Sealing over emotional problems with medication

I’ve never been convinced that any apparent response to antidepressants is more than placebo. Although short-term clinical trials may show a small advantage for active treatment over placebo, it is possible that this difference could be a artefact because of methodological problems with the trials and bias in the literature (see eg. previous post).

Placebos have effects because of patients’ belief in their treatment. These positive hopes about the effectiveness of antidepressants may be reinforced by the serotonin myth or other hypothesised brain mechanisms of antidepressant action. Patients are encouraged to take their medication by doctors telling them that their depression is due to a brain problem that is corrected by medication. However, by believing the myth that depression is caused by brain abnormalities, the real reasons for emotional problems may not be recognised and corrected. In other words, although emotional difficulties may be sealed over by taking medication, patients haven’t necessarily improved their understanding of the reasons for their problems. They do not necessarily incorporate their experience in a properly integrative way.

Beliefs about medication can therefore be powerful and the disadvantages of relying on medication need to be recognised. Believing treatment has been effective because of its antidepressant action, when the apparent benefit has really been due to placebo, can leave people feeling that their emotional problems have not really been solved. This may well be true because the social situation that caused the depression has not changed. Patients do not necessarily feel they have made a proper recovery or returned to their true self. Masking the real problem can create a sense of inauthenticity with the experience of flattening and numbing of emotional responses.

Avoidance of stress by taking medication is not necessarily an irrational coping strategy. Many people when they are depressed are in a desperate situation. It may well be understandable that they latch on to whatever is offered to them to make a recovery. Taking medication may seem like the only possible option available. But if there is an improvement, leading patients to have faith in the medication, it can mean that they continue on the medication becoming psychologically dependent on it over time. They become fearful about upsetting the mental equilibrium acquired through taking medication. No wonder they may have discontinuation problems.

Sealing over emotional problems with antidepressant medication can therefore cause withdrawal problems and emotional numbing as nocebo effects (see eg. previous post). Using medication as a coping strategy may not necessarily produce the better outcome obtained through incorporating emotional problems into the patients’ life narratives. However difficult it may be, recovery from a depressive episode can be transformative.