Will Medication Help?
When people come to me for depression treatment, many of them are taking an antidepressant medication prescribed by a psychiatrist or a primary care physician. Often I will have people ask me whether they should take one of these medications. Will it help with my depression? Will it make it go away?
In my practice, I have seen people experience some relief from depression by taking medication. For some this relief is significant; for others it is slight. Others have experienced little or no change in their mood. Some experience relief but don’t like the way the medication makes them feel. Some are eager to try these medications; other have some reservations. I do not prescribe medications, but since I work with lots of clients who take them and ask about them, I offer these comments and reflections.
In order to address an illness, it is important that the theory of what causes the illness is correct. Right now, in terms of mental illness, the dominant theory is the chemical imbalance theory. This theory suggests that depression and other mental disorders are caused by chemical imbalances in the brain: low levels of serotonin, abnormal levels of dopamine, and other imbalances. The purpose of taking an antidepressant medication is to address this imbalance. Once the imbalance is restored, the depression will lift.
Limits of Medication
There are some limits to this theory. First of all, there is no way to measure the level of neurochemicals in a living brain, which suggests it is difficult to know what a correct or incorrect balance of these neurochemicals is. Second, the theory doesn’t explain how the chemical became imbalanced. With depression, for example, could the drop in serotonin level be a random occurrence, or is there some other explanation? If some other factor is causing the drop in serotonin, that would be the real cause of the depression and needs to be addressed, not just boosting serotonin. Finally there are many studies where researchers try to measure levels of serotonin, and they find no evidence of chemical imbalance. There really isn’t consistent evidence from research that depressed people have lower levels of serotonin in the brain than no-depressed people.
Some of these limits may explain why the effectiveness of these medications can vary. I am not suggesting that antidepressant medication does not work. But I do question if the chemical imbalance theory is the only explanation for depression. When one theory is accepted as the cause for a problem, other approaches can be excluded. So from the chemical imbalance perspective, the only solution to the emotional struggles that you are experiencing with depression is to take the medication.
But what if there are other theories about where depression comes from. For example, the Psychological Injury (PI) theory states that a source of mental health problems is when a person experiences a psychological injury. This injury could come from neglect, abuse, trauma, or stressful life events. This PI theory may sound like psychological common sense, but it is based on extensive research. This research looks at specific types of psychological injury: childhood trauma, adult trauma, stressful life-events. The findings suggest that people who have these psychological injuries have a significantly increased chance of depression. If, then, there is a good chance that depression comes from PI, then medication may not be solution.
How Counseling Can Help
This is where counseling enters the picture, because counseling has been proven to be effective treating a variety of psychological injuries. Again, you have a right to choose what your healing will look like. And while medication is one possibility, three times as many people want to go to therapy as take medication. You may be one of those. You may want to talk with someone, not just take a pill. The research suggest that therapy can be a resource for healing.
When people ask me about medication, I tell them that antidepressant medication can certainly level off their mood. I also go on to say that there is no “change the way your thinking” or “look at the world a different way” pill. Stabilizing your mood can help you make the changes in thinking and perception that will help with your depression. And those changes in thinking and perception are what therapy is all about.
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