By Irene Oudyk-Suk

My friend called not long ago. “Yesterday was OK, but today is awful,” he said. “And business is bad. I’m not a good dad. And my brain won’t turn off at night. I’m tired all day.”

“So,” I ask, “are you taking your medications?”

“Not for six months now—I’m sick of meds. I don’t like the side effects. I want to go without. I just need to pick myself up and get over this.”

Many people find mental-health medications such as Prozac helpful for treating depression or anxiety.* But others, like my friend, resist medications even when symptoms—such as inaccurate self-perceptions—persist. Most people’s objections to medication, however, are unwarranted. Let’s examine them together and consider some strategies for deciding on treatment.

Get Over It
When my friend says, “I should be able to get over this depression,” he echoes an ancient belief that the mind and body are distinct, hierarchal entities. The Greek philosopher Plato suggested that while the mind, or spirit, was animated by a divine spark, the material body was home to ugly, material passions.

Making allowance for the body’s crude needs, while expecting more of the mind, has been part of our culture ever since. Today this attitude is evident when people feel free to take medications for physical problems such as diabetes but won’t admit to “mind” problems such as depression and feel that using meds for mental health is shameful.

The mind and the body, however, are inseparable and divine creations. God created both equally good and holy. The body and mind are also equally prone to the ravages of disease. Just as a blood thinner might be prescribed to treat cardiac disease, a drug like Zoloft might be necessary to treat anxiety. Our whole self—body and mind and spirit—is entitled to nurture, care, and if necessary, medication to be all that God intended for us.

Pray More
Christians sometimes blame depression on a lack of faith. “I need to pray more, then I’ll get over this,” they think. As a mental-health professional I’ve noticed that, actually, this usually works the other way around: depression often causes spiritual malaise. So, for example, depressed Christians who are asked to complete a symptom checklist when they first come to the office frequently check items indicating unhappiness in their spiritual life. Months later, when the depression has lifted, they no longer check these items as problematic, even though their prayer life or devotional time has not really improved. Once they’ve overcome their depression, however, they stop beating themselves up about spiritual shortcomings and, instead, work at them like all Christians do.

Side Effects
Daytime fatigue, nighttime insomnia, sexual difficulties, and weight gain are the most common reasons people give for discontinuing medication. Those of us who haven’t had to struggle with such side effects of medication tend to make light of them. A sensitive and knowledgeable psychiatrist can adjust, change, or add a medication to help ease side effects. But sometimes all the tinkering in the world doesn’t help. In such cases patients need to do a personal cost-benefit analysis of the pros and cons of taking medication. The results will be different for everyone. Spouses or parents can often help people struggling with depression work through some of the issues here—which, in the case of sexual difficulties, might also be opportunities for spouses to offer support and encouragement.

Deal with the Real Issues
During our conversation, my friend told me, “I’ve never really worked through my mother’s death. I don’t need meds; I need therapy.” Painful events can cause debilitating anxiety. But, as in my friend’s case, exploring deep emotional issues while your mental health is fragile—without the safety net of medication—could be more harmful than helpful.

Don’t Need It
Depression can be so pervasive that it begins to seem normal—and thus not worth treating. However, loved ones will still feel the abnormal effects of depression keenly. Mental illness always makes interpersonal communication difficult. Marriages sometimes break up because of untreated depression. Children who grow up with an anxiety-ridden parent in denial tend to reap negative repercussions well into their adult years. The needs of loved ones must also be taken into account when doing a cost-benefit analysis of taking medications.

Meds Don’t Work
Taking medication for anxiety is not always as easy as the drug-company ads on TV make it look. The first medication prescribed may be ineffective or have intolerable side effects. Some times five or six meds need to be tried before an individual experiences any improvement. Effective treatment may also require more than one medication—tough for someone who doesn’t want to try even the first. And sometimes meds don’t seem to work because the body can take a long time to respond—up to two or three months in some cases. No wonder people in the throes of depression sometimes run out of patience.

Don’t Trust Meds
People are increasingly cautious about the medications they ingest. This is good—we need to be informed consumers. The claims pharmaceutical companies make can be misleading. Much drug testing is done with white males of college age who meet strict criteria for just one mental-health condition. These studies often last for just 26 weeks. Few studies look at the effects of more than one medication. Not much help when you’re 46, Chinese American, female, and have multiple symptoms that fit into a number of different mental-health diagnoses.

