchful waiting, and psychotherapy, people
suffering from depression can become psychologically stable and live fulfilled
lives. There are many side-effects from antidepressants and there are times
when antidepressants can be the only solution. Watchful waiting is sometimes a
way to monitor a patient while trying to diagnose accurately and waiting for
the problem to go away. Psychotherapy can provide biological benefits as well
as teaching the patient to better cope with depression. Psychotherapy takes
effort by both the patient and the caregiver and is not as easy as the
prescription of medication. We cannot
abandon antidepressants entirely as they do have their use and can be
considered a good solution in many cases; however, with a little extra effort
on part of the caregiver and the patient, other forms of treatment can be far
more beneficial.
Works
Cited
Ahola, Pasi, et al. “The
Patient-Therapist Interaction and the Recognition of Affects during the Process
of Psychodynamic Psychotherapy for Depression.” American Journal of
Psychotherapy 65.4 (2011): 355-379. Print
Bostwick, J. Michael. “A Generalist’s
Guide to Treating Patients with Depression With an Emphasis on Using Side
Effects to Tailor Antidepressant Therapy.” Mayo Clinic Proceedings 85.6 (2010):
538-550. Print
Danco, Jeffrey C. “Why Psychiatric Drugs
Work: The Attribution of Positive Effects Due to Psychological Factors.”
Ethical Human Psychology and Psychiatry 10.1 (2008): 11-15. Print
Kary, Tiffany. “Are Antidepressants
Addictive?” Psychology Today 36.4 (2003): 15. Print
Sammons, Morgan T. “Writing a Wrong:
Factors Influencing the Overprescription of Antidepressants to Youth.”
Professional Psychology: Research and Practice 40.4 (2009): 327-329. Print
Sharpley, Christopher F. “A review of the
neurobiological effects of psychotherapy for depression.” Theory, Research
& Practice 47.4 (2010): 603-615. Print
Sims, George. “Depression: a leaf with no
color.” Countryside & Small Stock Journal 95.5 (2011): 98-101. Print
“Watchful waiting just as effective, less
costly than newer antipsychotics for AD.” Brown University Geriatric
Psychopharmacology Update 12.2 (2008): 1-6. Print
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