Dear Stephen,

I don’t know if you see people for depression. Maybe you only work with couples. But I’ve been feeling down for a long time now, and I don’t really have a good reason. My life is okay. I have a job, and I’m in a good relationship, and I really don’t have a lot to worry about. I know I could lose some weight, but I’ve even gotten to a better place on that issue, even though my mother did her best to shame me into the cycle of dieting that so many of my friends have also been caught in. I just feel – blah. And it’s springtime, which is usually a decent time of year for me. A friend told me I should try an antidepressant. What do you think?

Mysteriously Sad

Dear Mysteriously,

I’m glad to hear that your life is going fairly well, even if your emotions aren’t a good match for your life circumstances. (And yes, I do work with individuals, and sometimes we work on depression. Other times, anxiety, or relationship concerns, or whatever else is bothering the person.)

I worked for several years in various behavioral-health organizations, and I still appreciate the wisdom about medication that I learned at Group Health, where I was a therapist from 2004-2007. At Group Health, clients are encouraged to talk to a counselor and see in that face-to-face meeting whether medication is a good option for them. Some people have a big problem with medications, and in those situations, it’s probably better not to go in that direction and stick with counseling alone. Other times, a person is open to trying a medication, and they start a small dose (for example, 10 mg of Prozac per day) and see how things go for a few weeks.

I haven’t met you, so it would be unethical for me to state unequivocally what you should do. But from what you’ve told me, you sound like someone who might want to explore this question with your physician, or with a counselor. I personally try not to be a hard-liner in either direction: for some people, medications are essential, and for others, medications are not appropriate. In most cases, meds are most effective when combined with counseling.

One final note: I wouldn’t want anyone to ‘medicate away’ their sad feelings if the feelings are related to something that’s weighing on your heart and begs to be dealt with. Your life is going well right now, but is it possible that you feel down because it could actually be going much better? Or is there a loss you suffered a while back that you’re only now beginning to wrestle with? I encourage you to seek a counselor who can help you sort some of these issues out, and then address your question about medications.

Take good care!

Stephen

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