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.
And what do we know helps? Medication.* Antidepressants.**
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?
Alternative Treatments Alongside Medication
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.
Thank you for your wise and helpful post. You encapsulate a painful reality very well. Of course exercise is a wonderful thing. But you can’t always outrun serious depression.
Situational depression versus clinical depression. Which one are we talking about here? Because there is a big difference between the two. You can’t have a conversation about both at the same time.
I’m off the mindset that with clinical depression one must balance what you already have instead of boosting one neuro transmitter. The most effective anti depressant on the planet is natural. It’s called lithium. And in low doses it has proven to have FACTUAL benefits to the human brain. It’s neuro protective, anti suicide, and cognitive enhancing properties are well documented. But you won’t see shrinks doling out low dose lithium ( I’m talking 75-150 mg ) as a first line treatment as there is zero money in it for big pharma and it actually works with minimal side effects in most people at those doses. If you are a doubter at least read about it before you respond.
Another one. B12 injections / methlyfolate. Half the population has MTHFR mutations ( mutations linked to depression, CFS, bipolar, anxiety etc ). People with these genes require active forms of b12 and folate. Why not screen people and TREAT THE GENES. In the end all of this stuff is genetic. The problem is we know little about genes and even less about how to treat / modulate genes. Fifty years from now SSRI will be seen as barbaric.
Sorry if double posts….
People need to be careful when saying its situational depression. My GP originally diagnosed situational depression with GAD and Panic Disorder and sent me home with Xanax. Two weeks later I was back in his office even worse and requested to see a psychologist. I was on the verge of losing my friends bc I was so messed up. When the Psychologist and my GP talked they reached a diagnosis of Bipolar from history and what was going on.
My so called situationally depression is still a battle two months later and my psychologist has mentioned hospitalization more than once.
My point is sometimes GPs down play things and arent quick to prescribe antidepressants and that can be
dangerous. Its better safe than sorry. Ive been out of the situation for two months and Im still not stable.
Two months… is nothing. I don’t say it to be dismissive… but what can you do in two months? Certainly not change your life dramatically to better with lasting results. Even “quick fix” pills take some six weeks to kick in (and sometimes first…or second… or third-…) trial doesn’t work anyways…
give it few more months, be patient, work on yourself and look for what can you do… then you can judge… two months may sound long time *right now*…. but two months is really not long time compared to lifetime. That’s a summer break for school kids. Often one goes through few rough years… and still can manage to get up and live on.
I think what may be appropriate for those with mild to moderate depression quite different to those experiencing severe depression. The article you refer to well- intended but I agree potentially harmful particularly where it might cause someone to suddenly stop taking anti-depressants.
There’s a huge variation in degree of care one can get from GPs and although noted that they are not specialists in this area the initial screening and diagnosis of depression should be a lot better than what it often is. i find the best GPs are those with good listening skills and genuine empathy, rather than those who just rush you through a tick box exercise.
Personally I’ve gotten better with lifestyle changes (quite a number of them it has to be said) alone, but the best course of action for anyone is always going to be a holistic strategy tailored to that particular individual which may or may not include medication depending on the type and severity of depression.
Agree, agree, agree. Much like you, I’ve been dealing with this most of my life (in the system 18 years). When there are meds I can take and they do help ‘some’, I do my best to utilize that time to improve lifestyle. It all falls back into the ditch when the med(s) no longer work well or must stop it for other health reasons. Up/down. I just lost another good med due to other health reasons. I’m not even sure what or when I get to try something different. Before I get too low to function, I start putting ducks in a row and verbalizing (to everyone in my circle, including drs.), while I can.
Lifestyle changes have definitely helped me with bpd.I’ve almost completely cut out caffeine as it makes me feel anxious even though I really do enjoy a good cup of coffee and gave up alcohol because I was advised to by my therapist. exercise certainly helps a lot.it makes me feel alive and gives me something to take my mind off everyday thoughts.
