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Expert Q&A

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Does depression mean I'll be on meds for life?

Asked by Stan, Brooklyn

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I was recently scared by someone who told me that they have a depression that has "no cure," meaning they have to be on medication for life. This scared me because I am currently going through a depression and I DO NOT wish to take any medication.

I am completely determined to do it by perhaps learning skills that creative positive thought patterns, etc.

Perhaps I have more of a fear of depression rather than depression itself, I am not really sure anymore. I do feel low moods and my thoughts make me feel incredibly sad, but I still have energy to go to school, go to work, be out socially and I am motivated enough to conquer whatever it is, since sometimes I feel like I have nothing to worry about ... yet I am worrying.

My question is, should I fear that I might have to be stuck on medication for the rest of my life? Or does this person simply lack the proper skills to cope with depression and manage it?

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Mental Health Expert Dr. Charles Raison Psychiatrist,
Emory University Medical School

Expert answer

Dear Stan, Your question is a great one, and I bet you know what I'm going to say next if you read this column regularly: It has no answer. Every person with depression is unique and each needs a unique treatment plan to achieve best outcomes.

I'm a big fan of medications. I can't tell you how many people I've seen over the years whose lives were literally saved through their use. But let me say something that might surprise you. If you want to avoid being depressed for the rest of your life there is probably a treatment that is better than antidepressants and that is psychotherapy.

I say this based on several large studies suggesting that psychotherapy may have a better long-term protective effect than medications. The great thing about antidepressants is that they work, they are generally easy to use and safe, and they are inexpensive. But a significant weakness is that they appear to work only while you are taking them. Most people who have chronic depression will relapse pretty quickly once the antidepressants are stopped.

On the other hand, studies show that the effects of psychotherapy can persist for months to years, even for people who are no longer in therapy. This makes intuitive sense, given that good therapy will usually provide understanding of what makes one depressed and what one can do about it.

Let me close by making a few obvious observations about psychotherapy. The first is that therapists are not standardized like medications: There is no FDA for therapists. Some are great and some are terrible. This makes it essential to find a good therapist who has experience with interventions known to treat depression. There is no easy way to do this, but in general I recommend asking doctors in town whom you trust and admire for their recommendations.

Therapy can also be expensive and is often not covered well on insurance policies. I notice that you live in the New York area, which is a lucky break because there is probably more therapeutic expertise there than any place in the country, and that expertise comes attached with training programs that will often provide good therapy at rock bottom prices. If this is of interest, check out the websites of local psychology and/or psychiatry training programs.

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