Some depression treatments overshadowed by misconceptions about antidepressants

Depression affects tens of millions of Americans. More than 13% of adults in the U.S. take antidepressants.

Today's use of antidepressants grew out of a still unconfirmed theory about depression developed decades ago.

In an article for The Conversation, Elissa Patterson and Jay Kayser wrote about that history and made the case that reliance on medications has overshadowed the potential of other treatments. Patterson is a University of Michigan assistant professor of psychiatry and neurology. Kayser is a Ph.D. student in social work and developmental psychology at U of M.

A theory, still unproven

Researchers in the 1960s theorized that depression is caused by a chemical imbalance. Drug companies developed antidepressant medications based on that idea.

"The chemical imbalance theory has come to be popular shorthand for depression, and that has led many people to believe that the only way to treat depression is to take a drug that will repair that chemical imbalance," Patterson told Michigan Radio in an interview on Morning Edition.

But scientists still haven't been able to confirm the now well-known theory.

"Surveys show that over 80% of the general public believe that the theory is true. The research, though, does not back it up," Patterson said.

She believes the large market for antidepressant medications is one of the reasons why the facts about research have not been at the forefront.

"The cartoonized advertising material [about depression treatments] has been an easy shorthand way to think about what's happening in depression. And so there hasn't been a large motivation to correct that misinformation," she said.

In their article, Kayser and Patterson cite research that found nearly 3 out of 4 patients who take antidepressants do not get complete relief. Many of those patients eventually have their form of depression labeled as "treatment resistant." Kayser finds that can fuel a demoralizing and untrue perception that depression is "incurable."

"Depression, by its very nature, is really associated with an internal feeling of brokenness. So putting a label of 'treatment resistant depression' in some ways plays into that belief," Kayser said.

Different people, different treatments

But there is hope for those who don't get relief from medications.

"There are alternative treatments out there that really can tap into someone's own abilities to be resilient and to recover from depression. Medication is an excellent option for many, but we kind of want to expand the conversation out to cover alternative approaches, too," Kayser said.

Some alternative treatments for depression can come with improved physical health and social well-being.

"The mind and the body are actually deeply intertwined. So we're taking care of our psychological health by doing things with our body. Moving, connecting with our friends and family members, eating a healthy diet with mostly plant based foods, sleeping well as much as we can," Patterson said.

"If we can all adapt the idea that well-being is something within our control, I think we'll feel empowered."

Patterson and Kayser stress that they are not opposed to antidepressants, but instead favor a multi-pronged approach.

"There really is no one-size-fits-all. There are a lot of good options, but they may not work for everyone. Talking to a therapist [or] any mental health professional can be a really strong way to start to explore what the best options for you might be," Kayser said. "Expertise is not something that is located solely within mental health professionals. It's something that dwells within the clients, the folks that are reaching out."

"Some people might absolutely love to do yoga," Patterson added. "Other people might feel like that's the worst possible recommendation anyone could ever give them."

A larger lifestyle conversation

Depression is often misunderstood and can carry stigmas. Some people don't understand why people with depression can't just "snap out of it." While stigmas can discourage people from seeking help, Kayser has seen signs of positive change.

"The COVID-19 pandemic certainly was a big driver in increases in mental health concerns. It also, on the other side, was a big driver on increasing the popular dialog around depression," he said.

Depression can also have serious effects on energy and motivation, so it's easy to understand the appeal of a straightforward "here's a pill that will fix this" approach. Could it be too much to ask patients to take on self-driven, alternative treatments that can require significant time and effort? Patterson takes a broader view.

"Many people are overworking themselves because they have to in order to survive," she said. "If we, as a society, tried to help create a more equitable system where people are able to get by and have the time to thrive and to do the things that we know go into a happy, healthy life, we could remove some of the burden and some of the sense of guilt or shame about not being able to thrive and flourish."

Further reading: "Depression too often gets deemed ‘hard to treat’ when medication falls short" by Elissa Patterson and Jay Kayser for The Conversation

Editor's note: Quotes in this article have been edited for length and clarity. You can listen to the full interview near the top of this page.