And then that severely ill person? They could die. Yes. Die.
the problem is, it is not always severly ill people who walk in doctors office and walk out with pills. Paulina Porizkova recently admitted she went on ADs after being kicked out of Dancing with Stars…. and there are many who rush to doctor with minor issue, because that is what the commercials tells.
It would be nice if people got diagnosis because they are ill. Very ill. But many get diagnosis because they are human… hence sometimes sad or shy.
And sometimes people can be VERY depressed by being in bad situation. They have sucky job that makes them want to never get out of their bed…. sometimes they do burn out. And yes, in these cases lifestyle changes can help and no chemistry is needed. At least not on long term. And at times ADs can make person fuzzy enough to stick in bad situation…. they just don’t mind it anymore.
There are more sides to the story.
Venus,
I don’t disagree with you. That’s why I specified severely ill people and not just anyone. There is minor depression too, which is different because those people have more options. And yes, there is also situational depression which may need temporary meds but long-term life changes. Again, I agree.
But doctors have to make this determination. Unfortunately I don’t have the luxury of determining who is severely ill. All I can say is that in the cases where people _are_ severely ill, it makes sense. In the cases where they aren’t, well then, there are other options.
And life changes are often not something even the sick person is aware of. IE, they don’t realize their life is making them sick. And generally if they don’t know, then they can’t tell the doctor and so they can’t know. The person most likely able to make that determination is a therapist. And we know (from research) that therapy plus medication works better than either treatment alone.
And pretty much every doctor I’ve ever seen has recommended therapy. Now, I can’t comment on whether GPs do this, because I have a sneaking suspicion they don’t, but I know psychiatrists regularly do.
But again, there is the problem with therapist care access. Few people can afford therapy or have it covered by their insurance in the US. And so what is a doctor to do?
Yes, there is more than one side. Unfortunately, we can only do what we can reasonably do.
– Natasha Tracy
The real problem is not when people use meds as a first means of controlling symptoms. That is good and the correct avenue. I see the problem when life style changes are not implemented after people are feeling better and functioning at “baseline.” That is when many therapists (and more so doctors) let people go at it alone and don’t worry about the skills needed to create a flourishing life, in spite of the disease.
Ari,
I agree, skills have to be picked up once a person is able to do so. And people are concerned that doctors and therapists aren’t promoting the learning of those skills but that just hasn’t been my experience.
I’ve found that psychiatrists are very good at promoting skills-learning, skills programs, therapy and whatever other programs might be available in your area. Now, GPs are a bit different, they don’t tend to do such things, which is unfortunate, and which is just one of the many reasons I suggest people see a psychiatrist if they have a mental illness whenever possible. You wouldn’t expect a GP to know about oncology treatment and it’s not very reasonable to expect them to truly understand mental health treatment either.
And therapists tend to be even better about recommending lifestyle-type treatments.
That being said, I suppose the most useful thing to me has been my curiosity and my seeking out of these types of treatments and, obviously, you can’t count on people to share this. Unfortunately, I’m not sure how to overcome that hurdle other than to strongly encourage people to learn about their illness. Education is key.
– Natasha Tracy
Hi Jake,
Yes, absolutely. Medication gets you to the point where you can actually do something healthy for yourself or get therapy. (Good therapists know that therapy doesn’t work until people have a certain level of stability.)
– Natasha Ttacy
I have experienced exactly what you stated. I was stabilized on medications and then lifestyle changes were suggested. It is easier to focus on lifestyle change when your mind is not racing or suffering suicidal ideation.
For some people suicidal thoughts are brought on by environment or external forces ie. family tragedy, divorce etc. and anti-depressant medications can be a way to stabilize a persons mood and help them keep on track until they can get therapy or there situation resolves.
Some people have depressive illness that cannot be cured and may require medical intervention for a lifetime.
Maintaining a healthy lifestyle makes perfect sense when you have mental health issues but that is in combination with proven therapies.
I would love to be un-medicated, but I do tend to de-stabalize when I have been in the past. It is a necessary evil for me however it does not preclude the fact that I get regular therapy which for me
is an important component of my wellness plan.