“Better to be on meds than dead.” The psychiatrist was talking about a mutual friend she believed was being improperly medicated. He was depressed and not feeling “right” on his medication, but the alternative was not to be considered. Without medication he was suicidal.

The Lancet has published a review of research concerning antidepressants, a meta-analysis, that indicates they are effective. The Royal College of Psychiatrists claims the study “finally puts to bed the controversy on anti-depressants. . . .  the study found they ranged from being a third more effective than a placebo to more than twice as effective.” Better than the sugar pill is better than nothing. Anything is better than dead.

Here’s what troubles me. Depression is about more than feeling bad. Until the creation of modern antidepressants, human beings experiencing sadness or even clinical depression, mostly recovered with or without treatment. From 1999 to 2014, use of antidepressants have increased by at least 65%. According the a report from the CDC referenced by Harvard Health Publishing, use of antidepressants has increased by 400% since 1988. At best, antidepressants have been found to be effective for 20% more patients than sugar pills, at worst, they are in a dead heat. Some are associated with greater risk of suicide.

During the same 1999 to 2014 period, suicide rates in the United States increased by 24%. If antidepressants were really effective, shouldn’t that rate of suicides go down instead of up?

There seems little doubt that medication is helpful for some mental illness, that medication allows people to function, and that people believe it has kept them alive. Likely it has. But physician Marcia Angell is not the only professional who asks the obvious questions about how we treat depression.

If antidepressant medication were effective in “curing” depression, why are 1 in 6 Americans on these drugs today? (One in four women my age and race.) Why have more than 2/3rds of them been on the medication for years? Is lifelong addiction to antidepressants the best answer for almost 17% of the US population? If antidepressants were entirely or even mostly effective, why is suicidal ideation one of the risk factors associated with taking them? (You’ve seen the commercial: “Speak to your doctor immediately if you experience suicidal thoughts . . .”)

“Americans are awash in pills. The use of antidepressants has increased 400 percent between 1988 and 2008. They’re now one of the three most-prescribed categories of drugs, coming in right after painkillers and cholesterol medications.” The Atlantic 

Are antidepressants another opioid-epidemic crisis in the making? Have we evolved as a species incapable of emotional stability without drugs?

Perhaps medication would be more effective if we also made lifestyle changes and were actively taught how to manage our psychic pain?

No one gets through life without suffering. The old lie about “every happy family is alike” conceals a bald truth: So-called “happy families” are either better at hiding their suffering or have learned to deal with it more effectively than you have.

They do more than take pills. They commit to all the more challenging behaviors known to help us feel better emotionally. They drink moderate amounts or no alcohol and avoid other drugs, limit or give up caffeine, take regular daily exercise, sleep 7-8 hours a night, stay off screen time as much as possible, they read positive novels, they stay in contact with other people, and they contribute to their communities.

Family members and many of my teenaged students are on antidepressants. They do not seem “fine” to me. Most consume a lot of caffeine or alcohol or marijuana, sleep badly, never exercise, focus primarily on themselves, and spend up to eight hours a day online. They are teenagers or unemployed—two life situations most people find “depressing.” The are lonely and sad and isolated and confused. They read dystopian novels and play violent video games. They believe they need their medication, but without addressing the health of their whole lives, they are not getting healthy. They are barely hanging on as if they were taking opioids for the pain but go right on walking on a broken leg without cast or crutches.

At the end, feeling good, doing well, and being healthy requires more than popping pills. It requires living. Part of therapy for depression should be helping us do what we resist—changing our behavior for the better.

a little sweet

Well, here’s my problem: A prominent author a editor declared that photo at top “depressing.” I find it beautiful—maybe that’s because I am chronically depressed?