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
"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
"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
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
For anyone considering treatment with antidepressants, here are four
A1. Do you truly have
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