Treating Depression without Drugs - Part I | Chris Kresser
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Treating Depression without Drugs – Part I


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The most widely prescribed drugs in the U.S. are not for pain management, cholesterol lowering, heartburn or hypertension.

They’re for depression.

Last year doctors wrote $232.7 million prescriptions for antidepressants. That’s an increase of 25 million prescriptions since 2003 and translates into an estimated 30 million patients in the United States who spent $12 billion on antidepressants in 2007.

With numbers like these, a person might make these assumptions:

  • Antidepressants are effective treatments for depression
  • There are few, if any, effective alternatives to antidepressants

As reasonable as these assumptions would be based on the popularity of antidepressants, they are both wrong.

In my preceding articles in this ongoing series on depression and antidepressants, I’ve presented clear evidence that antidepressants are not effective for treating depression.

In this article and the following two, I will present evidence that several non-drug treatments for depression are at least as effective as antidepressants, with few (if any) of their side effects, risks and costs.

As you may recall from the previous articles in this series, recent meta-analyses have shown that antidepressants have no clinically meaningful advantage over placebos. What I have not yet pointed out is that the effectiveness of antidepressant drugs has probably been overstated due to methodological factors in the studies.

In the studies performed on antidepressant drugs, the people taking the drugs also received supportive weekly visits with doctors or researchers along with the medication. The resulting “therapeutic alliance” may have enhanced the efficacy of these drugs and given an inaccurate picture of their effectiveness in a managed care environment where antidepressants are often delivered in conjunction with infrequent visits to a physician or mental health professional.

We know from placebo research that the contact which occurs between the patient and practitioner can be a powerful treatment in itself. Therefore, the supportive visits that patients received during the drug trials could have easily amplified the effect of the drug and made it seem far more effective than it would be in a “normal” clinical situation where visits to a physician or psychiatrist are not regular or frequent.

With this in mind, it is very likely that antidepressants are less effective than placebos in normal clinical practice. Indeed, researcher Joanne Moncrieff has repeatedly pointed out that the term “antidepressant” is a misnomer. The drugs collectively referred to as “antidepressants” do not specifically treat depression (any more than placebo), and therefore should not be called “antidepressants” at all.

What are the alternatives, then, to treating depression? Imagine having a choice between five treatments. Treatment A produces a therapeutic response but also a large number of adverse effects including diarrhea, nausea, anorexia, sweating, forgetfulness, bleeding, seizures, anxiety, mania, sleep disruption and sexual dysfunction. Treatments B, C, D & E produce therapeutic responses similar to Treatment A, but with far fewer adverse effects and costs. Treatments B & C, in fact, have no adverse effects at all and have been shown to be significantly more effective than Treatment A in the long-term.

This is not, of course, simply a hypothetical question. Treatment A corresponds to the selective serotonin reuptake inhibitors (SSRIs) that have become so overwhelmingly popular. Treatment B is psychotherapy, which is as effective as antidepressants in the short term (even for serious depression), and is more effective in the long term. Treatment C is exercise, which has been reported to have lasting therapeutic benefits in the treatment of major depression with no “side effects” except for improved physiological and mental health. Treatment D is light therapy, which has been recently assessed in several clinical studies and is just as effective as antidepressant medication. Treatment E is St. John’s Wort, an herb that has been extensively studied and shown to be similar in efficacy to antidepressants with 10 times fewer adverse effects.

As depression researcher David Antonuccio points out, “whether one subscribes to the Hippocratic dictum ‘first do no harm’ or takes a cost-benefit approach to treatment, it is impossible to ignore the fact that antidepressants are not medically benign treatments.

Antidepressants have serious side effects (listed above) as well as medical risks (including increased risk of dying) when combined with other medications – as is often the case in clinical settings. Antidepressants have been shown to cause potentially permanent changes to the brain that can predispose a patient to depression in the future, and the withdrawal symptoms of SSRIs are substantial for many, if not most, patients.

A frequent argument made by supporters of antidepressants is that patients with serious depression need antidepressants to stave off suicide. However, there is no evidence whatsoever that antidepressants reduce the risk of suicide or suicide attempts in comparison with placebo in clinical trials. On the contrary, in a recent analysis of the data that compensated for erroneous methodologies, Dr. Grace Jackson found that antidepressants increased the risk of suicide by two to four times in adults, and by three times in children (Jackson 2005, p.122)

It has also been demonstrated that recent sharp increases in antidepressant use have been accompanied by increased prevalence and duration of depressive episodes and rising levels of sickness absence (Patten 2004). Naturalistic studies have also shown that depressive episodes are more frequent and last longer among antidepressant users than among nonusers, and that sickness absence is more prolonged (Moncrieff 2006). Finally, long-term follow-up studies show very poor outcomes for people treated for depression with drugs, and the overall prevalence of depression is rising despite increased use of antidepressants (Fombonne 1994).

Please allow me to summarize the research and simplify the preceding paragraphs:

Antidepressants don’t work. If anything, they make things worse.

Now that we have firmly established the ineffectiveness and dangers of antidepressants, let’s look more closely at the alternatives. We will evaluate each treatment based on Antonuccio’s criteria above:

  • Does the treatment do any harm?
  • How do the “costs” compare with the “benefits”?

and we will also compare their efficacy with that of antidepressants.


