Depression, medication, and treatment choices

People with depression may choose to take prescribed medications to help with depression symptoms. Some people we interviewed managed their depression with medication alone. Others used medication in combination with therapy, lifestyle changes and/or holistic and integrative treatments. Some did not use medication at all and only used other approaches to manage their depression. The ways that people manage their depression can change over time. Many people we interviewed described changing their thinking about medication – some growing more favorable, others less so – in response to personal experiences and growing self-knowledge. (For more about approaches to depression other than medication please see ‘Therapy and counseling’, ‘Depression and strategies for everyday life’ and ‘Holistic and integrative approaches to depression’.)

Crystal discusses the complexity of mental illness and different treatment choices including medication.
Interview Transcript

For me I find that mental illness is extremely complex and you know it’s medications can help sometimes and they can be beneficial but the medications that are out there, they, at least the most effective ones can take the longest to really take effect so there’s a lag in how effective they can be. It can cause other side effects and I mean in the grand scheme of things if you’re trying to get better in everything I think like medication plus therapy I do think is a really powerful combination. But I do think that sometimes depression issues can be really more of a thought process thing, that may not have to do with the fact that you know you have low serotonin levels or you have low dopamine levels or anything in your brain and you, you legit have a problem accessing happiness period.

And it’s a biological issue. I mean I’m not saying that I’m for or against one perspective but I do think about those things and I, maybe at one point I might want to consider it if I feel that it’s, my depression is debilitating enough that I do need to go down that path. But I have fallen down a lot of times and I’ve kind of made it through and I feel like there could be light at the end, at the end of the tunnel, if I continue to seek help and I continue to be just aware of it. But yeah I mean another medication to you know a list of medications that you know people are already on or that I’m currently taking and everything is just another thing to think about.

DEP Crystal
Profile Info
Age at interview: 20
Sex: F
Age at diagnosis: 15

Background: Crystal is an African American college student. She works campus jobs during the year and internships in the summers.

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Deciding to go on an antidepressant – or not

People we talked with considered many factors before making the decision of whether or not they wanted to take medication. Some started therapy first, while others carefully weighed the benefits, expectations, and potential side effects of different medications. Pete knew he didn’t want to “be dependent on a drug to fix my problems.” He talked with his therapist about medication options in addition to “weighing the pros and cons.” He also used the internet for research, talked with “other people who are depressed” and sought out the opinions of friends with social work or clinical backgrounds. In contrast, a few people knew they wanted medication right away.

Meghan talks about wanting medication and having difficulty getting it.
Interview Transcript

I, immediately when I was like, in my counseling sessions I made it very clear that I just wanted to get help with medication. And, [Clears throat] excuse me, it was kind of an odd thing to like, really make clear because that can seem kind of like with the wrong thing in mind or at least that’s what I think. But it’s just because that I knew that talking about it wasn’t going to help and that’s not what I wanted to do. I just wanted to, I just wanted to have my potential with my semester and get on track. So I, I made it very clear I wanted medication and it, through the university health services it was very hard to go about getting medication and that’s kind of unfortunate in my opinion, because not always is it that counseling is going to help people.

DEP Meghan
Profile Info
Age at interview: 18
Sex: F
Age at diagnosis: 18

Background: Meghan is a college student and has a job on campus. She is Caucasian.

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Some people we interviewed were initially resistant to taking medication, but eventually decided to try it. Casey first thought that taking medication to feel better would be “cheating.” Joey said his family noticed that he didn’t seem like his “normal self”, and although he agreed to talk with a therapist, he was reluctant to accept that he was depressed because “everyone is unhappy.” Eventually, though he decided to try medication when “pharmaceuticals sounded like a better option than staring out my window with like nothing to do every day.”

