The Overuse Of Antidepressants Isn't The Problem: It's Ignoring The Role Of Trauma In Suffering

There Are Many Common Criticisms Of Antidepressants, Including About Their Overuse 

Criticism of antidepressants is a trope employed to a number of different ends. Some frequent critiques of antidepressants are that they are unproven (I think there’s mixed truth here–we know less about how antidepressants work than people think, but some users experience some relief and a small portion receive significant relief), mind-changing and dangerous (unclear), and a placebo effect (maybe, but for some that is a welcome relief).

Perhaps the most common critique is that they are overused. I think this is very likely true, though complicated. It’s impossible to overstate how much easier and inexpensive it is to deliver antidepressants than effective psychotherapy. Yes, psychiatrists are expensive, but within a handful of visits an individual seeking relief from anxiety or depression can be on a path to needing infrequent maintenance. In fact, most antidepressants are prescribed by a primary care physician, and so take a similar amount of intervention as, say, managing cholesterol (which is to say, thoughtful diagnosis and then minimal effort to monitor effectiveness). One obvious concern here is whether this allows for the level of careful monitoring that would be needed–a handful of primary care visits with infrequent maintenance is nothing compared to weekly (or more) psychotherapy that’s needed for years.

As with many prescription meds, antidepressants are an easy solution for a physician looking to offer his/her patient some relief. However, I hesitate to cast aside the numbers as mere overuse. If people receive relief, that’s good. Of course, how much relief and how long-lasting is a separate question.

My Problem With Antidepressants: We Too Often Ignore The Role Of Trauma In Suffering 

So what’s my beef with antidepressants? For one, they don’t and can’t change life circumstances–they don’t get you out of a crappy marriage or crappy job, or get you to stop loaning money to your abusive unappreciative brother.

Secondly, their use seems to almost entirely ignore the role of trauma in suffering. Trauma is an underlying condition of most depression and anxiety. That to many, many people seems not to be the case. We have a profoundly powerful narrative about depression and anxiety. Both drug companies and psychiatrists, as well as those who advocate for civil treatment of those with mental health struggles, have insisted that articulating these experiences as biological disorders is the only way for family members and employers to understand, for research dollars to be spent, for insurance companies to pay for treatment, and for individuals to relate to themselves as having not a moral or spiritual problem, but a biological one. I’m not convinced that’s the right move for a number of reasons (for one, we haven’t exactly done a great job relating to people who are “diseased” humanely in our history). But, it’s almost an unassailable narrative.

As A Culture, We Don’t Want To Acknowledge The Amount Of Severe Trauma Many Experience

So why the reluctance to look at trauma as the underlying source of depression and anxiety? For one, it’s simply more difficult to treat. There’s not a pill for trauma, though there are pills that treat its symptoms like depression and anxiety, which are a welcome part of a solution.

I also believe we, as a culture, don’t want to acknowledge the amount of severe trauma that many people experience, especially children. Why? Because it’s painful, because it tells us something about ourselves, but also because to admit it means having to own the fact that poverty, dysfunctional schools, poor supports for women and children, a broken criminal justice system, violent threats, school shootings, racism, rape, childhood sexual abuse, poor protections in the workplace, and poor housing options, especially for women and children, have consequences far beyond the material. They affect our mental health and even when those who experience them can rise above them and achieve greater material stability, they very often affect the mental health of their children.

While it’s not the place of mental health specialists to change those realities, mental health specialists, were they to look honestly at these realities and deeper into the history of those who contact them with distress, would very likely find the biological story of depression and anxiety more suspect. They would also be concerned with the profound inadequacy of antidepressants to truly treat the emotional suffering of their patients.