Category Archives: Medical Model

Should I Take Medication for My Anxiety and Depression?

the truth about medication for depression and anxiety

Questions You Should Ask Yourself about Psychiatric Drugs:

Psychiatry is in fashion these days. Increasingly people are choosing to “pop a pill” to rid themselves of their depression or their anxiety. Statistics show that every 10th adult in the United States is currently taking an anti-depressant as part of their daily routine.

Oftentimes, however, people are not that well informed about what this kind of psychiatric treatment really means for their long-term health.

The story we are being told in advertisements is that depression and anxiety are “disorders” with some supposed biological basis, and that anti-depressants are to depression, what antibiotics are to an infection.

Although I am not against medication for psychological issues by default, and do believe there are cases when medication should be considered, all too often in my work as a psychologist, I encounter people who have suffered terrible faiths by going down this path.

Before considering medication for your anxiety or depression, or for any other psychological issue, here are three questions I would ask myself…

Can We Trust Psychiatric Research?

Although research generally shows some efficacy for psychiatric medication for a variety of concerns, including anxiety or depression, there are many caveats that should weigh heavily in people’s decision to treat their anxiety or depression with medication.

The profession of psychiatry in the US has very unclear boundaries in relation to the interests of pharmaceutical companies.

The consequence of this is that what appears like objective science frequently crosses the boundary into rhetoric and marketing. Pharmaceutical money pervades some, if not much of psychiatric research. Many studies that show the effectiveness of a particular drug is bought and paid for with pharmaceutical money. The flip-side of this is that if no benefits are found then we simply won’t hear of the study. This slant toward publishing only results that confirm the interests of those who finance the studies has undermined my own faith in much of psychiatric research.

For more information about the ties between psychiatry and Big Pharma, read Daniel Carlat’s book Unhinged, which will give you a good overview of some of the unclear ties between truth and money in the field of psychiatry.

Do We Know the Long-Term Risks?

In addition, it is concerning that we don’t quite know what the long term effects are of taking psychiatric medication.

In some cases, the long-term effects are quite clear. It is well known that some anti-psychotic drugs cause diabetes, weight gain, and sometimes permanent brain damage that can result in weird tongue movements.

Why should this be of concern to people with depression and anxiety? Because advertisements are currently telling people to ask their doctor to add the anti-psychotic Abilify to treat their treatment-resistant depression.

Other sources indicate that the long-term use of many of the most common psychiatric medications, such as anti-depressants and anxiolytics (anti-anxiety agents like Xanax), change the person’s brain chemistry permanently and make you more susceptible to relapse, once you stop taking them. In other words, unless you want to take them for life, you may be better off not taking them at all.

Robert Whitaker’s book on “The Anatomy of an Illness” and Peter Breggin’s book “Toxic Psychiatry” both weigh in with some alarming arguments that cannot be taken too lightly.

Is it Philosophically Sound?

Finally, I think we have to question if it is philosophically sound to treat anxiety and depression as if they were simply ailments to be cured, rather than symptoms or signs of something that is not right in our lives. No matter if medication can indeed make us more numb to our pain, or help alleviate our anxiety, they are no substitute for introspection into our patterns of behaving.

It is human to struggle emotionally and to be caught in difficult dilemmas. We all feel down-trodden and incapable at times. We all have to struggle to create close ties with others, to risk love, to endure loss, and to face rejection. We all have childhood wounds and special sensitivities. Life is not easy, but we learn from it, and we develop strengths and wisdom through the insights taught to us by our emotional pain and struggles. There is no medication for life itself.

Should I Take Medication for My Depression or Anxiety?

Since we know psychotherapy is effective for helping people not just cope with their depression and anxiety, but make sense of it, and use it as a growth opportunity, why would anyone as a first choice choose to gamble with medication?

Psychiatric medication may sometimes be the best or the only option, but it should never be the first choice. I respect each client’s right to make their own free choice, but given the ambiguous picture of benefits and risks of taking medication for your anxiety or depression, I would be both cautious and conservative.

Unfortunately, many times we don’t get the opportunity to make this choice. Few people really know the literature that warns us of risks and dangers, and the general societal discourse, backed with pharmaceutical money, marketing, and pseudo-science tells us a propaganda story. Science is not so neutral after-all, and no profession is going to openly turn its back on its own bread and butter.

This is why in today’s society, it pays to be an informed consumer.