Several studies show that psychotherapy (particularly cognitive therapy, behavioral activation, and interpersonal therapy) compares favorably with medication in the short-term, even when the depression is severe, and appears superior to medications over the long term (Antonuccio 2002). When medical cost offset, relapse and side effects are considered in a cost-benefit analysis, psychotherapy can be very cost-effective – particularly in a psychoeducational (e.g. therapist-assisted bibliotherapy) or group format (Antonuccio et al. 1997). Finally, studies show that most patients prefer psychotherapeutic intervention to drugs when given the choice. (Unfortunately, they are rarely given the choice; today, fewer than 10% of psychiatrists offer psychotherapy to their patients.)

It is important to note that several studies have shown that combined treatment (psychotherapy + medication, exercise + medication) produces inferior results when compared to the non-drug modality alone (Hollon et al. 1992). The failure of this combined approach is not surprising when one considers the counter-productive effects of invasive chemical interventions (e.g. suppression of REM sleep, elevation of cortisol, induction of mania).

Unfortunately, the mental health profession remains largely ignorant to this “tragedy of its own making”:

“Some investigators have argued that the relatively high relapse rate after drug treatment indicates that depression should be treated like a chronic medical disease requiring ongoing, long-term medical treatment indefinitely. This logic appears tautological: Drug treatment results in a higher relapse rate than cognitive-behavioral therapy; therefore, the patients should be maintained on drugs to prevent relapse.” (Antonuccio 1995)


Several studies have shown that aerobic exercise is at least as effective as antidepressants in treating depression. For example, one recent study published in the American Journal of Preventative Medicine in 2005 indicated that the “public health dose” (5x/week frequency burning 17.5 kcal/kg/week) of exercise led to remission rates of 42%. For the sake of comparison, the Collaborative Depression Study, conducted by the National Institute for Mental Health, indicated remission rates of 36% for cognitive behavioral therapy and 42% for antidepressant medication.

A frequent criticism of exercise as a treatment for depression is the supposed lack of compliance in patients. The argument is that people who are depressed are too depressed to exercise. While this may be true in some cases, adherence rates in exercise studies were comparable to many medication trials, where rates vary from 60%-80%. Thus, evidence does not support the notion that exercise is not a feasible treatment for depressed patients.

Another benefit of exercise as a treatment for depression is that the only “side effects” are improved physiological and mental health.

In contrast to antidepressants, exercise has no adverse effects whatsoever. Instead, it has a moderate reducing effect on anxiety, can improve physical self-perceptions and in some cases global self-esteem, and can enhance mood states and – in older adults – improve cognitive function.

In a study published in Psychosomatic Medicine in 2000, another important advantage of exercise over antidepressants was revealed. Participants in the exercise group were less likely to relapse than participants in the two groups receiving medication. Other studies have confirmed this effect, demonstrating that aerobic exercise is especially helpful in the prevention of relapse and recurrence of depression.

Once again, as was the case with psychotherapy, there was no benefit when combining antidepressant drugs with exercise. In fact, the opposite was the case, at least with respect to relapse for patients who initially responded well to treatment. According to the authors of the study:

This was an unexpected finding because it was assumed that combining exercise with medication would have, if anything, an additive effect.

The authors go on to speculate on why antidepressant drugs would decrease the exercise’s beneficial effects on depression:

One of the positive psychological benefits of systematic exercise is the development of a sense of personal mastery and positive self-regard, which we believe is likely to play some role in the depression-reducing effects of exercise. It is conceivable that the concurrent use of medication may undermine this benefit by prioritizing an alternative, less self-confirming attribution for one’s improved condition. Instead of incorporating the belief ‘I was dedicated and worked hard with the exercise program; it wasn’t easy, but I beat this depression,’ patients might incorporate the belief that ‘I took an antidepressant and got better.’

It is also possible that the metabolic and physiological effects of antidepressants described above (suppression of REM sleep, elevated cortisol levels, etc.) could counteract the positive benefits of exercise to a certain degree.

In part II of this article I will discuss light therapy, St. John’s Wort and acupuncture as treatments for depression. In part III I will examine other lifestyle modifications that can both prevent and treat depression, such as proper nutrition, stress management, getting adequate sleep, the experience of pleasure and prayer or spiritual practice.

  1. How do you get to the point where you can make yourself go outside and exercise? What if there is no want to or who cares?
    Yes exercize is the answer but what if every time you step out the door to go do something you stop midstream and say no thanks I’m too tired.? Sorry but your answers are for someone who cares they don’t apply to those of us who are so depressed that they don’t care anymore? There must be something natural that lifts the mood first..I need help, therapy, Accupuncture, St. John’s, amino acids wort don’t work for me

    • OMG. I just got my Thyroid labs back…wow! My thyroid is low! No wonder I’m always sleepy..My free T3 and my free T4 were both low!!! That’s the reason I’ve been so depressed, tired and negative
      Please people…..check your numbers…it will make all the difference in the world..