Even though Jacob was reluctant to try medications, he decided to take them after realizing depression was affecting important relationships.
Interview Transcript

I was not taking medication for quite a while actually. I’ve sort of always been anti-medication. I didn’t want to rely on a substance to get me through. I liked the idea of just figuring out what was wrong and fixing it sort of on my own naturally. And then, I, it just wasn’t working even with my, my therapies because my, my depression often manifests as anger and agitation. Some people get you know, sad and dysfunctional. I get upset and angry and irritated. And it was, it was hurting my personal relationships, especially my romantic relationships, just getting confrontational and irritable. No one wants to be around that and I didn’t, I wouldn’t want to be around that either. And so when I was single, I didn’t really put much stock in it, because I was just getting mad at nobody. Just mad in general, at myself, but once I started targeting another person, that’s when I realized that I, that’s not okay, and its going to end up derailing relationships so I needed, I needed to get some outside help even if it made me a little bit uneasy.

DEP Jacob
Profile Info
Age at interview: 25
Sex: M
Age at diagnosis: 18

Background: Jacob is a software engineer at a large company. He lives with his girlfriend and a cat. He is White.

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Many people we talked with decided not to take medication because they were worried they would become dependent on it. Pete worried about the permanence of medication and having to take it “for most of the rest of your life until you are completely healed.” He also worried about dependence and future access to medications, saying, “what if that pill runs out, what if I, there is a situation where I can’t get another one then I burst from the seams.” Ben, however, said his depression was severe and left him he no other option. He described, “I didn’t want to depend on the medication but now I have to.” A few other people expressed they only wanted to use medication as a “last resort”, if their depression became severe or if they were out of options. Kate felt “pretty functional without it.” She worried that medication “would carry a risk of undoing the work that I’ve already put in.”

Nadina describes concerns about becoming dependent on medications.
Interview Transcript

I’m kind of worried about any kind of treatment for it because I would prefer not to be on pills. My, my friend is and she can’t leave the house unless she has something in her system and it’s just kind of sad to watch because sometimes she can’t get a prescription for that day you know depending on what she’s taking and I just feel like your brain eventually gets dependent on that sort of thing and then if you can’t get it at that moment it’s just not a really fun way to live. I, I sometimes try to just like deal with my issues head on and sometimes I feel like I’m not strong enough necessarily to, to defeat whatever issue or resolve whatever issue is going on.

DEP Nadina
Profile Info
Age at interview: 23
Sex: F
Age at diagnosis: N/A

Background: Nadina lives with her parents in a suburb near a small city. She completed college and works as a freelance illustrator. She is Caucasian.

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Elizabeth discusses wanting to use medication only if she feels there is nothing else that can help her.
Interview Transcript

I really recognized that what I was feeling was depression probably about a year before I was really treated properly and effectively. And I just remember thinking to myself, “If I start taking medication and it doesn’t work, what am I going to do?” Because I felt like there was nothing else that could really help me. So I always kind of felt like I wanted to keep that as a last resort for fear of nothing else really working and I don’t really think I have that mindset now but I kind of feel like I don’t want to be on something unless I really, really, really need it. and like I said I know it’s there if I do need it but it’s not something that I want to just jump to and you know, I think that there are points in my life where I, and of course at that time, when I did need something to chemically help me and I don’t really feel like I’m there.

DEP Elizabeth
Profile Info
Age at interview: 28
Sex: F
Age at diagnosis: 17

Background: Elizabeth lives in a house with her husband. She works as a parent educator. She is White/Italian.

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Sophie, Julia and Crystal had family members who were against them taking medications. This led Sophie to choose to manage her depression through behavioral therapy. Julia, whose mother was against both medications and therapy, decided to take medication anyway because she “was just really desperate” and “couldn’t keep going with being as impulsive as I was.”

Others thought that antidepressants weren’t necessary or effective given their reasons for feeling depressed. Teddy said he doesn’t feel like he needs pills, and that, “it’s kind of more I need my friends and family to know that I’m there to support them and they’re there to support me when I need it most”.

Brendan discusses why he thinks antidepressants need to be combined with the ongoing process of making life changes.
Interview Transcript

I also think that the problem is that, you know, we’re such like a sort of cause or like problem-solution oriented society. I think we want to be like, “You have depression, you take an antidepressant pill, and then you are no longer depressed.” And like, you know, it just makes like this nice, simple logic and I don’t think most people understand that like, no, antidepressants, basically all they’re meant to do, is for people who’s depression is caused by unstable brain hormones, it’s meant to stabilize it a little bit so that you can put in the hard work of changing your life such that you are no longer depressed. And that’s the thing, like getting out depression is a process and it’s an ongoing one. And I think that a lot of people think that they’re going to take antidepressants, and then they will feel great. And then when that doesn’t happen, they’re like, “Oh, well these things don’t work.”

