Anxiety and Depression: Why Don’t We Want to Take Medication?
By Martha McLaughlin
Depression and anxiety are commonly talked about these days, yet many people still hesitate to address it all, let alone take prescription medication for it. It’s not unusual to have concerns about treating your mental health concerns with medication. If you’re dealing with anxiety or depression, maybe you face issues and thoughts like these:
Ideas of self-control – Sometimes we think maturity should mean emotions are constantly in balance, but emotional maturity actually involves many things, including knowing when to ask for help. If you’ve got an infection, you may need an antibiotic and if you break a bone you may need a cast. In the same way, biology, genetics or circumstances may trigger a need for extra mental health support.
Fear of being labeled – There’s a tendency to view emotional health differently than other health conditions. Maybe you believe your condition lacks legitimacy or worry that people will think less of you if you’re treated for anxiety or depression. In truth, the conditions are much more common than many people realize, and the unspoken understanding much more widespread. The National Alliance on Mental Illness reports that one in five adults in the United States experiences a mental illness in a given year.1
Belief that treatments are ineffective – You may have read some studies that linked improvements from antidepressant drugs to the placebo effect, but since those studies were published, the data has been analyzed in new ways. Time magazine reported on a study using a technique called growth-mixture modeling which found that about 75 percent of patients did better on antidepressant medications than on a placebo.2 Finding the most effective medication may take some experimentation. WebMD notes that about half of depression patients studied who didn’t improve with one drug had beneficial results when they changed medications or took a second one along with the original.3
For anxiety, drugs in the benzodiazepine category often work quickly and effectively, but tolerance tends to develop quickly as well, making them less effective over time and best for short-term use. Matching patients to the right treatment is an art as much as a science, and a mental health practitioner may be more likely than a general physician to have the experience to minimize experimentation time.
There are also effective non-drug treatment options that you can use instead of or in addition to medications. Electroconvulsive therapy (ECT) has been shown to be more effective than all other depression treatments studied.4 Cognitive Behavioral Therapy and other psychotherapy approaches can also be surprisingly powerful. Consumer Reports polled 1,544 readers and found that talk therapy alone was almost as effective as medication and that people who combined drugs with at least seven sessions of talk therapy had the best outcomes.5
Fears of medication side effects – All drugs have potential side effects, and only you can decide whether they’re tolerable and how to measure them against your depression or anxiety symptoms. For example, some anti-depressants lower libido, but so does depression itself. Many side effects disappear after a few weeks, but if they persist and are problematic, your doctor may recommend adjusting your medication dosage or timing, or trying a different drug.
Fears of addiction – Medications commonly used to treat depression and anxiety include selective serotonin reuptake inhibitors (SSRIs) and benzodiazepines. Both can produce physical dependence, meaning that if you stop them suddenly, you may experience uncomfortable symptoms. To avoid them, your doctor will help you decrease your dosage slowly over time. The risk of true addiction, which involves cravings and loss of control, is associated with a drug’s ability to increase dopamine levels. It appears that benzodiazepines are more likely to cause a dopamine surge than SSRIs, and therefore have higher addiction potential. If you have a personal or family history of addiction, or other addition concerns, it’s wise to discuss them with your doctor.
Uncertainty of how drugs work – Our understanding of emotional health is evolving and so is our understanding of how drugs reduce symptoms. They affect levels of neurotransmitters in the brain, but may act in other ways as well. Depression may be at least partly related to brain inflammation, and some researchers believe that many of the commonly used drugs decrease it. Medications may also increase neurogenesis, the creation of nerve cells, which may help explain some of their effects. Many common drugs that treat a variety of health conditions work without doctors or researchers fully understanding why.
Depression and anxiety can affect every area of your life, and addressing them as actively as you would address any other health challenge is necessary. No one approach is right for everyone, but there are lots of options for treatment and so much hope for recovery.
Sources:
1 “Mental Health By The Numbers” National Alliance on Mental Illness, Accessed October 26, 2017.
2 Szalavitz, Maia. “New Research on the Antidepressant-vs.-Placebo Debate” Time, January 18, 2012.
3 “How Your Depression Medicine Can Affect Your Life” WebMD, Accessed October 26, 2017.
4 Pagnin, D. et al. “Efficacy of ECT in depression: a meta-analytic review” The Journal of ECT, March 20, 2014.
5 “Best antidepressant for anxiety according to our readers” Consumer Reports, July 2010.