    • Exactly. These types of articles infuriate me. I WAS on an antidepressant and it WORKED. But it also had a lot of undesirable side effects so I went off to see what life is like without them. I exercise like crazy, eat well, sleep well, see a wonderful therapist weekly, took a 12 week CBT course. None have worked to alleviate the crippling depression I experience. St. John’s Wort, btw gives me panic attacks (as does trying to go back on SSRIS–so obviously I’m now hyper sensitive to anything that stimulates seratonin)
      Bullshit that ssri meds are no more effective than placebo

  2. You wouldn’t take an antidepressant 3 or 4 days a week, so you must exercise every day. I am sharing my experience as I no longer treat my depression and anxiety with drugs. For me daily yoga has helped. I also find walking and swimming helpful. Prayer and meditation help too.

  3. Hi I recently out of nowhere have started to feel frustrated, angry, short tempered and not patience i have this anger that just sits there and boils and boils to the point i feel like screaming this started about 2 weeks ago I am a large guy with normally a big appetite and last weeks i didn’t eat anything for 4 days straight i just couldn’t be bothered with it i have also been either sleeping wrong or too much i will get teary eyed at random things like a song i heard or reading something now this was weirder to me because i am not a crier but it reminded me how about 5 months ago i just broke down in front of someone it hit me like a wave and it was just them being kind and making me feel like they got my back which is quite rare my family is not the most supportive people to give you an example i will first explain my father although i did not know him took his own life in his mid 30’s I am 29 now he suffered from among other things schizophrenia and depression so knowing this i am starting to think a lot of what i am feeling was pre-destined or genetic I am going to go to a doctor to rule out any sort of hormone imbalance or anything and i am strongly against taking the medication so i am going to look into some therapy but anyways my family i thought i could talk to my mother about how i am feeling and why i think it is and instead of being supportive she started to push all the issues she had with my father and what he went through onto me and how she thinks it is just weak-willed to be like this she really doesn’t get it i am so confused on how i feel i can’t explain why i feel this way or even what may have triggered it instead it just hit me recently and the more it continues the worse it gets because i start thinking about other things that give me cause to feel sad and i just dig deeper and i have been trying to not focus on it or shake it off which is obviously easier said than done i just hate being this way normally i am a fairly happy person always joking and laughing but now i just keep snapping at people or getting frustrated or have this bubbling rage inside where i was not a angry person before and in fact hated confrontation and was quite shy but now i will rip anyone’s head off because i get so frustrated and exhausted. there is also some relationship insecurities and issues i have involving women that are just compounding and fueling this anger I am quite afraid of how it will all come out will i just simply break down and cry or will it develop into violence which i really do not want it to do so i am making and appointment to see my doctor this week to get some advice.

    • Matt, there is a fairly new research being done on the MTHFR gene mutation, which causes methylation problems in people who are prone. It may be something you want to read about and be tested for … I have known people who have reversed extreme symptoms of major illness by following the appropriate protocol for their specific tests results. A qualified Naturopath can help you with this, as the mainstream medical community does not address it properly. Dr. Ben Lynch is a well known researcher and consultant to the medical community for MTHFR issues. You can find info on his website at: I pray you find the help you need! 🙂

  4. I have Chronic Dysthymia which I believe has turned into Major depression over the last 2 years. Depression runs in my family. I am only 24, but have suffered depression for as long as I can remember, which is about 12 years old. My mom (who has Bipolar II) has told me numerous accounts of my mood swings as a kid, and how although at times I was happy, I could never stay happy for very long. I also must mention that I had an amazing childhood, and wonderful parents. I have resisted medication for years because I am a health nut, and am very passionate about nutrition, well being, and exercise. I could go on for hours.

    I have worked harder at being happy than I have at anything else in life. And here are some of the steps I have taken:

    1) Vitamin Supplementation- I have taken high quality Omega Three fish oil, calcium, magnesium, raw vegetable multi-vitamin, vitamin D, niacin, B vitamins. These have made it easier to cope, because I feel healthier, but so far I am still depressed. I also took St. Johns Wort, 5-htp, L-theanine, and Lithium Orotate. (These all helped ALOT but would stop working after about 1-2 months.)
    2) Exercise- I have gone on thirty minute runs 3-4 times a week. I also do strength training, yoga, and dancing.
    3) I have gone to see a Counselor, practiced mindful meditation, living in the now, spiritual practice, and journaling.
    4) I have gone on several diets, switching from Vegan, to Raw food, to Paleo, to Whole Foods. The only diet that gave me a mood boost was the Raw Food Diet, but it is very hard to stick to, especially in cold weather.
    5) I have tried hormone balancing and light therapy.
    6) I have gotten 15 minutes of sun per day without sunscreen.
    7) I have quit caffeine and alcohol completely.

    So far, nothing has worked past temporary relief. I am trying one last treatment, Homeopathic medicine, before taking the Lexapro I was prescribed. I think if you have exhausted all other options medication is the only thing you CAN do. From my experience and research, I noticed depression left untreated increases chances of depression relapsing. For example, my episodes comes in waves, which used to come about twice a year, and now I get hit with it about once every 6 weeks.

    I think if you are depressed about a SITUATION or life circumstance, all natural healing and counseling can work miracles in boosting mood! It is unfortunate that in this day and age, it is very hard to cure GENETIC depression that runs in families, there is only treatment for symptoms. I have heard both miracles and disasters of anti-depressants, but at this point all I want is to feel better and feel like myself again.