DEP Brendan
Profile Info
Age at interview: 21
Sex: M
Age at diagnosis: 15

Background: Brendan has three jobs and is a fulltime college student and musician. He lives in an apartment with a roommate. Ethnic background is White.

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Some, like Sophie and Tia, had other reasons for not taking medication. Sophie says, “quite frankly…I don’t like pills. I can’t take pills”. Tia says she used to use “prescription drugs and alcohol…as an outlet,” so she did not want to take antidepressants. (For more about depression and substance use, see ‘Depression, substance use and abuse.)

How medication can help

Medications were seen by many as something that eventually improved their lives. Shayne says it helped her neurochemical imbalance and allowed her to get better. Although some mentioned that medications took time to become effective, many people also said that medications helped them better cope with issues in their life and generally made them feel better. Frankie feels “like there are much fewer lows now, now that I consistently take it.” Elizabeth says, “It really helped calm down what I like to call the noise, it helped me focus on working with a therapist, working on behavior, working on coping skills, problem solving and it really was the key to me getting better and I don’t think that I would have if it weren’t for that.” Ben also says his thoughts are “much clearer” when on medication. Joey felt like on the medication he could “be more productive” and “get things done.”

Violet says medication helped her feel better than she had in her entire life.
Interview Transcript

I continue to take my medication, you know the medication did take about a month to get in your system and after that I was, I felt amazing, I was like “I cannot believe that this is how I was supposed to feel my entire life but I’ve never felt this way before,” I’ve never felt like that cloud wasn’t hanging over me anymore and I finally felt it. I was like this is, I was overjoyed.

DEP Violet
Profile Info
Age at interview: 23
Sex: F
Age at diagnosis: 22

Background: Violet is the mother of a young child and a part-time student. She has worked as a nanny. She lives with her father and daughter. She is Caucasian.

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Medication helped a few people feel more sociable. Meghan says when she’s on medication she feels she is “more bubbly, more approachable.” Maya the medication helped her “deal with the amount of stress that my family caused me.” For Frankie and Jacob, the medication helped reduce irritability.

For Mara, medication helped alleviate her desire to self harm. (For more about self harming, see ‘Depression and self-harming’.)

Finding the right medication and dosage

Several people we interviewed said they tried multiple medications or multiple dosages before finding the right medication or combination of medications that helped their depression. For some people this was very frustrating. However, although it was time consuming, Shayne said she “recognized that medication could make me feel better and it was worth it to try to find the right medications.” People described needing to talk with their doctor about why a certain medication was or wasn’t working for them, and working with their doctors to develop the best treatment plan. Sometimes, this involved lowering the dose of medications. Maya, for example, realized that she needed a lower dose than what was prescribed so she could feel normal emotions, including the “highs.”

Natasha discusses the process of talking with her doctor about how she was feeling on medication in order to find the medication that worked best for her.
Interview Transcript

I guess I didn’t know anything about medications when I started out so he just picked one that he thought would work for me and it wouldn’t be like too crazy to start out with but it’s really, I guess it’s more me deciding things than him like what I feel is working. I’ll like tell him how I’m feeling on it and then he won’t, I was worried that he would be like pushing things on me but he’s really open about sort of switching up medications if something’s not working or like trying different combinations. Yeah, so I would try something I think for four or five, four to six weeks I would say and then come back and check in to see how that’s working. If it’s not working switch to something else, take it for a while and see what’s going on and, yeah. We did that for a while until we found what I’m taking now.

What do you think about that kind of negotiating with your doctor to…?

Yeah, I think that’s a good thing, I think it’s important to sort of be able to like talk to them freely whenever something’s not working or whenever something is working, being comfortable I think is important.

DEP Natasha
Profile Info
Age at interview: 20
Sex: F
Age at diagnosis: 19

Background: Natasha is a student at a large university who lives in a dorm room on campus. She is African American.

