Depression: Why See a Therapist if You Can Just Take a Pill?

A few months ago, while riding in my brother's car in Israel, I listened to a talk-show psychologist answer questions. A seventeen year old woman called in. She said that when she went to bed at night she couldn't sleep because she thought of important people in her life dying. "Stop," the psychologist said, interrupting her. "You don't need to say anything more. I don't need any more history. There is a simple solution. Make an appointment with your internist. Have him give you a prescription for anti-depressants. You don't need more than that--nothing more complicated or time-consuming. Take the pills. You will feel better."

This snap advice gave me pause. I wondered: is this the kind of psychological evaluation being conducted in doctors' offices throughout the world? Once depression is diagnosed, no matter how mild or severe, is the treatment plan a foregone conclusion? I worry that general practitioners offices are becoming the drive-thru window for antidepressants. Economic factors support a "don't ask, don't tell" culture in the doctor's office when it comes to taking a detailed psychological history. Was this young woman sexually abused? Was she subject to childhood emotional or physical neglect? Was she traumatized by a death in the family? Does a general practitioner have the time (and expertise) to explore issues of deep psychological significance with patients before making a decision about the most appropriate treatment?

Certainly it is possible the young woman's problem is biologically based - if so, altering the biochemistry may "fix" the disorder. But what if her fears are based upon deeper psychological issues, not revealed in a cursory psychological exam? By taking anti-depressants, the symptoms are reduced and the client feels better. But psychological issues still linger in the background.

Does this matter? Should we concern ourselves with addressing underlying psychological issues when we can simply treat the symptoms?

There are three reasons why treating the underlying psychological issues is important.

First, there may come a time when the client must go off medication because of side effects, medical condition, reduced effectiveness, or simply because he or she prefers to be drug free. If the underlying psychological issues have not been treated, the symptoms may return in full force. If these issues aren't treated, the client may be held hostage by a drug they can't or may not want to take their whole life.

Second, underlying psychological issues may interfere with the development (or choosing) of healthy relationships, which in turn may contribute to the client's depression. For example, "little voices," (people who ask for little from their partners, but instead emotionally twist themselves into a pretzel to earn a "place" in their partner's world--see Little Voices link below) may feel better after taking anti-depressants, but without psychological help, they will have no insight into how their relationship is contributing to their depression. As a result, they may remain in the destructive relationship for years, and continually require anti-depressants to counter the effects. Even if they are able to end a bad relationship, if the psychological issues go untreated, they are apt to repeat their mistake and make another bad choice (see Why do People Choose One Bad Relationship After Another.)

The final reason applies to parents and people who will have children. Anti-depressants may help parents to be more attentive, less preoccupied, and more patient. However, they will not provide the necessary awareness and self-consciousness to prevent psychological issues, such as "voicelessness," from being passed to the next generation. Since these issues are the precursors to depression, narcissism, and other disorders, by not addressing them, we are putting our children at risk. Simply put, anti-depressants, by themselves, will not break the intergenerational cycle of voicelessness. A thoughtful and well-trained therapist helps us fully understand our personal histories, reveals how hidden messages have influenced our lives, and teaches us how not to unconsciously repeat our parents' mistakes.

About the author: Dr. Grossman is a clinical psychologist and author of the Voicelessness and Emotional Survival web site.

next: Vulnerability: the roots of compassion