    • I hear ya. Been through the exact same process with the same results. I am not going to say that what I went through will definitely apply to you, but it worked for me. And this is also not a “situational” case – I’m talking over 20 years starting in adolescence and diagnosed as Bipolar II as well as schizoid personality disorder.
      I would wake up every morning and while showering before work think “F*** I’ve done everything I should do. Nothing works. Dying would be better.”
      I went years being on meds. One night I ended up in the lock down ward of the hospital because the cops scooped me off the street after a crisis call. The next morning the on-call psych asked me what I was on and as a conscientious pill popper I rattled off the mood stabilizer and anti-depressant I was on as well as what I was on previously. He looked at me and said “No wonder you spiked. That anti-depressant is twice what it should be”. Not only had meds not helped for over a decade, they damn near killed me.
      A few months later (while on a medical leave that started soon after that night) I had a bloody horrible day and thought “S*** I’m getting sick. AGAIN.” Then I had another thought “Wait. It’s just a bad day. I don’t need a pill to get through a bad day.” Step one.
      I then pulled a book off of my shelf that I had for a while but hadn’t read yet called “The Mindful Way Through Depression” and was struck by what they said – What if “fixing” makes it worse? What if there isn’t anything to fix? They described the thought patterns of someone relapsing – at shorter and shorter intervals and for longer and more severe episodes, and it described my thoughts exactly.
      I concluded I wasn’t sick, but that considering myself sick was what was actually making me “sick”. This is an online comment so some of the nuances may not get through but I’ll try my best (I’m 42 so my life story won’t quite fit lol)
      Looking back I realized what the psychologist (not psychiatrist) was trying to get at with his questions – to make me question why I thought I was sick.
      I should have owned a home by then. I should have had a retirement fund at a certain level. I should have…Should is a horrible word. I want to be HAPPY. He looked at me and said “do you really think that is realistic? You can’t be happy all the time. What about content?” He also mentioned boredom. a lot. How boredom leads to inward thinking, then to self-criticism and downward
      It was far easier for me to say “I’m sick. The disease is the reason for the disease. I can’t help it.” But in my darkest moments I always asked “why”? Turns out there was an answer to that.
      I started to feel better when I no longer thought of myself as broken and needing to be fixed; when I accepted certain things about myself and my personality; when I did CBT to figure out my triggers(Extremely important and useful to me); and when I finally believed that being sad is valid.
      I am a firm believer that our society will not allow melancholy, that we are conditioned to believe that unless we are happy every. single. moment. then there is something wrong with us. Emotional pain is no different than physical pain – it exists to tell us something is wrong. Others may not think it is wrong, but the individual’s feelings and emotions are valid, and masking the pain with meds is like taking morphine to keep walking on a broken ankle but never setting the bone.
      Books like The Four Agreements by Ruiz, (and in fact a form of CBT in my opinion) In Praise of Slow by Honore and Flow by Csikszentmihalyi were helpful.
      Now, I don’t walk around with a perma-smile these days, and my financial and work situations are deplorable, I have days where I am angry and frustrated (see financial and work) and sometimes I feel like crap, but I no longer think I am better off dead and I am no longer miserable every waking moment. I have many, many more enjoyable moments than miserable ones and I am generally content. I slip in my awareness of my moods and thinking, but I know now how to bring that back without being angry with myself or considering myself a failure. I know that if I feel awful that’s a valid emotion. That was the key – allowing myself to accept what I was feeling, then and there in that moment, as valid.
      I don’t take herbal remedies or vitamins (tried them – didn’t work. Tried homeopathy too – didn’t work a bit), I don’t have a special diet but I do eat way less fast food with most meals home cooked and increased the veggies and fruit (Magic Bullet/frozen fruits/all natural whey protein and milk takes 30 seconds), I don’t have a fitness regimen but I walk about 20 minutes 5 days a week and try to get on a trail in the woods for a few hours two or three times a month, I read a lot because I love it, I have a few beers every once in a while but no where near as much as before (not that bored anymore) and when I really need to numb my brain and not think I binge on XBox for a few hours guilt free knowing I’ll be productive tomorrow. Other than Xbox binges I shut electronic devices down early in the night and avoid things like the news or social media (just ticks me off) so I can get to bed with a mind that isn’t racing. Sometimes a quick body scan and deep controlled breathing slows things down, maybe with a compassion exercise thrown in, as well as having the lighting dimmer and dimmer. I try my best to keep the same sleep schedule (unless on evil shift work) waking up early – the only time in the day when I am alone BEFORE the crap of the day hits the fan. I am open about my experiences and no longer hide what I went through, stigma be damned. And if I slip in any of those habits I no longer chastise myself and say “screw it can’t do it”.
      We are all individuals and there is no single solution, this is what works for me. People may say it’s simple, but it isn’t easy. I wish you the best of luck.

      • You are amazing! I “should” myself and get “shoulded” by mother all the time! According to her, a 32 year old ‘should’ have this that and be here or there. I’m nowhere I ‘should’ be according to her standards.
        I’m sure you know that relating with someone, anyone is a god-send! I can relate to you and your stories very much! Thank you for sharing 🙂 I see a light at the end of the tunnel now.

      • Chris, Thank You for your informative blog and Kevin, Thank You for your comment. I just ordered the book “The Mindful Way through Depression”.