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Sara describes working with her doctor to find the right medication and dose.
Interview Transcript

Because I was on a lot of different medications before I found the right one and it took a long time to find the right one, but when I did, it helps so much. Like, it really does.

How did you know the medications were wrong when they were wrong?

I just didn’t feel like myself and I didn’t like the way I was feeling. So I wasn’t, I wouldn’t take it. I would stop taking it after like 6 months, 7 months because I, that’s, I’m not acting like myself. I’m not going to take something that’s going to make me not me. And the doctor was like, “Oh we tried so many medications, something has to work.” And that, she didn’t give up. Which is, was good because some doctors would just give up, be like, “If you can’t take this, this is all you can take now.”

And I was like, “Oh great, another medication that’s not working,” And the doctor’s like, “Well this is a really high dose for you, so let’s lower your dose.” So they cut my dose in half and that ended up being the perfect amount. So I was almost about to give up on it, but she was like, “Please don’t, please don’t, because this medication works differently the way it works.” She was like, “We started you at a high dose, so let’s cut it down and see what that does.” And I did, I listened to her, which I didn’t listen the last time [Laughter]. But I did this time and it was the right medication. It worked. Half the dose worked. So, I guess the dosing helps. Like, too high of a dose could be not affecting me the right way too.

Right.

Which I didn’t try with other medications, I just stopped taking them.

Yeah.

So I gave this a try with the dose.

DEP Sara
Profile Info
Age at interview: 26
Sex: F
Age at diagnosis: 12

Background: Sara is the mother of a young daughter and was pregnant at the time of her interview. She has been living with her daughter and fiancé in various places, none of them permanent. She is Caucasian.

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Side effects and other issues with antidepressants

All medications have potential benefits and side effects. Many people we talked to said they experienced side effects when taking antidepressants. These physical side effects included feeling “extremely sleepy,” gaining weight or nausea. Others reported having a change in personality. Several people said they felt numb or no emotion, or felt “foggy” after taking medication. Sara described “I didn’t feel like myself I felt like I was just, blah, very just, no emotions and I didn’t like that. I didn’t like that I couldn’t feel things, I didn’t like the way I acted. I wasn’t myself.” Joey felt like there was a “glass emotional ceiling” that limited his ability to feel. Devin said the medication “would…make me extremely angry” and realized this was not how he should be feeling. A few people switched medications or stopped taking some of the medications that were initially prescribed to them, due to side effects. Joey and Ryan said the medications made them feel “less creative,” which ultimately led to their decision to stop taking them. Some had other issues with antidepressants. Ben found it difficult to remember to take them daily. Brendan felt a “distrust” toward antidepressants after the medication he was taking suddenly seemed to stop working.

Joey discusses how medications caused a creative block for him.
Interview Transcript

That was one of the reasons that I got, or that I had to get off the medication was that there was some creative block or like, it wasn’t even like I couldn’t be creative because I could make music that sounded good but it did like nothing for me. Like, it was just like, yeah. I was just like, I guess it was because the, well the emotional spectrum. It like elevates it, but it like constricts it so instead of feeling like this, you feel like this, but this happens to be in like, you know, there’s all this that you don’t have to like deal with and compared to being depressed, it’s like this is the high end of the spectrum. But yeah, I don’t know. Depression is not good for music. I mean I need like a variation in emotions or I appreciate a variation in emotions but it was like, I was not making, in my eyes, was not creating good art when I was depressed. It was all just kind of like slow and the same and like, yeah. There was just like no variety to it, it always just kind of came back to like the same thing, where it was just like meh. Kind of sad but kind of you know, optimistic and I don’t know. I prefer a broader range of feelings.

DEP Joey
Profile Info
Age at interview: 28
Sex: M
Age at diagnosis: 26

Background: Joey lives in an apartment in an artists’ building in an urban area near where he had gone to college. He works part time in retail stores and is a musician. He is White.

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Frankie describes feeling numb after starting medication.
Interview Transcript

I hated being on it.

What did you hate about it?

