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Can Antidepressants Work for Me?

A look at the complex mix of factors -- and key questions -- to consider.

Trial and Error

Antidepressant treatment can be tricky because scientists haven't truly cracked the secrets of depression. Despite the widespread belief that depression stems from chemical imbalances in the brain, it's only one theory.

"One of the hardest things in psychiatry in general, but particularly in mood disorders, we do not know what the broken part is. We don't know what the pathophysiology of depression is. We have some guesses," Payne says. "But we really don't understand this well enough, and it's likely that major depression really represents a group of illnesses, meaning that there several different ways, biologically, to get to what we call major depression."

That leaves doctors with trial and error to find the right antidepressant.

"We can't tell ahead of time if a particular class of medication is going to work better for this particular patient or not," Payne says. "We are essentially doing an experiment. We're going to try this medication, we're going to see how you do. If that doesn't work, we'll try a different medication."

Using an Antidepressant: 4 Questions to Ask

Despite the limitations of antidepressants, Mischoulon says, "It doesn't make me less enthusiastic about antidepressants because I've always thought that I've had a fairly balanced and realistic picture of how these medications work in the world of practice. So in terms of making recommendations for my patients, I know that not everyone is going to do well on these medications. They have to be used carefully, and you have to select them carefully for each patient."

For anyone considering treatment with antidepressants, here are four important questions.


A1. Do you truly have depression?

Seek a professional opinion to make sure you have "major depressive disorder," Mischoulon says. "I tell people, ‘You have to get a diagnosis by a medical professional, preferably someone who is a psychiatrist or psychologist, somebody who understands the diagnostic criteria very well.' "

Why? Because life crises can trigger symptoms that look a lot like depression, but don't lend themselves to being treated with medication, he says. "For example, say a person loses their job. It may be normal for them to feel sad or blue about it for a while, particularly if they're having trouble finding a new job, which in this economy is increasingly common."

"It's normal to feel sad or discouraged about these things, but that doesn't necessarily mean that you have a psychiatric disorder," he says. "Likewise, if there's the death of a loved one, again, grieving is normal. It's a human process, and grieving can sometimes be similar or overlap a little bit with symptoms of depression. So we shouldn't necessarily assume that people who come in with these situational problems are the ones that need to be treated with medications."

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