Why Aren’t Lifestyle Changes Frontline Treatment for Depression?
Many people complain about overmedication. They lament that the first thing doctors do is prescribe a medication for depression or another mental illness rather than suggest lifestyle changes like exercise and meditation.
This is often true. Doctors, including psychiatrists, often prescribe medication over suggesting lifestyle changes when a mental illness like depression is diagnosed.
And that’s a completely reasonable thing to do.
Mental Illness Diagnosis
When someone gets a mental illness diagnosis, it’s because they are very ill. No one goes to the doctor when they’re not ill. No one goes to the doctor because they’re having a bad day. People go to the doctor because they need help. Not need-help-in-a-little-while, but need help now.
Yup, I know people don’t want to believe that, but for a severe mental illness, we know that’s what works. Or, at least, we know it works better than anything else of which we know.
The Mentally Ill and Major Lifestyle Changes
Typically when people are mentally ill, they are not capable of making major life changes. People with severe depression can’t even get themselves out of bed to take a shower let alone ensure a quality diet and exercise program – if that could even help, were they capable of doing it. In fact, going to the doctor, getting a prescription filled and taking medication is enough of a battle for severely ill people.
It’s not reasonable for them to leave a doctor’s office with a “prescription” for kale, sunshine and park-walking. Because it just won’t happen. And it probably won’t work.
And then that severely ill person? They could die. Yes. Die.
In fact, most people who attempt suicide have seen their doctor within seven days of their suicide attempt. Many people within 24 hours of their suicide attempt. Doctors are aware of these statistics. They know the dangers of letting a severely ill person out of their office without offering them real help.
And how would you like death on your hands after suggesting a person take up jogging?
This is why I recommend that people try alternative treatment with medication (and therapy). Because if the person successfully stabilizes, they can taper off the medication if they so choose. If they feel whatever lifestyle changes they’ve made have helped their illness to the point where they no longer need the medication, they can get off of it. It’s not really rocket science.
American College of Physicians Recommendations
And for the record, the American College of Physicians (ACP)recommends the use of antidepressants in the treatment of depressive disorders. The ACP then recommends the treatment be altered if the patient does not show a positive response to therapy in 6-8 weeks. Further, once the patient shows an adequate response to antidepressants, the ACP recommends continuing the therapy for 4-9 months if it is the first episode of depression.
In other words, in those without a longstanding mental illness, antidepressants are a temporary treatment. And many people have had depression and used antidepressants in just this way.
A Note on Exercise for Depression
There was a study not too long ago that showed that an exercise program for depression could be as effective as an antidepressant in some cases of depression. This is still a questionable finding. It’s worth noting, however, that no long-term benefit was noted in exercise study participants upon follow-up.
It is for these reasons that exercise is not considered a treatment of depression.
Frontline Treatment of Depression is Medication for a Reason
So while lifestyle factors can impact depression, sometimes dramatically, they are not a frontline treatment because medication works better, overall, in the treatment of mental illness.
By erring on the side of medication, you run the risk of overmedicating people. By erring on the side of non-medication you run the risk of killing people. One of these things can be corrected, the other cannot.
*Technically, electroconvulsive therapy is the most effective treatment for depression; however, it is not a frontline treatment for a host of reasons.
**And psychotherapy but that is not the focus of this article. Therapy is also a frontline treatment but is often not chosen due to cost to the patient.