I felt like. It just, it evened me out too much in the sense that, like previously I had a lot of highs and a lot of lows, and I, I was just even. I didn’t have the highs that I had anymore. I didn’t feel much of anything, and I just, I sort of felt numb. My parents really liked it and they didn’t want me to go off of it because I was no longer being disagreeable. I was just sort of going through the motions and doing what they told me to do, and that was great for them [Laughter], and I can see that now, but I hated it. And so I just stopped taking it at a certain point.

DEP Frankie
Profile Info
Age at interview: 24
Sex: F
Age at diagnosis: 13

Background: Frankie works fulltime in customer service and lives with her husband. She takes antidepressants is not in therapy. Ethnic background is Caucasian.

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A few people, like Sierra Rose and Colin, experienced an increase in suicidal thoughts after being placed on a new medication. Although this is an uncommon side effect of antidepressants, it is serious and needs immediate help. The FDA has placed a “black box” warning label on antidepressants to alert people up through age 24 about this rare but serious possibility. For more information about suicide and depression, see ‘Depression and suicide’.

If you or someone you know is considering harming themselves, call 911 or The National Suicide Prevention Lifeline, 1-800-273-8255.

Deciding to discontinue medication or use medication long term

People we interviewed discontinued taking medication because of feeling better, experiencing negative side effects, or having difficulties affording the medication. Several people said they decided to stop taking their medication when they “felt better.” Elizabeth met and found social support in her husband and felt the combination of “medication and different changes in my life… really helped me get a lot better.” She has been off medication since then. Others, like Shayne, turned back to medication when experiencing another depressive episode. Sally also found it “unbelievable how hard it was for me to control my emotions again” after stopping her medication and ended up deciding to take them again.

When some antidepressants are stopped suddenly, there can be side effects*. After feeling better, Joey decided to discontinue his medication “cold turkey.” This led to a “zappy kind of feeling, where it’s like almost like a twitch or something.” Marty, Teddy, and Sam said they discontinued their medication due to cost-related issues. Marty found the medications too expensive and instead self-medicated with substances. Teddy says he felt like the medication was not working and didn’t see why he should “keep paying for it.” Sam said medication did help him, but after taking a semester off, he no longer had access to student health insurance.

Shayne made the decision to go back on medication after experiencing another depressive episode.
Interview Transcript

When I got to college, I stopped. I went off of my medication for, you know, good reasons. I thought by the end of my senior year of school, I was feeling better so I didn’t think I needed medication and my parents were ok with me going off of it. It took me a long time to take it seriously at first because I thought it meant there was something wrong with me. And it’s not, it wasn’t anything wrong with me, it was a, it was just a neurochemical imbalance. So it’sl ike, It’s like having a cold-nose, like a stuffy nose, except it’s in your brain. And it was just hard to realize that it wasn’t me personally. And, you know after, after experiencing severe depression in college, having gone off my medications, I realized what a big difference it makes to be on them. Because I can’t, can’t be myself, like who I want to be without my medications at this point in time. Like if I don’t take my medications, I’m just not functional at all. Not functional, like couldn’t go to work if I didn’t take my medication now so I’m really happy that I do take medication.

DEP Shayne
Profile Info
Age at interview: 27
Sex: F
Age at diagnosis: 13

Background: Shayne lives in a house with two roommates and three cats. She works in research, exercises regularly, and does art. She is White.

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Sam says he stopped taking his medications because he did not have a way to pay for them.
Interview Transcript

So, I stopped taking medications, not on the advice of my therapist, but out of financial necessity, and that did not do wonders for my mood. I would not recommend stopping medications that have been prescribed to you without a doctor’s authorization if you can help it. Again, financial and class privilege plays a huge role here. In terms of my life going forward, once I return to the university setting, I will, again, have access to the resources of student health and student health insurance, which will allow me to resume taking antidepressants, if I and my therapist think it necessary.

DEP Sam
Profile Info
Age at interview: 23
Sex: M
Age at diagnosis: 19

Background: Sam works as a young professional to earn money to resume his university studies. He lives in an apartment with a roommate. He is White.

Click here to view Sam's profile page

References

* Haddad, Peter M. “Antidepressant discontinuation syndromes.” Drug Safety 24.3 (2001): 183-197.

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