Is it Depression or Is Life Hard?: One reader wonders if her antidepressants are necessary anymore

Dear C and Dr. B;

I am 61 and have been on antidepressants over 20 years. I am doing well and feel fine these days, but does depression ever really go away? I mean on its own? I ask because my mother was depressed when I was a kid and there were no antidepressants back then. Her doctor told her to get out more and be more active. As she got older she did get better and by the time she had died, she was not depressed.  

My doctor recommended I stay on the medications – I was pretty bad off when they were started. I had also gone through two abusive marriages. I married men very similar to my dad. My current husband is a very respectful and nice man. They say three times a charm. Do I still need to be on antidepressants?       

– Debbie Downer

Dr. B says: Depression has a million possible causes, so this is not an easy question to answer. Your mom may have been more oppressed than depressed; this was most women’s plight back in her day. In this time period in our culture, woman’s lives pretty much sucked, as did the lives of most non-white minorities. Was it nature or nurture that caused those suburban housewives to be on valium? Later on, Xanax and Dexedrine dominated their medicine cabinets, followed by Doxepin, then Prozac. These drugs were the family doctor’s answer to everything. Now it’s Adderall, Phentermine, and Xanax, with Celexa close behind. 

Our society is sleep deprived, over worked, and economically unstable & unequal in so many ways. Our climate is unstable, racial injustice persists, and people are entitled, rude, and downright mean to each other. The pandemic is the icing on the cake. But what we need to remember is that feeling better and actually being better are not the same thing. Medications can make you feel better, because you just don’t care so much. But medications can’t bring meaning to your life. The suffering that we are trying to avoid is intimately tied to finding meaning. It requires intent and effort, not avoidance and numbness. 

So – whether or not you stay on meds is a conversation you need to have with your doctor. But if you are asking if your life is meaningful you need to examine your social ties and commitments. Do you have enough of them to provide meaningful suffering?

C says: Debbie, what I hear you asking is whether your circumstances have changed enough that you don’t need antidepressants anymore. If you have been on antidepressants for over 20 years, I’d say that the real question is: Why in hell hasn’t your doctor asked that question yet?

According to recent studies, long term efficacy of antidepressants is questionable. For one thing, patients generally develop tolerance over time. For another, the long-term effects are still largely unknown. The current thinking on medication is that after the first episode of depression, antidepressants should be taken for 9 months, then re-assessed. Although this will vary depending on the individual case, a maximum of 2 years is recommended for patients who have further episodes of depression. You have been on them for far too long.

Your problem now is finding a responsible, up-to-date doctor who can assess you. If he decides it’s a good idea to get off the medication, he can help you taper off. Depending on what you’ve been taking, some drugs are addictive long term. Suddenly removing them is not a good idea. That can trigger a relapse or other harmful symptoms, such as suicidal thoughts.

Regular follow up and close monitoring is essential for anyone who is taking antidepressants of any type. If your doctor is not doing this, you need a new doctor. 

You can visit Dr. B’s blog at drbrilliantcliche.wordpress.com