      • Thank you for this share. I think that acceptance is the real key. Instead of fighting something they call a depression, we need to embrace the fact, than we are sensitive to everything and everyone. this so called depression thing might be just a reaction of a highly sensitive person to the world as it is. When you come to the point, to accept you as you and good and not ill, than the switch is about to happen.
        You gave me insight and hope. Thank you.

      • Kevin,

        Thank you for that comment. Just reading it made a “light bulb” come on in my head, on a day that had me weeping first thing in the morning, trying desperately to not think about killing myself. I relate so much to what you’ve said – and it instantly helped me shift perspective in my head – like a curtain just lifted. I’ve been in CBT for two weeks now, and have been questioning why I have been feeling spectacularly worse than before I started therapy (which is saying something). I’ve never taken medication and am not very inclined to – but I’ve been feeling so desperate the last few days, I was googling medication when I chanced upon this blog and then your comment. I’m 34 and have had depressive episodes – triggered by a major bereavement when I was in my early twenties, and then onwards by several other factors, because I never quite resolved my grief and my reactions to the loss, and therefore just kept getting more and more dysfunctional as time passed. Thank you for writing this.

      • Appreciation beyond words can explain or express. I can relate on so many levels. Thank you so much for sharing as well as shining a light on such a dark subject. Thank you, thank you. Huge hugs!!!!!!!!

  5. Thinking back, I knew I was depressed by the age of 8. I attempted suicide many times; dying would have been better than spending one more miserable day living my life. However, I’m still here. I consider myself “cured”, it has been three years and i have not felt even sadness for one day. I’m not sure how it occurred since just 2 months before, i had just been hospitalized for my last suicide attempt. I am convinced it was devine intervention as I knew I couldn’t go on anymore. In my heart, Jehovah felt it necessary to intervene. Today, I am living a purposeful life and I’m testifying that healing is possible.

  6. Hello Chris,
    TMS great way to treat depression without drug or medicine. People who are suffering from major depression also can go for TMS treatment. It is just 40 minutes treatment and people can resume their daily work after treatment which is really great thing. Also if people follow few things in their daily life like exercise and mind healing food then they can help their self. Hope my share will help to others.

  7. Chris,

    Do you have any experience with or knowledge of people on SSRIs who have transitioned from a SAD to a whole foods diet and had dramatic changes in mood ( became aggressive and verbally abusive) and thinking (all-or-none)? I am asking for a friend (really!) whose husband has been on an SSRI for about 14 years with fairly effective mood stabilization and has been unsuccessful in his attempts to wean off or even change SSRIs. He recently transitioned to a whole foods diet and had a dramatic change in body composition and related health.

    I am curious if it’s possible that the gut has begun to produce serotonin (or whatever is responsible for stabilizing mood since the mechanism of action of SSRIs is poorly understood) and he is experiencing a serotonin syndrome type effect.

    I would really appreciate your thoughts on this. Unfortunately, the gentleman has zero confidence in his SSRI prescriber and does not have a relationship with a knowledgeable and trustworthy healthcare provider. So troubleshooting this issue is difficult.

    I deeply appreciate and respect your work! Thank you!!


  8. While I do agree that medications are overprescribed and don’t work for everyone, I must agree with others on here that suggesting that antidepressants don’t work and that natural remedies will cure everyone is irresponsible at best and dangerous at worst.
    I am a huge fan of natural products and remedies and tried everything out there, nothing worked. Exercise made me healthier, but didn’t get rid of my irritability and anxiety, nor did it stop the off and on depression and occasional mania. I thought I was “normal,”but was constantly pissing myself and others off with my extreme irritability. I was also depressed and withdrawn. A couple of years ago, I went on Cymbalta and it was like a miracle. I felt happy about life and relaxed, I noticed people reacting to me more positively. I could think clearly and suddenly had an active social life again, and also started dating very actively for the first time in several years. It was amazing to see that life could be good and that I could be happy.
    I have a coworker who constantly lectures me on antidepressants and tells me I just need to go jogging and take herbs. It has almost ruined our friendship. Articles like this really hack me off.

  9. I am a 55 year old chiropractor with a natural skepticism and even disdain for pharmaceuticals. I have been taking 10 mg of Lexapro (an SSRI) for 13 years. The only side effect I have experienced is complete relief from my depression.
    It took me many years to get to an SSRI. Based on continuous research for years, here is what I tried first: yoga, mindfulness meditation, therapy (for 4 years with a very very good therapist), a very clean paleo templated organic diet, supplements including St. John’s wort, later 5HTP and later still, Tryptophan, very high quality omega 3 supplementation, hiking, strength training and cardiovascular exercise. None of it worked. I just got worse. Finally, at my husband’s and physician’s begging and near insistence, I tried Lexapro. It was a miracle. I got my old self back. It has helped me deal with my mother’s agonizing and losing battle with cancer. Then my father’s similar losing battle. And then menopause.

    Oh yeah, did I mention that my mother, uncle, several cousins and siblings all show clear signs of serotonin deficiency to varying degrees?