Dr. Rune Moelbak

About me: I am Rune Moelbak, a psychologist in Houston, TX, who treats people – not disorders. To read more about how I can help you with your anxiety or depression, visit my website: www.bettertherapy.com

 

The Myth of Major Depression – Why Depression is not an Illness…

depressed person

The Rise of Major Depressive Disorder

It has become common nowadays to think of depression as a medical condition. If you visit your general health practitioner, she might ask a few questions about your energy level, appetite, sleep, and mood and, if you answer these questions in a particular way,  tell you that you have “Major Depressive Disorder”. Major Depressive Disorder, you will be told, is a real illness. And like any real illness, it even comes with its own pill prescription (SSRIs)…

This way of thinking about depression, however, is really the product of a medical discourse that has been spoken so many times that it is has begun to ring true. And yet, as a psychologist with many years of experience helping people who are depressed, I am here to tell you that the emperor has no clothes on…

The Reduction of Subjective Distress to Objective Symptoms

The talk about depression as an illness is really the result of a more overarching trend in the mental health field to reduce life to objective behaviors or symptoms. We take two individuals and observe how they act, talk, or say they feel. We extract the behavior they have in common, and bam! we have arrived at a symptom. One person’s sleepless nights, for example, are equated with another person’s sleepless nights, and what we now have is the symptom of “reduced sleep”. When we observe a collection of such abstract symptoms that appear to frequently occur together, we end up with a “syndrome”, or a certain cluster of symptoms. And when we give a name to such a cluster, by inventing nouns like “Major Depressive Disorder” or “Generalized Anxiety Disorder”, these nouns then take on the status of illnesses that appear to preexist and explain the appearance of the symptoms.

The Loss of the Subjective Meaning of Depression

So what is the problem with this way of thinking? Well, for one, we have abstracted the symptom from the life of the person, and without this person, the symptom has lost its meaning. It is for example quite different to have a sleepless night because one feels empty inside and can’t stand the stillness of the night, and to have a sleepless night because one lies awake beating oneself up about things one should have done differently during the course of the day. In the one case, the sleeplessness announces to the person that they have become too alienated from their own experience (emptiness being the result). In the other case, the sleeplessness may bear witness to a traumatic event that the person has resolved to deal with by feeling eternally guilty…

The idea of the symptom as some abstract behavior erases these differences and treats each individual’s behaviors as if they were the same. Reduced sleep thus becomes a rather hollow concept. In its abstractness, it hides more than it reveals. To say of both instances of sleepless nights that they refer to the same phenomenon is a stretch, for what looks the same on the surface, betrays significant differences when an understanding of the life of the person is taken into account.

When depression becomes a universal construct or set of behaviors, its true meaning is lost. For in reality, there can be no depression outside the concrete life of an individual. And even though we may label two people’s behaviors as depressed, the meaning of their depression can vary widely. One person may be depressed because they are faced with a life situation that demands they assert themselves, but have fears about doing so, and therefore can do nothing but admit defeat. Another may be depressed because they have cut out social contacts to deal with their social anxiety and now find themselves devoid of meaningful relationships. In short, there are as many types of depressions as there are people who are depressed. There is always a unique story to be told…

The problem with a construct like Major Depressive Disorder is that it gives us the illusion that it exists as some “thing” in itself. It conveys that the “wizard behind the curtain” is a disease process and not a person.

A Faceless Healthcare…

In line with this view, “treatment” of depression becomes a rather impersonal endeavor. One treats “symptoms” not “people”. Instead of taking time to listen and understand, to help people figure out what depression means in the context of their other life problems, one now gets prescribed an SSRI or gets education about sleep hygiene…

Constructs like Major Depressive Disorder, and the philosophical assumptions that underlie them, lead to a faceless kind of healthcare that is devoid of the subjectivity of the person. They trade an abstract category, for the real deal…

Depression is, and always will be, shorthand for a multitude of particular ways that people struggle. Only when we understand the life of each struggling person, will we succeed in understanding what depression really is, for it is many different things to different people. Depression is not a “thing”, and is not an “illness”. Instead it is a marker of a particular stuckness in a person’s life. It  acts as an invitation or perhaps a dictate to discover something deeper about ourselves…

About me: I am a clinical psychologist in Houston Texas. Visit my therapy website to read more about my treatment approach to depression.