The Truth About Antidepressants from a Psychiatrist
Updated: Aug 14, 2020
I am really pleased to have the opportunity to talk about antidepressants. I know from my practice that these medications are safe and can be life changing. It is so gratifying to hear people describe that being on medication is like being handed the glasses you never knew you needed and seeing the world clearly for the first time. Or that they didn’t even realize they were wearing shoes that were one size too small for the past year and yes, they were walking, but there was this constant background discomfort permeating their days and being on antidepressants feel like they are now in the right size shoes.
To be clear- the decision to take antidepressants isn’t a small one and should be discussed with a psychiatrist who is really listening to your concerns and answering all your questions. Most of my patients do come to see me when they want to hear their options regarding medications. By that time, they have tried talk therapy or lifestyle changes such as exercise that are known to be good for mood and those things were just not working to adequately relieve depression. Antidepressants do not take the place of therapy and a healthy lifestyle, they compliment those things. Mental wellness is rarely achieved and maintained with just one thing.
Antidepressants and anxiolytics or anti-anxiety medications are two different things and I don’t want to conflate the two because they are not at all the same and have different mechanisms of actions.
What I will say is that many people in the field including myself feel that almost always anxiety and depression is one thing. Anxiety is a symptom of depression. Some people have anxiety, prominent depression, some people have extreme anger or sometimes even emotional numbness as a symptom but underneath all of these is the same thing. The root of the problem is depression. So, I never take the approach of just treating the anxiety. I aim to treat the source of the symptom.
What I will say is that anxiety is extremely uncomfortable. It is a misfiring of your fight or flight system which has the sole purpose of keeping you alive. When your life is in danger, you are of course extremely uncomfortable. Think of the discomfort of running out of oxygen or going a day without water. Now those are biological discomforts but it also sets off psychological panic. Some people live with that level of background alarm in their lives for months or even years at a time. It’s a very uncomfortable way to live. Your brain doesn’t know that your boss yelling at you doesn’t actually put your life in jeopardy so you have all the same biological responses associated with being chased by a lion when your boss yells at you.
So, yes, sometimes I see a patient who is presenting for the worst symptom that they have which is anxiety but I don’t “spot treat.” As in, I wouldn’t give my patient a medication for anxiety, something to help them sleep, and then a stimulant to help them focus and maybe another thing to stop their emotional eating when all of those things are symptoms of depression. The best analogy I can think of is if you have a fever that is caused by a bacterial infection. Now, you can take Tylenol to address the fever every day but the best and most logical approach is to take an antibiotic to treat the infection and that is how I see antidepressants. It treats the root of all of those symptoms.