  10. Hi everyone. TY Chris.

    Drugs should always be a last resort, in all cases, with all problems, because drugs ussually do not work on the cause but the effect. I appreciate that Chris has this POV. Psychotherapy, meditation, excercise, spirituality are life long pursuits they are needed in different amounts to different people but always help. I’ve come to believe that we are chemicals first. We can affect those chemicals with the least amount of side effects by diet combined with the things listed above. What we know changes as we grow. Had I known about paleo and all the things I do now prior to my life long battle with anxiety that peaked witha year and a half very intense constant anxious state I might have not taken 25Mg’s of Zoloft daily. Looking back the peak, the thing that finnally made me go see a doctor was probably caused by too much alcohol and poor diet (SAD high carbs). Leading up to my decision to take it I excercised, I read every book i could, and talked to everyone that would listen. I even tried following the normal type diets that everyone says are healthy. I quit smoking for 3 months. I felt no improvement. When I got to the point when I could find no peace ( I don’t mean joy and elation I mean simply being ok being alive type peace) I went to a Dr. and took Zoloft. It was a good experience for me. I did care less about stuff, but it wasn’t terrible. I didn’t become a robot. I did suffer some sexual side effects, but they were worth it. After a year I was able to look at my anxiety and say to my self…if chemicals changed it then chemicals caused it…and I’m not going to die. Through a continued effort of the steps I mention above combined with this understanding I took my self off the medication. I did get the brain shivers feeling…it was weird, but ended after a month or so. I’ve been off Zoloft for almost 2 years now and I’m good, things are good. I still have a tendency to become anxious or think very dark thoughts, but I get it now, its ok, and it doesn’t persist.

    One of the main and important things I got from Chris’s article was that if a person is not interested in fixing the cause and only lowering the effect they are going to trap them selves into this dependancy for life. There are people who need the drug. There are people who do not need it. We are better off without it if we can be, with every drug. the people who have the most trouble in life are the ones who take a drug frist approach whether its pot, oxycontin, alcohol, or anti depressants. The way to know the difference is through wisdom and seeking peace. For those people who are on it. I would follow the diet Chris reccomends, as well as look for other spiritual and psychological methods like the ones Nora Gedgaudas talk about with Neurofeedback, with the intention and effort to grow grow grow…learn learn learn. I hope that those on it are able to find or reach peace, or enough peace, because its terrible being depressed and anxious.


  11. @Mona

    I was struck by your comment, “I didn’t care about anything anymore so nothing bothered me”. This appathetic condition caused by anti-depressants is known as “flatlining”. You don’t feel the highs and lows of normal emotions anymore. This is one of the many negative side-effects of these drugs that most don’t realize.

    I went through a depressive episode about 10 years ago. It was a “life event” type of depression which is true of many people. It is NORMAL for a person to feel depressed when bad things happen. I recently learned that the scientists have discovered that the pain of depression is actually the brain trying to rewire itself to solve the problem that is making them so depressed. The drugs actually short-circuit the process and make things worse in the long run. I’m glad that I didn’t succumb to drugs even though my doc offered them. At one point, things had progressed so that I had lost a significant amount of weight due to the fact that I hadn’t eated much in a few months. I finally had a conversation with myself and said if I wasn’t going to eat properly, I at least needed to choke down some vitamins and other supplements like amino acids. The honest truth is, after I took them the first time, I woke up the next day feeling much better. I had allowed myself to get nutritionally deficient and that compounded the problem.

    I wonder how many people who are depressed are really just deficient and depleted of key nutrients that would make them feel better than drugs? Remember, you’re not depressed because you have an SSRI deficiency! One of the things I ended up taking was Sam-e in very small does of 50-100 mgs in the mornings. I only did it for about 1-2 months but it really helped. a recent Harvard study confirmed it’s anti-depressant benefits. There are other things as well but if you’re on drugs, you absolutely must consult with a doc about adding supplements like this since they can interfer and cause bad side-effects.

    And speaking of the drugs, I found a website not long ago that specifically deals with helping people get off RX drugs especially anti-depressants, benzos, ADD, etc. I hope it’s ok Chris to post this link, if not feel free to remove it. My nephew was diagnosed with OCD (not sure if it’s really the case, tho) and he’s only 15 but has been on some pretty powerful drugs for years and I can see the change in his personality. I’d like to see him get off them. I hope this helps people here.

  12. Ralph – maybe you missed the point.  There are some people that suffer from true biological depression, like Joan.  And from her statement anti-depressants improved her mental health and quality of life.  That’s a good thing.  But these ‘serious’ medications are being scripted out like candy.
    When I was prescribed an SRRI (3 different ones at 3 different times) I had the ‘rare’ reaction.  I became angry and emotionally aggressive.  The “doctor’ that prescribed them got frustrated with me and we ceased our relationship.  I found ways to cope.  But they have yet to find a solution.
    It is difficult to get medical doctors to look for an underlying cause for the depression many people are suffering with.  They just recommend you off to a shrink doctor, who then puts you on the anti depressant medication.  If the medication doesn’t make you feel better, they label you ‘difficult’ and move on to the next patient.
    This is not effective medicine… just sayin’