Just the Easy Way Out
My friend has never accepted easy answers for complicated issues. He correctly points out that modern society appears to use medication as a panacea instead of wrestling with the real ills of the 21st century. However, I’ve also noticed that my friend thinks better about complicated issues when the fog of depression lifts.

What Others Think
“People look at me funny when they learn I take medication,” I often hear. And people do sometimes look askance because they, too, struggle with the same misconceptions and prejudices that we do. Yet disclosure can also result in a gracious response of care and empathy. Don’t shut that possibility out! When you share your story, you may also learn of others who face similar struggles.

Deciding on Treatment
So what is the 46-year-old Chinese American woman to do when she isn’t sure about her prescribed meds? Or the 60-year-old man who sits next to you in the pew every Sunday?

Alternative treatments are a possibility (see box). However, the effort of following through with other treatments is often overwhelming for people in the throes of a major depression. Alternatives are usually best explored after traditional medication has brought the depression under control.

A visit to the family doctor is a good first-time strategy, but a psychiatrist is the specialist of choice when the side effects of medication are intolerable or the depression recurs. A good working relationship with a knowledgeable psychiatrist is vital. Finding the right psychiatrist may take a few tries but is worth it in the long run.

Remember, too, that just as heart conditions or certain types of cancers run in families, so do some mental-health conditions. It’s as important to be fully informed about your family mental-health history as it is about your family’s cancer or heart history. Such information can be very helpful to psychiatrists and therapists in particular.

Treating mental illness takes vigilance and research. Support systems are invaluable. Family members, small church groups, therapists, and friends can help with research and provide honest feedback on the effect your depression has on others. They can think aloud with you through a cost-benefit analysis of taking medication. List the pros and cons, and discuss them with your trusted circle.

Lewis Smedes, the late Christian Reformed pastor and author, wrote of his own struggle with depression. He tells of God breaking through his despair and lifting him straight up into joy, “though,” he says, “I must, to be honest, tell you that God also comes to me each morning and offers me a 20-milligram capsule of Prozac. . . . I swallow every capsule with gratitude to God” (My God and I: A Spiritual Memoir, Eerdmans, 2003).

Exploring Other Treatments
Ideally, treatment for mental-health conditions should include more than medication. Occasionally medication can be reduced, or alleviated, with other treatments. Some alternative treatments are better researched than others, and some are appreciated by the medical community, while others are not. Internet access is helpful in exploring the mental-health treatments listed below.

The list is not exhaustive—entering key phrases such as alternative mental health, cognitive therapy, or neuro-feedback into a search engine will bring up plenty of websites to explore. You will run across on-line support groups that, over time, can prove helpful. Exercise caution, however, before spending a lot of money on anything that looks promising. Discuss alternatives with your support group—including your psychiatrist and/or therapist.

1. Research has shown that spiritual disciplines such as prayer, meditation, and regular church attendance are helpful for dealing with many diseases, including mental-health problems.

2. Healthy Lifestyle Habits: Enough sleep, regular exercise, good nutrition, and stress-management tools such as relaxation and journaling are the basic building blocks of all health, including mental health.

3. Counseling: Therapists use various models of psychotherapy. My favorites include Cognitive-Behavioral therapy, and Eye Movement Desensitization and Reprocessing therapy.

4. Light Therapy/Neuro-Feedback: Helpful for some people. Not necessarily supported by the medical establishment.

5. Support Groups: Most communities have them, and they provide encouragement and valuable information about psychiatrists, therapists, and treatment strategies.

6. Supplements and Allergy Testing: With the deterioration of food quality due to some modern farming practices, some mental-health advocates argue for the addition of various vitamins and supplements to the diet. They also suggest that food sensitivities and allergies may be responsible for many more mental-health conditions than the mainline medical community acknowledges. You must keep your psychiatrist informed of your interest, but don’t expect your psychiatrist to be knowledgeable about this area. You’ll have to do your own extensive and careful research. You could begin by looking at Andrew Stoll’s research on mega doses of omega-3 supplements and Daniel Amen’s advice. Dr. Amen is an expert on attention deficit disorder, as well as on depression and anxiety.

*This article uses the words depression and anxiety generically and interchangeably to refer to all kinds of mental-health conditions, including bipolar depression, obsessive-compulsive disorder, social anxiety, attention deficit disorder, schizophrenia, major depression, and more.