Can an LCSW treat depression

Why we need to stop demonizing antidepressants

Source: TomMerton / GettyImages

One of the leading causes of death in the United States, suicide has become a major public health problem both here and around the world. Mental illness is one of the many risk factors for suicide, most commonly depression. Unfortunately, only half of those with depression live and other mental illnesses are actually treated. Most often, the culprit is stigma. Whether individually, as with internalized stigmatization, or on a societal level, evidenced by a health policy The Center for Disease Control (CDC), which treats mental illness as inferior, names stigmatization in connection with mental illness and seeking help as one of the main risk factors for suicide.

In addition to the stigma surrounding mental illness itself, the stigma is potentially life-saving treatments, particularly psychotropic medication. As demonized as antidepressants Many must not forget how many lives the same drugs have saved and what quality of life they have improved. Especially for those at high risk and in cases of treatment-resistant depression, medications can be very helpful. They can serve as a supplement to treatment and help patients deal with debilitating symptoms.

"The stigma surrounding mental health care, including treatment with medication, prevents those who need it from seeking help," says Dr. Louisa Steinberg, PhD, postdoctoral fellow at Columbia University. Steinberg said the stigma of treatments such as medication contributes to early treatment discontinuation and is the number one cause of treatment failure. "Depression is a serious, life-threatening disease," she says, "and blanket statements that demonize its treatment are a real disadvantage for those in need, neglecting the underlying complexities of both the disease and the treatment."

Psychiatrist Alex Dimitriu, M.D. agrees that stigma only perpetuates barriers to entry and treatments for mental illness. "Whenever I hear criticism of modern psychiatry and its drugs, with some studies saying that these drugs don't work better than placebo," he says, "I would ask myself what am I doing here as a doctor?" I could mean Not doing work every day when I felt like my work was in vain or worse and causing damage. "

Resolve common misunderstandings about medication

The risk of side effects can be minimized.

In response to general and reasonable concerns about the medication, Dr. David Hellerstein, professor of clinical psychiatry at Columbia University that this is something that psychiatrists know and appeal to. "Some drugs can cause undesirable side effects such as emotional clouding," Hellerstein admits, "a common concern of creative artists. Switching to or supplementing with more activating drugs can solve this problem. New drugs are also being developed all the time."

Dimitriu agrees that while drugs can have side effects, reducing anxiety levels with depression come at risk of higher costs.

Medication does not have to be taken indefinitely.

"Many abandon drug treatments, especially when they work in therapy," says Hellerstein. "Often times, it can act as some sort of jumpstart and ease the healing process. Some people try it for a limited trial period of a year or two: it's safer than substance abuse."

"Often with clinical depression we also have to use medication to release the stuck biological system," says Dr. Eric Nestler, Ph.D., Mount Sinai and a member of the task force at Hope for Depression Research Foundation. "It can help you rearrange your life and reach a healthier state so that you can work in therapy and engage in behavioral activities such as exercise."

Medicines are effective.

According to Nestler, antidepressants are effective in around half to two thirds of those affected carefully diagnosed as depressed. "People who argue otherwise," says Nestler, "are wrong and biased."

While clinical trials of antidepressants in recent decades have shown less effectiveness than studies conducted a few decades ago, this reflects the simple fact that, unlike a few decades ago, the vast majority of people in the US with depression today have access to medication. "The only people who are currently looking for clinical trials of new drugs are those who have not responded to existing drugs." He says: "It is therefore not surprising that studies today show less effectiveness in the group of patients with so-called treatment-resistant depression."

The downside of drugs

Are drugs overprescribed in our country? Absolutely. "When drugs like Prozac first hit the market, there was a big problem with overprescribing," says Sal Raichbach PsyD, LCSW, Ambrosia Treatment Center. "They were viewed as the 'miracle pill." When people realized it wasn't and these drugs, like other side effects, had side effects, the pendulum swung in the opposite direction. In many ways, society has not recovered from this mindset Problem arises when society places a stigma on mental health care, be it seeing a therapist or taking a pill, "says Raichbach." Although antidepressants don't work for everyone, they save countless lives. They instill the sense of balance and emotional regulation needed to begin the healing process, and they bring the individual back to a place where they are more receptive to treatment. "

Medication is not for everyone

Both Raichbach and Hellerstein make it clear that drugs are certainly not the only answer and that they are not for everyone. According to the National Institute of Health (NIH), as it applies to many other treatments, medication can help in some situations and not in others. “They're effective for moderate, severe, and chronic depression, but probably not for mild cases. Their goal is to relieve symptoms and restore emotional balance. "

There are several other treatment options for depression such as: B. Brain stimulation treatments, light therapy, and behavioral activation therapy. "In many cases, such as mild to moderate depression, one of these treatments or psychotherapy alone may be sufficient," says Dr. Bryan Bruno, medical director at Mid City ETC, a New York City-based medical center focused on treatment Focused on depression. "For example, transcranial magnetic stimulation (TMS) is an alternative outpatient treatment that uses magnetic pulses to activate certain areas of your brain where low activity leads to depression. According to Bruno, TMS treatments should be given particular consideration when antidepressants have not been sufficiently beneficial. "Antidepressants aren't always necessary to treat depression, and they don't have to be taken alone."

A message to the prescribing doctors

It is important that health professionals not rely solely on medication as the initial treatment for every case of depression. Prescribers would neglect not to refer their patients to a therapist or at least offer psychoeducation on the importance of therapy in treating mental illness. As studies consistently show, the most effective treatment for depression is neither therapy nor medication alone, but a combination of both. Drugs can relieve symptoms faster than therapy alone; However, only the biological components are addressed. Since depression is not a one-dimensional disease, the psychological, emotional, and social factors must be ignored in order to treat it half-heartedly.

Prevent suicides

Especially for those who experience tired thoughts, renouncing mental stability and quality of life in the face of fears and misunderstandings and the persistent stigma can be a life-threatening decision. "People who receive no treatment at all are putting themselves at a disadvantage," says Hellerstein. “The effects of untreated depression or anxiety are much worse on mental function than the effects of treatment. You have to weigh the costs and benefits. ”

Reviewing our own prejudices and maintaining the stigma

Regardless of your stance on the drug discussion and your own beliefs, it is crucial not to generalize. We are all vulnerable, so we must be careful not to participate in the perpetuation of the mental health stigma.

To say drugs are all bad is to throw away their many benefits. We cannot rule out a treatment that has been proven effective for millions. Such generalized statements are dangerous if even a life can be saved or suicide prevented.

If you have thoughts of suicide, call the National Suicide Prevention Hotline at 1-800-273-8255.