Psybersquare Logo depression image
  depression image

Depression - To Medicate or Not to Medicate...
by Jennifer Orleans, PhD

I'm a clinical psychologist who has worked with college students for 15 years now. I'm definitely not into having people take psychiatric medications as the typical, first-line approach to dealing with their difficulties. Psychiatric medications are not solutions; coming out of depression--even with the assistance of medications--is hard work. Psychiatric medications have potential positive and negative effects (like any other medicine), and should be used prudently. But before recommending psychiatric medications, I always do a thorough assessment, and in most (non-acute) situations, want students first to try counseling or therapy without meds.

That's not to say that I'm completely against antidepressant medications; they can be incredibly helpful to a lot of people who are in agony. In any six-month period, 9.4 million Americans are suffering from depression. It's the most common form of psychological disorder. Serious depression is not just "the blues" (normal mood shifts that everyone experiences on occasion); rather, it is a profound and unremitting sense of sadness, hopelessness, helplessness, guilt, and fatigue. People who are depressed typically find no happiness or pleasure in things they once enjoyed doing, or in being with friends and family. They may be irritable and withdrawn, have trouble focusing and studying or working, and develop problems with sleeping and eating. Without treatment, it's possible for depression to be lethal, as those with depression are at high risk for suicide. Medication can relieve the excruciating misery of depression, freeing the person to address the psychological aspects of their depression and do the work of healing in therapy or counseling.

It's also important to note that you don't have to wait until you've reached the brink of suicide to seek treatment and legitimately consider a trial of antidepressants. There is a "continuum" of depression. While people with the mildest forms can benefit from counseling alone and don't need medications, there's also a middle range that's quite painful and can be helped with counseling and antidepressants. You and your health care provider can decide together whether it makes sense for you to give medication a try. And no matter what, counseling or therapy is tremendously important here. In order to have the best chances of overcoming depression and preventing relapse, you should have a professional help you look at the psychological components of your depression.

If you're wondering whether antidepressants could be helpful for you, try going to your campus counseling or health center to see a counselor, psychologist, psychiatrist, psychiatric nurse, or physician. They'll help you assess whether you could benefit from a trial of antidepressant medications. After you've begun taking meds, you should be monitored by your doctor or psychiatric nurse throughout the time you're on them. Keep in mind that medications may take a few weeks to become fully effective, and that side effects, if they occur, often disappear in a short period of time. If they don't, your health care provider may change the dose or switch to another medication to reduce the side effects. Because the prices of medication can be difficult for students to afford, many college health center psychiatrists, psychiatric nurses, and physicians provide students with free samples of anti-depressant medications (often given to them by drug companies) in order to help them reduce costs.

You shouldn't get numbed-out on antidepressants. I've heard their effect most frequently described as "taking the 'edge' off"; that is, you experience the normal range of feelings (ups and downs), but without the ever-present edge of intense despair looming in the background. If you do experience a distressing narrowing of your emotional spectrum, then you could be on the wrong dose or wrong medication. There are a variety of anti-depressants, so there are a variety of options. Your health care provider will work with you to find the one that's most beneficial for your symptoms, with the fewest side effects.

You also have to make decisions about whether or not to take medications all the time. If you have an infection, you might take an antibiotic. If you have diabetes, you'll need to take insulin. If you have a mild cold, you may not take anything, and let it work itself out. But if you have a miserable cold, you might take a decongestant to help yourself feel better as you recover. Antidepressant medications are in your range of options if you suffer from depression. But just as you shouldn't view psychiatric medications as the solution to your problems, you shouldn't automatically close your mind to them, either. Become knowledgeable about antidepressants. Carefully consider the recommendations of professionals you trust, and remember that, ultimately, it's up to you.

Types of Antidepressant Medications (For more detailed information about these medications, how they work, and their potential side effects, review the resources listed below, and/or search the web.)

There are three classes of antidepressant medications:
  • Heterocyclic Antidepressants (formerly called Tricyclics) - named for their chemical structure.

  • Monoamine Oxidase Inhibitors (MAOI's) - prescribed less frequently because their use requires rigid dietary restrictions: no cheese, beans, coffee, chocolate, red wine, or medications such as some over-the-counter cold and allergy meds that contain the amino acid tyramine. This amino acid interacts with MAOI's and causes a severe and life-threatening increase in blood pressure.

  • Selective Serotonin Reuptake Inhibitors (SSRI's) - act on the neurotransmitter serotonin, and some on norepinephrine as well. If you'd like, read an article about one author's thoughts regarding Prozac.

  • There is also a newer antidepressant, bupropion, that is chemically unrelated to the other antidepressants, and has more effect on norepinephrine and dopamine than on serotonin.

  • Herbs like St. John's Wort are still medicine; just because they're "natural" doesn't automatically mean they're safe or that you should use them with any less caution than you would a prescription drug.

American Psychiatric Association. Accessed August 21, 2000.

National Institute of Mental Health. "Antidepressant Medications." 1995. Accessed August 21, 2000.

Article courtesy of
"Where Health and Reality Meet."

Send to a Friend                  Print this Article


Prozac Diary
by Lauren Slater
Our Price: $21.95

"...[a] powerful book ... What makes her book most worthwhile is her discussion of the subtler perils of Prozac..." -- The New York Times, Christopher Lehmann-Haupt

For a selection of books on this topic, visit the Psystore.

** All prices subject to change without notice