There have always been poor souls who just can’t seem to shake off their melancholy.
The first known description of that condition was pressed into a clay tablet by a Babylonian priest about 3,500 years ago. The Babylonians believed that unshakable melancholy was a spiritual affliction best addressed by clergy. One millennium later, the Greek physician Hippocrates cast a secular eye on the problem and pronounced it “melancholia.”
Subscribing to the humoral theory of medicine, Hippocrates believed that all illness resulted from an imbalance of bodily humors, and that an overabundance of black bile—literally, “melancholia”—manifests as persistent fear and despondency, poor appetite, sleeplessness, irritability, agitation, restlessness and an aversion to food.
Treatments for melancholia have varied widely through the ages. Hippocrates favored frequent baths, strict sexual abstinence and purging. Roman doctors preferred exercise and bloodletting. The 10th century Persian physician, Al-Akhawayni, prescribed a diet of wholemeal bread, beef and salted fish liberally seasoned with cumin, saffron and coriander. More enlightened Renaissance treatment plans included eggs, freshwater fish, grapes and exorcism. By the 17th century, music therapy was widely applied.
About 200 years ago, “melancholia” was rebranded “depression” and drugs were added to the sufferer’s diet, substances including ferrous iodide, ergot, arsenic and opium. As science advanced, so did treatment options, and those grappling with depression in the 1930s were customarily subjected to hydrotherapy, convulsion therapy and insulin shock therapy, practices thankfully retired in the 1940s in favor of psychotherapy. It wasn’t until the 1950s that the current generation of antidepressant drugs started changing the game.
When doctors say depression, they mean clinical depression, also known as major depressive disorder (MDD). It’s believed that genetics, brain chemistry, stress and medical conditions can all contribute to clinical depression. Symptoms include sadness, low self-esteem, agitation, emotional fragility, self-isolation, loss of sleep, loss of appetite and difficulty concentrating. Importantly, at least five of those symptoms need to be present, and to persist for at least two weeks, before a proper MDD diagnosis can be made.
Clinical depression isn’t grief. It isn’t the blues. It isn’t a bad week. It’s wretched, smothering quicksand that swallows light and hope, drains the life from mind, spirit and body. Those suffering from clinical depression are 20 times more likely to commit suicide. Drugs like Prozac, Celexa and Zoloft have saved countless lives and eased untold suffering.
In theory, antidepressants work by elevating levels of mood-improving neurotransmitters like serotonin and noradrenalin in the brain, restoring what doctors presume to be the brain’s natural chemical balance. In practice, no specific chemical imbalance has ever been identified or definitively linked to depression, and there is no evidence that any drug precisely targets a specific biological abnormality. In effect, scientists aren’t entirely sure why or how antidepressants work, or exactly who should be taking them. But that doesn’t stop doctors from dispensing them like Skittles.
According to the National Institute of Mental Health, about 21 million adult Americans, roughly 8.3 percent, are experiencing MDD. At latest tally, more than 15 percent of adult Americans, roughly 37 million, take antidepressants. Women outnumber men more than 2 to 1 in both categories.
Antidepressant use among the young has increased 64 percent since 2020. While it’s tempting to blame COVID, teen antidepressant prescriptions have been on a sharp upward trajectory for 20 years, at least, and it’s a distressingly one-sided phenomenon. The rate of antidepressant use by males ages 12 to 25 has actually gone down slightly since 2019. For women ages 18 to 25 it’s gone up 58 percent during the same interval, and for girls ages 12 to 17 it’s up 129 percent.
Whether all of these people have an MDD, or whether we’re fudging the standards to include the gloomy, the glum and the woebegone, depends on which expert you ask. But the fact that 14 million adult Americans are taking powerful, psychoactive medications they may not need, and that may do them more harm than good, gives cause to pause.
Antidepressant medications can precipitate headaches, nausea, blurred vision, constipation, excessive sweating, skin rashes, decreased alertness, nervousness, insomnia and fetal malformations, and they cause suicidal thoughts in about 18 percent of patients under 25 years old. A significant percentage of users will also suffer a harsh withdrawal period if and when they get clean.
For those diagnosed with clinical depression, antidepressants are appropriate and necessary. For anyone else, they’re a quick fix, a magic bullet for the sometimes difficult human condition, an easy way to feel better without putting in the work. There’s also a growing body of evidence that antidepressants have become fashionable in some circles, particularly among the young. Many medical professionals are now urging that, before strong-arming your doctor for happy pills, try putting in the work. There are plenty of proven tactics for improving the mood short of medicating it.
Eating healthier is an excellent place to start. A diet rich in fruits, vegetables and whole grains improves internal chemistry naturally, and St. John’s Wort, lavender and omega-3 fatty acids have long been known to support good spirits.
If you frequently imbibe alcohol or drugs, stop it. It’s making you feel worse, not better.
Exercise. Vigorous physical activity gooses precisely the same neurotransmitters as antidepressants do, and all the side effects are good.
Talk about your problems. Whether you choose to share with a professional, in a group setting, or simply with a trusted confidante, getting it off of your chest is powerful emotional therapy.
Try to get enough sleep. Maintain a consistent sleep schedule and, if you don’t have a relaxing bedtime routine, get one.
Make a point of going outside and interacting with people. Friends and family are a good first string, but anyone will do. Social isolation is deeply depressive.
Creative outlets like arts, crafts or writing divert the mind from gloomier avenues of thought and award an uplifting sense of accomplishment.
Perhaps the most insidious side effect of antidepressants is that they make it easier to hide from adversity than to face it head-on. If you can identify the source of your depression, try to do something about it. If the problem can be corrected, correct it. If it can be escaped, escape it. If it can’t be either, try to reach an emotional accommodation with it.
Everyone’s life is plagued by anxieties and dissatisfactions. If your depression is clinical, medication can be a potent ally. If it’s not, your single most effective weapon against the blues is your attitude.
