Do antidepressants provide a permanent solution for depression and anxiety?

Question

Antidepressants works temporarily (as long as you take them), and also affects the cognitive behaviour. Should they be seen as a permanent solution for depression? Shouldn't we find a solution at the psychosocial level, which actually works rather than suppressing the thoughts?

Answer 1

Most studies exploring the impact of medication for the treatment of depression track patients in the short term. Also, these clinical studies are typically not as comparable to the general population as many of exclusion criteria are strict, and rule out individuals who have co-morbid conditions like an anxiety disorder.

http://psych242.class.uic.edu/Articles/Zimmerman,%20Sampling%20in%20depression%20research,%20AmJrPsy,%202002.pdf

Overall, medication without any psychological intervention is largely a short-term fix. Most studies have shown that the most effective course is to have a combination of antidepressants and therapy, like CBT. In my experience, getting to the core of a psychological issue requires exploration through therapy, while medication is important for managing some symptoms, specifically in the case of severe depression. It is important for a person to be stable before engaging in intensive psychotherapy, hence, medication should be the first course of action, along with more behavioral approaches such as behavioral activation, positive coping skills, etc.

"In any comparison between psychotherapy and medication, it is important to examine whether the sample was responsive to medications and whether pharmacotherapy was adequately implemented. Among more severely depressed participants in this trial,ADM significantly outperformed placebo through 8 weeks of treatment. There were no significant differences in outcome between ADM and placebo for the less severely depressed participants, consistent with findings from numerous other studies (Hollon et al., 2002). In the absence of a demonstrated drug effect for such patients, there may be little justification for prescribing psychoactive medications when there are comparably effective psychosocial alternatives free of side effects."

Among more severely depressed patients, behavioral activation was comparable to antidepressant medication, and both significantly outperformed cognitive therapy.

Depression occurs for many reasons. One route is commonly due to negative and distorted core beliefs (in line with CBT theory). These beliefs and narratives need to be brought out of automatic processing and explored, and ultimately changed or replaced with beliefs that are not distorted. Also, depression occurs when automatic thoughts are highly negative, bringing about debilitating emotions. Often, people attempt to suppress these thoughts by avoiding situations or even resorting to means of distracting themselves by using drugs.

Depression can also occur when one is no longer living in line with their core and true values, and rather responding to life based upon avoidance of feared outcomes, often irrational and unexplored fears. This is in line with Acceptance and Commitment (ACT) theory, which proposes that through mindfulness and learning to observe the process of your mind and body rather than getting attached to the content, you will gain freedom from the impact of the thoughts. Then, you can start to focus on your values, and slowly identify how you interrupt your pursuit of a meaningful life.
If depressive symptoms are severe, and a person is struggling to get out of bed, than medication can help provide reduce these symptoms enough to motivate the person to engage in therapy.

Overall, medication alone is not a long term fix to psychological problems, although it can be highly effective and necessary for certain populations. Medication also communicates that depression and anxiety are things to be fixed; they are not. All humans, at some point in their lives, will struggle psychologically. Moreover, we all do our best and have ways of responding that we typically learned as children and that helped us to survive at certain points in our lives. The issue becomes that when our context changes, some become stuck in old ways of responding to a new context. Adaptation is key, and to adapt you have to become self-aware in order to have the choice to make a positive change.

Answer 2

Your assumption that antidepressants works by "suppressing the thoughts" is not supported. Arguably it's quite the opposite. But let us not comment any further.

Now onto your question

Do anti depressant provide permanent solution for depression and anxiety?

At least for Major Depressive Disorder (MDD), they normally do.

• According to a brochure from the Boynton Health Service of the University of Minnesota:

  Once you respond to an antidepressant, we recommend that you continue to take the medication for at least six months. If you stop taking the antidepressant before six months have passed there is an increased chance that your depression will return. For depressions that have lasted a long time (a year or longer), or for a recurrent depression, longer periods of treatment should be considered. If you wish to discontinue your medication, we recommend that you do this during times of decreased demands, such as during breaks or during the summer months.

  Source: "Common Questions About Antidepressants" (2005) - page 2

• According to an article available from the Massachusetts Institute of Technology healthcare service MIT Medical:

  Clinicians usually recommend that people continue taking antidepressants for about six months after they begin feeling better. Although it is tempting to stop taking the medication as soon as you feel better, abruptly stopping will greatly increase your risk of relapse.

  Source: "FAQ: Antidepressants" question #7: "How long should I continue to take antidepressants?"

