Illustration by Michael Burmesch
Pills with dollar signs
In recent years, the use of antidepressant medications has soared in the United States. At any time, roughly 18% of women and 9% of men use these drugs, a far greater number than just a few decades past. The pandemic hasn’t helped, as overall prescriptions for these psychotropics rose by almost 9% since it began, while the number of adolescents taking these medications has soared by a whopping 41%. Why so many? Most of these folks are simply trying to improve the quality of their lives by reducing emotional suffering. And most of them have been told by big pharma that these pills will do the trick. But do they?
Not long ago, the use of these drugs was largely confined to folks with major depressive disorder, meaning those with debilitating depression (think can’t get out of bed). Today, these concoctions are applied to a wide array of mental health conditions including anxiety, obsessive-compulsive disorder, PTSD and a host of others. The operating premise is that depression is caused by neurochemical imbalances in the brain, but this theory remains just that . . . a theory.
Do they work? Researchers have probed that question for years. The initial studies on their efficacy, largely funded by the pharmaceutical industry, characterized these drugs as game changers. However, subsequent research challenged this rosy picture. In fact, there is evidence big pharma practiced its own version of confirmation bias by emphasizing favorable outcome studies while downplaying others showing limited benefit. A recent, large-scale review comparing depressed folks who use antidepressants with those similarly afflicted who do not found minimal differences in quality of life between the two groups.
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Garden Variety Blues
What’s more, there is growing evidence that using these medications to treat mild to moderate melancholy is no more effective than placebo, the proverbial sugar pill. Regular exercise, particularly cardio, appears more beneficial than a pharmaceutical approach, except when it comes to severe depression. Translation? Those suffering garden-variety blues may be better served by lifestyle changes rather than popping these pills, while those severely depressed should seriously consider taking them.
Another fly in the ointment is that the original research on antidepressant effectiveness and safety focused on short to moderate term use. Most folks, however, take these drugs for years, even decades. In part, this reflects the allure of the medicinal approach. After all, how much effort is required to swallow a pill versus hitting the gym, optimizing nutrition and practicing good self-care? But this “quick and easy” approach often falls short. Antidepressants take weeks to kick in, often come with side effects, and can be difficult to get off. What’s more, there’s no way to know in advance if the chosen variety will prove helpful, so it’s primarily trial and error, and, too often, just plain error.
On the provider side, big pharma has made huge profits off these medications, which they openly advertise to healthcare consumers. Their feel-good messaging suggests that even mild and temporary emotional downturns are reason enough to take antidepressants. The implication is that being upbeat and well-adjusted is the normal condition of Homo sapiens, and if you don’t feel that way, well, we have a pill for that. But emotional suffering is an inescapable part of existence, so learning to rely more on one’s own efforts and agency to address it constitutes a vital life skill.
Don’t get me wrong. I am not anti-medication. In my practice, I’ve seen many seriously depressed folks benefit from a course of antidepressants. However, I’ve also witnessed many with mild to moderate melancholy who turned things around without these drugs. Interestingly, the preponderance of research in this area suggests pairing antidepressants with psychotherapy yields better outcomes than the medications alone, leaving open the question of which has the greater influence. If one wants to address depression without hitting the pharmacy, the best combination appears to be exercise (cardio is optimal), psychotherapy, nature time and an anti-inflammatory diet.