  13. I am 60 yrs old and have taken SSRI steadily for the past 13 yrs.  My first experience with antidepressants was at age 34 when I took a TCA for 3 months –  I was reluctant to see what I was experiencing as Depression (ie meeting DSM3 (at that time) criteria but was persuaded to try a TCA just for a couple weeks to see if I got any response.  I did, and it started on about the 7th day.  It was like a miracle.  Profoundly helpful.  I had every side effect in the book and successfully went off the medication after 3 months which was what was recommended at the time.
    I continued to be highly reluctant to take medications to treat subsequent episodes of depression.  I have tended, since I have studied pharmacology, and do have a healthy degree of scepticism, to want to avoid drugs when ever possible.  I have suffered through periods of depression without meds but with substantial costs in my family life, and costs in terms of personal suffering.
    I have worried that I  might be doing harm to myself by not treatment depression chemically.   Several years after developing a chronic illness (autoimmune) that i decided to take drugs if they helped.  So now I have taken Celexa for 13 yrs.  At times I have reduced the dose form 40 to 20 mg, but have not done that for at least 6 years.
    There is multigenerational suicide and depression in my family -and I have felt very lucky to live in a time when antidepressants are available.  I have accepted that I do have a genetic tendency toward depression.  I do light therapy in the winter as I do also have SAD.  Aerobic exercize is not a possibility for me.
    I am concerned re long term side effects of Celexa and do want to get off of it.  So,I am planning to do another trial of reduction of dose.  I will of course go slow.
    What suggestions do you have for things I can do to mitigate against the disruption I am bound to experience with a brain that has become accustomed to Celexa for so long?

    • Joan,

      All of my recommendations are contained in the “Treating depression without drugs” articles, Part I – Part III. Remember, it’s essential to have qualified medical supervision if you try to reduce the dose of your antidepressant. Diet is crucial, as I point out in the articles.

  14. Tam,

    That’s great news.  I support any therapies which bring you the results you desire.  For me, it must be a combination of psychotherapy and supplements or medication to address the underlying neurological disorder.  If psychotherapy in the form of meditation, Reiki, yoga, etc works for you, then I concur with you that you should utilize them first.

    I think you are correct that your depression was a result of a big life change and not indicative of an underlying psychiatric disorder.  My point to the author of the blog was that some people do have serious psychological issues which won’t be cured by exercise, meditation or diet alone. 


  15. First let me say thank you Ralph for your personal response.  I hope you are doing well.
    It’s been 9 months since my previous post on this site. I did not take the SSRI prescribed to me in 07/2009.  I started seeing a new counselor who is a better match for me. She is actually teaching me things which are helping me tremendously.  I have started taking better care of me by doing things I used to love: running, yoga, meditation.  I have been certified in first degree Reiki and am taking the second degree Reiki class tomorrow. Reiki has been wonderful for me; it relaxes and calms me like nothing else. I’ve learned to speak up for myself instead of constantly feeling like a victim. My self-esteem is getting stronger. I’m learning about myself and why I act and react the way that I do and how to change those actions that are less than desireable. I’m learning that it’s okay to feel unhappy, sad, mad, happy, glad, etc. I’d put myself into a spiral of guilt because I thought I should be happy all the time. My life is really good so why would I feel sad? I realized that I was/am grieving the loss of my single life after I got remarried a year and a half ago to a wonderful man with a lot of baggage in the form of an ex-wife, 2 children and an overly involved mother! No wonder I was unhappy! ha!
    Anyway….what I want to say is that I am glad I didn’t go the medication route. For me it was not the best treatment.  I am not even sure that I was really depressed. Yes, I displayed some symptoms of depression but I think I was in mourning. Mourning the “death” of my previous lifestyle.
    I can’t say that I agree or disagree with the treatment of depression with medication. I guess if the disease is debilitating and the person doesn’t respond to any other treatment then okay. I am blessed and grateful that I am not in that situation.
    Peace and blessing to all that are.

  16. I know you’re trying to bring healthy skepticism to all branches of medicine, but I think you need to be careful when discussing recent claims that antidepressants are no better than placebo. 

    Remember, prior to SSRIs like Prozac, antidepressants had such a bad side effects profile that only people with true biological depression were being treated.  And we know from that period that the MAO inhibitors and tricyclics did in fact save lives and reduced depression as compared to placebo.

    And that’s with crappy first generation drugs.

    Where we’re running into problems now is SSRIs are being prescribed to people who are just upset about a divorce or a death in the family.  Of course, in that instance, they would be no more effective than placebo since life event depression (without a biological enforcer) typically goes away in 6 months anyway.   

    I have used Prozac and I come from a family which definitely has biological markers for depression and anxiety.  When I first had depression, it did provide relief better than anything I had tried previously.  I have since learned there are natural things (i.e., GABA and its derivatives, valerian root, D-phenylalanine, high omega 3 fish oil, etc), but to say that antidepressants have no role in treating biological depression is simply false.

    The brain and nervous system is a chemical messaging network.  Just as computers use electronic 0’s and 1’s to communicate messages between subsystems, the brain uses messaging chemicals to communicate information between neurons.  In some people, those systems don’t work properly.  I know this because I can see how supplements and drugs affect my moods and my mental state. 

    My depression was made worse by the exercise which you describe as a treatment.  I would have a panic attack after a heavy workout thinking, like you, that I could treat this thing with exercise alone.  It turned out that Prozac helped me get over the panic attacks so I could buy some time to learn other methods of depression management.

    To Tam, I hope you do learn more about depression and don’t simply read blogs which suggest that exercise and psychotherapy will cure it.  For people who have depression in their genetic makeup, drugs can help a lot and may save your life.  I hope you do learn about the major mood neurotransmitters like serotonin, norepinephrine (adrenaline), dopamine and GABA and how drugs which target each system can help you manage your depression.

