The ‘problem’ with antidepressants is the varying effectiveness of them across the populous because of individual deviations in the biology of patients, not because of something intrinsically ‘wrong’ with each form of medication. A good example of this is how birth-control medication differs between women — for some a brand will work well, for others it will bring shifts in mood and unwelcome side effects. The same is true for any medication. There is no ‘fix-all’ for disorders, but we do have effective ranges of medication that we can apply to our patients — though this must be reviewed, regularly, by a multidisciplinary team.
Anyone who works in mental health knows (or should know) that pharmacology is only one branch of treating a patient. The terrible healthcare system in the US. has created a phenomenon whereby primary care physicians are prescribing medication they are ill-equipped to measure and monitor, with incorrect support. Many psychiatrists are in a similar bind, having limited resources of quality psychotherapists to consult and confer with.
Some people are what we call ‘medication resistant’, but a majority of people (almost all of those I have treated) have benefited from antidepressants, mood stabilizers, and anti-psychotics. They have found effective respite from their disorders and been able to engage with meaningful psychotherapy. This is key, medication alone is an effective ‘suture’ to the psychic wound of mental health, but psychotherapy is the operation to actually attend to the causation of the wound, and to heal it.
We live in a society where mental health is highly stigmatized, and engaging with therapy is seen as a privilege, or an indulgence. Literally EVERYONE on the planet will benefit from psychotherapy, myself included — not a few weeks, but actual deep work with solution focused, empowering, skills building sessions.
The ‘mystery’ of depression lies in the causal and corporeal impact of life on the psyche — people wish to be better yet a considerable proportion of their malaise stems from how they interact with and interpret their lives. If mental health is a capsized ship then medication is a floatation device, one must still identify and swim toward a shore, then learn to thrive upon said shore. Mental health treatment (as currently funded and viewed by society) is akin to bringing someone to shore, showing them how to make an SOS sign, and then leaving them to watch the horizon for a ship, while telling them ‘it will be ok’. Too many people become stuck waiting for change, without the necessary insights, tools and skills to effect change themselves.
Effective mental health treatment is getting the person to shore, teaching them to thrive on their island, and showing them how to get help to move beyond their island — but learning how to foster wellness, generativity and wellbeing on ‘your island’ gives a person the strength and wherewithal to function in the larger world.
I always say to my patients who tell me ‘I just want to go back to the way I was’ — “Why, why would you want to do that? The way it was brought you here, how about we work on building a new way forward the incorporates the best of what was with the better of what will be?”
Antidepressants give patients time and space to look at that mechanism through psychotherapy, and to learn how to elicit change within their lives — if antidepressants simply ‘cured’ depression then we would be very, very simple creatures indeed, but we are not (and they cannot), and their effectiveness (or not) has more to do with our psychology than straight pharmacology.
