“Antidepressants are just a crutch”

Yesterday I evaluated a new patient, a young woman who wondered whether medication might ease her depression. She was in therapy elsewhere, and although seeing me was her idea, she was apprehensive about adding an antidepressant. I did end up recommending one, at which point she asked: “Aren’t antidepressants just a crutch?”

I relish this question. It is asked in anxiety, hesitation, and doubt, yet carries within it its own hopeful answer.

“Why yes,” I answered with a smile. “Antidepressants are exactly that, just a crutch.” I pointed out that antidepressants, and all psychiatric medications, are symptomatic treatments. Despite pharmacologic hand-waving about how they supposedly work, the truth is that no one really knows. We do know that antidepressants relieve mood symptoms, in the same way we knew aspirin relieved headaches long before we knew how. Likewise, an actual crutch relieves pressure on a healing foot or ankle without our necessarily knowing the cause or exact nature of the injury.

Like a crutch, an antidepressant provides relatively quick relief without addressing the underlying problem. There is nothing wrong with that. Relief is good, that’s what crutches are for — that, and helping to prevent further injury while the part is healing. The danger is in mistaking this for treatment of the underlying problem. A crutch alone can’t treat a fractured leg bone or a foot infection, and an antidepressant can’t repair the family dynamics or interpersonal losses (or genetic vulnerabilities) that result in depression. Fortunately, crutches are added to treatments, such as casts and antibiotics, that do remedy the underlying problem. And my patient was in psychotherapy to address the underlying problems that led to depressive symptoms. (While we cannot as yet offer definitive treatment for bad genes, that too will come eventually.)

The old concern of psychoanalysts that mere symptom relief would lead to “symptom substitution” and a more difficult analysis has not been borne out. On the contrary, combinations of psychotherapy and medication appear in studies to work better for depression than either type of treatment alone.

I assured my patient that the antidepressant I was suggesting was indeed a crutch: a temporary means to relieve her suffering while her mind is healing. It would also help minimize further psychic injury from poor sleep, social withdrawal, undue pessimism, and perhaps suicidal urges. Like a crutch, when she is feeling better she will stop using it, secure in the knowledge it is available again if it is ever needed.

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