Introduction

I've been a psychotherapist for the last twenty years. Not long ago, I found myself in the client's chair, facing my own mental health care provider. What I learned from that experience helped me understand - like no book, journal article or academic course ever could - what my clients go through when they develop a major depression. I also learned first-hand what they are sometimes up against when they agree to a try antidepressant medication.

The Stress Factor

I had just returned from a vacation when I came down with a virus that lasted more than three months. I had stomach and abdominal pain and nausea; my ability to think was impaired (I felt like I was in a fog); and I would cry for no reason every day.

After a while, as a result of the burden of dealing with my prolonged symptoms and their impact upon my functioning, I started to develop signs of depression. I dreaded getting up in the morning. I was unable to accomplish much beyond showering each day. Moving was an effort. I would look at the dishes piling up in the sink and turn away from them; I couldn't muster the motivation even for these easy chores. I tried to read, but couldn't concentrate. I felt drained of energy, but also restless at the same time. It was as if I couldn't get comfortable in my skin. Though friends and family were compassionate and loving, I felt that they could not understand my anguish no matter how much they tried.

Fortunately, my virus eventually faded and most of my physical symptoms went away. I was able to gradually resume my normal routine. I started going back to work, and resumed daily activities such as cooking, cleaning, and socializing. But something still wasn't quite right. I was still crying every morning and for no reason. I still felt bereft - helpless and hopeless.

Getting Help

Because I continued to have symptoms of depression, I decided to find a psychiatrist. That in and of itself proved a daunting task. There were long waits for some, others did not accept my insurance, and some had offices too far from my home. I almost gave up, but I wanted to get better so I continued my search.

Finally I found a psychiatrist who, on the basis of my condition, suggested I try an antidepressant. Now it was my turn to try the kind of medication I often referred my clients for. What an eye-opening experience it was! The good news was that I responded within a few weeks. Also, my initial response was dramatic: Lingering physical discomfort (including Irritable Bowel Syndrome and headaches) vanished and I began to feel more optimistic.

But then a side effect kicked in and I was so nauseated that I couldn't stand up. I tried another medication. That one created insomnia. Then another, which caused me to break out in hives. Four kinds of antidepressant medications and one month later, I eventually found one that was a good fit for me.

My despair diminished and my good spirits returned. After a couple of months I was back to my "old self." Unfortunately, that's when I developed side effects with this last medication. Rather than try another, I decided to stay on a very small dose, mostly because I did not want to go through trying yet another medication. At the same time, I was afraid my depressive symptoms would return if I abruptly stopped the medication. Eventually I discontinued the medication.

As a psychotherapist, I have always thought that, when appropriate, medication can be the most effective way to find relief from severe depression. Psychotherapy may not be especially helpful in the beginning of treatment since it's hard to ask someone who is having trouble thinking, and is feeling emotionally out of control, to delve into complicated ideas and feelings, which is what psychotherapy sometimes entails. With medication, my clients become ready to do this work, including determining what feels good - and doesn't feel good - in their lives, and what changes they want to make for the future.

Many times this is what happens. But I realize that for some people, finding medication that agrees with them is not such a simple matter. Though the newest class of medications, called Serotonin Selective Reuptake Inhibitors (SSRIs) is a vast improvement over older medications, SSRIs are not perfect either. At a time when scientific breakthroughs are promising to revolutionize medicine, the truth is, the treatment of mental illness is slow-going. This is because no one really knows for sure which chemicals in our bodies cause depression - and how - though researchers have ideas. It's not a precise science yet.

Depression - The Big Picture

In the United States, depression strikes about 17 million more adults each year. According to the National Institute of Mental Health, it exceeds the incidence of cancer and coronary heart disease.¹ Women are twice as likely to experience depression as men, both in the U.S. and around the globe. No one knows why this is so, though susceptibility to depression is probably the result of a combination of biological, psychological and social factors.²

Despite the fact that women are reluctant to seek treatment, they do so more often than men. Research indicates that men are more likely to turn to alcohol than to a mental health professional for help with depression. And sadly, more men than women commit suicide as a result of depression.³

Conclusion

Even after mustering the motivation to seek help for depression, finding an antidepressant medication that reduced my symptoms without intolerable side effects was a frustrating experience. Several trials were necessary. Some unlucky people may never find a satisfactory solution. Still, it's definitely worth experimenting since I have seen in my practice that many people do respond well and experience no or a minimum of side effects.

These days, when I refer clients for medication, I'm able to tell them what to expect. I tell them they will have to work closely with their physician to find the right medication at the right dose. This means they will have to be very specific about their symptoms, so it's a good idea to make a list of them. Then, after starting a medication, it's critical to report any side effects, but also to give those side effects a few days to subside - if they're tolerable. This is so because it is possible that the side effects will go away.

Those that don't go away can often be reduced. For example, many people - men and women alike - develop sexual problems such as difficulty reaching orgasm with SSRIs and other antidepressants. Men may also experience problems with getting an erection. Although it's an awkward subject to talk about, it's important to report this development since most doctors will know what to do to get around or eliminate these problems.

When a person is feeling severely depressed, finding an acceptable antidepressant is a particularly unpleasant process to go through. Many people think about giving up on finding one - and some people do. When people feel blue, they lose sight of the fact that they can be happy again. Sharing my own experience lets them know that it is important to stick with the process. With medication, spirits lift and thinking becomes clearer. Then, in psychotherapy, they can evaluate what stress factors may have contributed to the depressive episode, and figure out how to decrease or get rid of those stressors.

If you feel depressed, don't go it alone. A combination of psychotherapy and antidepressant medication can be an effective treatment for many people. I know from personal experience that depression can be debilitating. I'm grateful - for myself and for my clients - that medicine is making progress toward finding better ways to manage depression when it strikes. And I know that finding the right medication and the right kind of help can really make a difference.