Depression Versus Unhappiness – Are We Over-Prescribing?

I saw a segment on The Today Show this morning about the millions of antidepressants prescribed. Questions arose as to whether or not this is an indication of Americans wanting a quick fix or are doctors over-prescribing the medications. This opens a pandora’s box of issues ranging from who should treat depression to the state of health care (e.g. doctor’s offices becoming mills where many patients are churned in and out with little time to talk). I could go on about many of these issues, but only have time for one today and that’s the issues of what is unhappiness versus depression?

People experience depression differently, but there are a set of criteria that we use to diagnose depression. But rather than list the criteria, let me paint a picture of a depressed person for you. Symptoms vary depending on the person and the severity of their illness, but generally speaking:

• people who are depressed may have trouble experiencing pleasure in anything
• their limbs may feel heavy
• they may sleep all day or have trouble sleeping
• they may have trouble thinking and concentrating such that it affects their work
• they may have constant anger and irritation that is unusual for them
• they may go days without bathing because they just don’t care
• some people describe noticing that colors look duller
• some even feel like life isn’t worth living

This is not an exhaustive list, but some the symptoms depressed people may experience.  This is in contrast to feeling down after a relationship breakup, or having trouble getting out of bed to go to a job you hate. No amount of medication is going to prevent people from feeling bad when bad things happen. I tell patients, whatever problems they have will still be there with medication. The difference is, for a person who is depressed, medication can strengthen their foundation so they can more effectively use their emotional resources to deal with their problems. Depression exhausts your emotional reserves so that you may be unable to handle the stresses of life in your usual way. There are some who have poor coping mechanisms and have trouble dealing with the day to day problems of life and are not depressed but may feel chronic distress. This person may respond better to therapy to help them handle their problems differently.