Mind Matters with Kyle MacDonald: Depression therapy and antidepressants together are more effective

Talk therapy can help point out the things that need to change to live a life free of the debilitating impacts of depression. Photo / 123rf

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Q: I've been struggling for a while, and my GP has given me some antidepressants to take. They seem to be helping, but I'm worried that I'll get addicted to them. Is it worth doing counselling too?

A: It can feel like a big step to start medication, but the first - and perhaps only - test is do they help? And from what you've said they do, so that's a good start.

In terms of any worries you might have about what you've been prescribed, it isn't true that the medications most commonly prescribed for depression are addictive, but some people find they can be difficult to stop.

And while that might sound like the same thing, it isn't.

Addiction is defined by an escalating need for the substance or behaviour - tolerance - negative consequences from use, and cravings or a strong desire to use.

This isn't the case with modern antidepressants - the so-called SSRIs or selective serotonin reuptake inhibitors and SNRIs or serotonin and norepinephrine reuptake inhibitors (you can see why they shortened the names).

It is, however, true they can be hard to stop - what is technically called a discontinuation
syndrome. This is largely because they work.

It's a bit like taking a cast off a broken limb. The cast is required to allow the bones time to knit, but once it comes off we have to build up the muscles again because the cast has been doing all the work.

Medication acts a little bit like a cast, supporting us to do what is needed to allow the change to take place. Most of those changes will be changes to behaviour - including thoughts and thinking patterns - and ultimately it's the behaviour change that really makes the difference.

And just like taking a cast off, when we stop medication it can take time for our brain to recalibrate - which is why in most cases it's wise to stop the medication slowly, and with the supervision of your GP.

And that's where counselling comes in. Think of it as the physiotherapy you have to help you rehabilitate the limb. It's more active than just taking medication, requires work and sometimes can even be painful.

Talk therapy can help us to understand the things we need to change - that we may not even be aware of - to ensure we can live a life free of the debilitating impacts of depression.

The trend in the research is clear. Depression therapy and medication together are more
effective than either on their own - in this case, one plus one does equal three.

Not only that but the effect seems to get stronger as the depression is more severe. So-called mild to moderate depression is less helped by medication and more helped by therapy but, regardless, doing both is always a good idea.

So in answer to your second question, yes, doing counselling as well is a good idea, if you have access to it. And even if you don't, concentrate on using the support of the medication to make changes in your life that will stick.

What sorts of changes? All that boring healthy stuff - exercise, working on a regular sleep
schedule, reduce alcohol, caffeine and any other drugs, connect with other people more, and generally get more active - physically and mentally.

Because ultimately getting active and engaged with life is the opposite of depression. And in my view, anything that helps with that is a good idea.