Image: Frank Douwes, Steve Snodgrass, CC BY 2.0
There’s this one meme going around about antidepressants. I can’t tell you the number of times some thoughtless person has posted this meme and it’s found its way into my feed. It’s reductive, absurd, and anti-science. Here it is:
Okay, so number one, depression — not the emotion, the clinical condition — is a real and serious disease. This meme is no different than advocating “eating clean” over chemotherapy for someone who has cancer, or advocating letting your children “acquire immunity” to Polio by letting them get Polio. It’s irresponsible in the extreme, and contributes to the social belittling of people with mental illness. While a mental illness is literally “all in your head” (as in physically), it’s not imaginary and can’t be wished away through the power of positive thinking.
So there’s that. But this meme (and the deep-seated suspicions of mental health medications) also fundamentally misunderstand how medicine works.
Medicine is the professional practice of risk mitigation. I’ll explain.
My mother had breast cancer. She had surgery, radiation, and chemotherapy. The side effects were awful, but she survived and is doing well. Recently, she was diagnosed with bladder cancer, and the consensus seems to be that the bladder cancer may well have been caused by some of the chemotherapy drugs that saved her from breast cancer. She’s had the bladder cancer removed and had chemotherapy for it, and at this point it’s more of a chronic condition than a life-threatening one.
And here’s the kicker: we’d still have treated her breast cancer the same way knowing the risks.
The reason is simple: bladder cancer is less dangerous and more easily treatable than breast cancer, and the chemotherapy drugs only raised the risk of her contracting bladder cancer, they didn’t guarantee it. If you could just magically trade them one for one — breast cancer for bladder cancer — your doctor would advise you do it. Not because bladder cancer is something you want, but because it’s a lower risk. That’s how medicine works.
Mental illness is the same way.
Antidepressants (real ones, not photos of wooded landscapes) are drugs. They have side-effects, and a lot of them aren’t good ones. Maybe you don’t have the mental illness equivalent of cancer. Maybe your mental illness doesn’t render you a threat to yourself or others, it just (“just”) makes you have a lower quality of life. Maybe you have what’s referred to as “mild depression.” Well, if you live in the UK and are diagnosed with mild depression, they won’t prescribe you with antidepressants — at least, not at first. Since the risks of the side effects are much lower, they’ll probably try a combination of therapy (like Cognitive Behavioural Therapy) and lifestyle changes (like quitting that job where your boss gaslights you on a daily basis). Maybe, if your symptoms are mild enough, meditation and long walks in the forest would even do it for you.
But if you have a serious mental illness, you and your doctors are going to look at the risk-to-benefit ratio of the powerful classes of drugs available — SSRIs, TCAs, MAOIs and so on — and make a judgement call as to what’s the lesser of two evils. Someone whose life is at risk from depression or bipolar disorder should probably be taking medications despite the side effects (which, by the way, nobody’s happy about) because their life is at risk. That’s how medicine works.
Going for a walk in the woods is a lovely thing to do when you’re having a bad day. When you have a serious mental illness — just like any other serious illness — you take medications. So, here, I’ve fixed it for you:
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Richard Ford Burley is a human, writer, and doctoral candidate at Boston College, as well as an editor at Ledger, the first academic journal devoted to Bitcoin and other cryptocurrencies. In his spare time he writes about science, skepticism, feminism, and futurism here at This Week In Tomorrow.