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• From an article published by the Journal of Clinical Psychiatry, doctor David Louis Dunner has this to say:

  According to the AHCPR Practice Guidelines(1) for the treatment of major depression, acute episodes of depression should be treated for almost a year and recurrent episodes should be treated somewhat longer.

  However, Dr. John M. Zajecka states:

  Clinicians should perceive depression as potentially being a lifelong illness that may require treatment indefinitely in many patients rather than as an illness that can usually be cured with a single, short course of treatment like an antibiotic.

  Dr. Michael Edward Thase notes:

  There is a difference between “forever” and “indefinitely.” In the future, treatments that target the altered pathologic mechanisms of recurrent depression may be available and may have a more curative effect than the present medications, which suppress illness activity.

  While it's debatable whether all "present medications" simply suppress depressive symptoms, consider that this article was published in 2007.

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  Source: "Preventing Recurrent Depression: Long-Term Treatment for Major Depressive Disorder" - PMC 1911177. PMID 17388700.

  References:

  (1) Clinical Practice Guideline. Number 5: Depression in Primary Care, vol 2. Treatment of Major Depression. Rockville, Md: US Dept Health Human Services, Agency for Health Care Policy and Research; 1993. AHCPR Publication 93-0551.

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• Last but not least, from Wikipedia:

  Studies have shown that 80% of those suffering from their first major depressive episode will suffer from at least 1 more during their life,(1) with a lifetime average of 4 episodes.(2) Other general population studies indicate that around half those who have an episode recover (whether treated or not) and remain well, while the other half will have at least one more, and around 15% of those experience chronic recurrence.(3) Studies recruiting from selective inpatient sources suggest lower recovery and higher chronicity, while studies of mostly outpatients show that nearly all recover, with a median episode duration of 11 months. Around 90% of those with severe or psychotic depression, most of whom also meet criteria for other mental disorders, experience recurrence.(4)(5)

  Recurrence is more likely if symptoms have not fully resolved with treatment. Current guidelines recommend continuing antidepressants for four to six months after remission to prevent relapse. Evidence from many randomized controlled trials indicates continuing antidepressant medications after recovery can reduce the chance of relapse by 70% (41% on placebo vs. 18% on antidepressant). The preventive effect probably lasts for at least the first 36 months of use.(6)

  Those people experiencing repeated episodes of depression require ongoing treatment in order to prevent more severe, long-term depression. In some cases, people must take medications for long periods of time or for the rest of their lives.(7)

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  References:

  (1) Fava GA, Park SK, Sonino N (2006). "Treatment of recurrent depression.". Expert Review of Neurotherapeutics. 6 (11): 1735–1740. doi:10.1586/14737175.6.11.1735. PMID 17144786.

  (2) Limosin F, Mekaoui L, Hautecouverture S (2007). "Stratégies thérapeutiques prophylactiques dans la dépression unipolaire [Prophylactic treatment for recurrent major depression]". La Presse Médicale. 36 (11–C2): 1627–1633. doi:10.1016/j.lpm.2007.03.032. PMID 17555914.

  (3) Eaton WW, Shao H, Nestadt G, Lee HB, Lee BH, Bienvenu OJ, Zandi P (2008). "Population-based study of first onset and chronicity in major depressive disorder". Archives of General Psychiatry. 65 (5): 513–20. doi:10.1001/archpsyc.65.5.513. PMC 2761826. PMID 18458203.

  (4) Holma KM, Holma IA, Melartin TK, Rytsälä HJ, Isometsä ET (2008). "Long-term outcome of major depressive disorder in psychiatric patients is variable". Journal of Clinical Psychiatry. 69 (2): 196–205. doi:10.4088/JCP.v69n0205. PMID 18251627.

  (5) Kanai T, Takeuchi H, Furukawa TA, Yoshimura R, Imaizumi T, Kitamura T, Takahashi K (2003). "Time to recurrence after recovery from major depressive episodes and its predictors". Psychological Medicine. 33 (5): 839–45. doi:10.1017/S0033291703007827. PMID 12877398.

  (6) Geddes JR, Carney SM, Davies C, Furukawa TA, Kupfer DJ, Frank E, Goodwin GM (2003). "Relapse prevention with antidepressant drug treatment in depressive disorders: A systematic review". Lancet. 361 (9358): 653–61. doi:10.1016/S0140-6736(03)12599-8. PMID 12606176.

  (7) "Major Depression". MedlinePlus. 10 March 2014. Retrieved 16 July 2010.