Pills Don’t Always Work for Depression

I told my friend to just take the meds; I should have listened instead

This weekend a close friend texted me from CVS: She was filling a new prescription for an antidepressant. This one was a tricyclic. She wanted to know if I’d taken it. “Well, of course,” I said. “What haven’t I taken?” I didn’t have any particular feelings about this drug, I told her, but I had some very particular feelings about her getting another prescription.

I should explain that my friend has been down this road before. She has a history of mild depression. She’s tried antidepressants over the years, and either they haven’t worked for her or they’ve presented unbearable side effects.

She went without psychiatric medications for several years. And then, last year, she found herself feeling depressed. She was still functioning—going to work, cooking dinner for her family—but the things that used to give her pleasure no longer did. She lost her appetite. She had trouble sleeping. She seemed down at work, and people noticed.

So she went to a psychiatrist who prescribed her an antidepressant. It didn’t work. She tried another one and didn’t like the way it made her feel. She tried a different one and became so hostile and suicidal, I was worried she wouldn’t make it through the night without harming herself. (Those black-box warnings are there for a reason.)

Still, I urged her to keep trying. “If not this one, maybe the next one,” I’d say. I didn’t want to see her suffer anymore. I didn’t want her to kill herself.

I wasn’t listening.

She was trying to talk to me about things in her life that were making her sad. I told her those things just seemed sad because she was filtering them through a depressed lens. “As soon as you’re better,” I said, “things will look brighter.”

Pills, I told her. Pills are the thing.

But when I learned firsthand how she reacted to one of these antidepressants—chills, nausea, hours in a fetal position—I took a step back. Why was I recommending these powerful medications in the first place? She’d always been sensitive to them. She’d always had bad experiences. They’d never even helped her. But here I was pushing, pushing.

I was pushing, I realized, because I didn’t know what else to do. I was scared. I didn’t want her to kill herself. Since I know how awful it is to be depressed, I wanted her to get some relief—right now. Pills always seem like an easy fix.

So I hadn’t really listened to all the things she was saying, things I imagined we could talk about after she was better. Eventually, it seemed like her psychiatrist got the message: He diagnosed her with reactionary depression. I’ve never liked that term—it sounds like a Tea Party problem—but it’s apt. Her depression was a reaction to something—several things, actually. None of those things would be resolved with a pill.

In fact, we now know—partly as a result of the STAR*D data and all the subsequent rabbinic interpretationsthat antidepressants aren’t especially effective for mild to moderate depression. For that, something else works just as well, if not better: psychotherapy. It has a lengthy, well-documented history of efficacy and it’s delightfully non-invasive. And no dry mouth!

I told all this to my friend—via text, which is our way. I urged her not to take the tricyclic. I said, “You know, you should try psychotherapy. There’s a lot going on in your life. You should talk about that stuff. Meds are always there.”

Later I got another text: “prescription filled.” Onward and upward.