Can Antidepressants Work for Me?
A look at the complex mix of factors -- and key questions -- to consider.
"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."
Psychotherapy or even professional coaching might be the best route for them, Mischoulon says. "A lot of these people with bereavement may get well on their own."
But many are put on antidepressants too quickly, he says.
"Those people might be taking a medication that they don't really need. Thus, they would be risking getting side effects, which many antidepressants have." These effects include dizziness, drowsiness, and stomach upset, Leuchter says.
"Also, by giving everyone medications, we're sending a message that it's not normal to feel badly," Mischoulon says. "To grieve when you lose a loved one -- ‘that's something that we can treat with a medication,' and that's not the case. There is a certain amount of normal suffering that is part of the human condition, and unfortunately, we live in a society that increasingly wants to be happy all the time and feels that if you're not happy all the time, then something's wrong," Mischoulon says. "That's just not the way it is."
But in some cases, it's tough to distinguish normal sadness from clinical depression.
"Sometimes it can be difficult," Mischoulon says. "Sometimes grief can actually complicate into a major depression. A lot of people who lose their jobs, as a result of the stress of it, may actually develop a major depressive episode. One of the ways in which we make the distinction is that we look at the degree of impairment."
For example, a grieving person might cut back on work and other responsibilities for a while and then gradually return to a normal routine.
But if the person misses a lot of time from work, stops leaving the house, stops engaging in activities, or feels suicidal, those are more serious signs of depression, Leuchter says.