Why you should not always go for antidepressants

People have different perceptions when it comes to defining ‘depression’. For quite some time now, majority of Tanzanians haven’t acknowledged depression as a serious condition.

Statistics reveal that a lot of youth have died in silence by committing suicide; the very underlying major factor remains to be depression. Close to 800,000 people die due to suicide every year, globally, according to reports from World Health Organisation (WHO). Suicide is the second leading cause of death in 15-29-year-olds. However, my long time concern is how to help people with depression in managing the condition. As a matter of fact, depression comes from variety of factors and how to control it remains different for each.

Pills aren’t the answer

For the longest of time we have preferred different categories of antidepressants as the first and best way to manage depression to our patients, regardless of the different causes of depression. This has eventually turned our people, especially the victims of depression to be more dependent on just antidepressants to seek for relief.

But the big question to both patients and healthcare providers is: “Are the antidepressants always an answer to depression? Are people well aware of antidepressants dependency? Do they really know that there is such a thing called antidepressants addiction?”

My case: Supressing an underlying condition

Few days ago, I attended to a lady in her 30s who looked pale with extreme fatigue. This patient was known with long history of depression due to some social and family issues she had encountered.

During consultation, she confessed that she even had suicidal thoughts multiple times.

She has been through several rounds of antidepressants from other facilities, with no signs of improvement. This patient clearly shows every symptom of depression, but the trickiest part is, even antidepressants were of no help to her.

I ordered laboratory investigations for her, and her results showed that she has iron-deficiency anaemia and very low glucose in the blood, a condition medically known as hypoglycaemia. Prescribing an antidepressant in her case would not do anything about relieving all of the fatigue that she has been experiencing.

She has a long history of depression, but that does not mean it should be assumed that her current episode of fatigue should be attributed to it. I prescribed iron tablets for her and other medications to stabilise her sugar level in the blood. Also we had to coordinate with her primary care doctor for further assessment of the cause of her iron-deficiency anaemia and her hypoglycaemia. We also made a timetable of appointments to monitor her response to iron treatment and continue to assess for psychiatric symptoms.

When she returned for her follow-up, a week later, she started to cry when she expressed gratitude for her relief. She was frustrated that her anaemia and low sugar level in the blood were never diagnosed before and that she was unnecessarily put on many pain medications in attempt to bring relief of the pain.

There are many other physical illnesses that can present similar to how depression is experienced in some patients. It is very possible, from a medical point of view that her depression unknowingly led to both of these conditions. That’s why before the patient jumps to ask for antidepressants, he/she should look out for some other factors that leads to his/her persistent depression and present all those factors to a doctor. So many medical conditions have been the cause, or at least a contributing factor, to symptoms perceived by the patient as depression. It’s wise to look beyond just symptoms and carefully look for cause and contributing factors of the presenting chief complaint of depression.

An antidepressant isn’t always the answer to what appears to be depression.