Coping With Stigma and Depression continued...
“Someone will be taking an antidepressant but maybe a family member says, ‘Are you still on that stuff? Is it a crutch?’” says Jonathan E. Alpert, MD, PhD, chief of clinical psychiatry at Massachusetts General Hospital. “There’s a misconception that antidepressants are happy pills. And as a result, a person might have made the move to get treatment, but someone around them is undercutting their efforts.
“When I went to medical school 30 years ago,” Alpert adds, “no one would have ever admitted to being depressed … now it’s kind of expected that you, friends, or family members have been on antidepressants. But there are still cultures where it’s stigmatized, and there are individual families where it might be the worst thing to admit.”
Looking at Depression Treatment in the Long Run
Many depressed patients have difficulty continuing treatment even after they get past the initial stigma of taking a brain pill. One thing that preys on their minds is the worry that once they’ve committed to taking antidepressants, they’ll be on them permanently.
“‘Will I be on this forever?’ is probably the most common question I get,” Alpert says. Unfortunately, Alpert’s response is not that comforting.
A patient who comes in after 3 or 4 months of depression is typically treated for about a year beyond “remission,” but has a 50% change of another bout of depression. A patient who has had two bouts of depression has a 75% chance of requiring treatment for a third bout. And those who’ve been depressed on three or more occasions are very likely to relapse if they go off therapy. The longer you’ve been depressed, in short, the likelier you are to relapse at some point after stopping antidepressants.
“For somebody with a very chronic depression or a very severe depression -- for example they’ve made attempts on their life or been psychotic -- typically we’ll treat them a much longer time,” Alpert says. “But if you’ve been doing really well the last 5 years and you’re in stable position with good support we might very cautiously taper antidepressant. In some cases, each time we do that they plunge into severe depression. In those cases, we say the risks of staying on are outweighed by the risks of coming out.”