    Also, people who have gone through traumatic events may have altered brain function.  They may be overly sensitive to adrenaline — as I believe our family has a genetic tendency toward — and it may take a while for the brain’s receptors to “down regulate” (meaning reduce their sensitivity).  People who have post traumatic stress disorder often have just had too much adrenaline pumped through their systems to the point that their bodies do not react to it properly.  GABA acts like a big stop sign to overactive neurons and supplements which enhance GABA transmission in the brain can help calm the symptoms of PTSD.

    I am a firm believer that we do need chemical intervention at times to deal with depression.  If you get right down to it, food itself is a chemical fuel and we already know our choices of food can affect mood and depression.  The most important thing is to educate yourself about both sides of the issue.

    By the way, I do agree with the blog author that cholesterol appears to not be the big risk factor in coronary heart disease — however, oxidated LDL does — and therefore we must learn how to control oxidation in the body.

    Which, once again, is a chemical process.

    Ralph 🙂

    • Thank you, Ralph. I am a psychotherapist, and I am currently taking Lexapro after a depressive episode so bad that I lost 35 lbs in 5 months and 1/2 my hair fell out. I have FM and CFS, so exercise is not the answer for me. I have also been in a lot of therapy of the kind mentioned with no improvement. I do not often recommend antidepressants to my patients, because I work with grief and trauma, and depression is a temporary part of that. But the occasional person I refer has seen a HUGE improvement in their depressive symptoms. To say that they simply do not work is dangerous. People do not all fit neatly into one box.

    • I come from a long line of “thinkers,” off of both sides. My family is replete with writers, therapists, and strategists. I also found out, after starting an SSRI/SNRI, that there are very few members who have not been medicated at some point.

      For me, my sister, and my cousin, at least, there was no traumatic event that brought about an overwhelming anxiety. It built, steadily, for a few decades, and then sent each of us into a “crash” that incapacitated us in every way. My sister and cousin were hospitalized, whereas I had my sister’s experience to lean on and knew better what to do. When I “crashed,” I spent 3 weeks taking an SNRI, living a moment-by-moment nightmare, sitting on a friends couch, eating a half of a banana a day, taking a benzodiazapene to sleep at night. The SNRI helped me come out of this, but it also included many unappealing side effects.

      I spent the last two and a half years, among other things, researching brain chemistry and the nervous system. I also spent that time taming my “strategic” brain. Through counseling (I now think all counselors should experience being counseled!), the relaxed/slow state that the SNRI put me in, and an amazing, beautiful relationship with Jesus Christ, I have literally seen a rebirth of my personality. I no longer say/think, “That’s just how my brain works, absorbing countless possibilities and charting actions based on best-strategy analysis.” I no longer think I can CONTROL this life. I simply enjoy what I enjoy, in a balanced way, and trust that I’ll be able to deal with a situation when it arises (rather than having an emergency plan for every possibility). I take great joy in my modest abilities to counsel, write, and help others with health and nutrition. And I have slowly lowered my SNRI, so far without seeing a reason that might keep me from completing the process and THEN learning to live without meds.

      All that said, I would guess that the large percentage of people taking SSRIs are tempering their own unbalanced thought patterns unnecessarily. If only we were taught prudence and restraint where our minds are concerned, rather than being applauded when we push ourselves past thresholds in order to “maximize our potential.” Anyone who truly wants to be healthy needs to be ready to do the hard work of removing themselves from the “mob,” and finding truth where it has been shunned and hidden. If you can find someone else who has done this already, you will have found a treasure beyond compare!

      I appreciate this website, and I appreciate the thought and time that others have put into their own comments. For some reason this site seems to be somewhat protected from the silliness, the rants, and the bitterness smothering so many other sites.

  17. I am just starting this journey of depression/anxiety treatment. I am seeing a counselor which helps a little. I think therapy would be more effective if the couselor/patient match was better. She recommended that I take antidepressants and scheduled me to see a Nurse Practitioner who gave me sample doses of Lexapro to try for 3 weeks. That was a week ago and I have yet to take the first pill. There is just some sense of apprehension inside me not to do so, even before researching the side effects, which, by the way, the nurse didn’t share with me.
    I am hoping that my condition is temporary and related to a number of major changes I have experienced in the past couple of years and will eventually get better. I am going to try some of the recommendations in this article. I used to practice yoga, meditate and run regularly but stopped doing so once this depression set in. I am going to do my best to start these practices again. I’m also going to try eating healthier as I find I eat lots of junk food in response to stress. That can’t be helping the cause!
    My dad committed suicide 2 years ago. My main fear is that I will end up like him.

  18. @Mona:

    Thanks for your comment, Mona. I’m glad you’ve learned some non-drug strategies that have helped you to be more resilient.


  19. I have used both medication and non-medicinal methods for treating my depression.  The first time I went through a depression, it was overwhelming.  I was a full-time student and working part-time in a Biotech lab with grad students so I had to stay focused.  I was a little scared at the ease of actually getting a prescription for antidepressants.  It was a list of questions that qualified me as a candidate (if the patients says yes to any of these then they qualify).  

    I started them at low doses and read the warning label.  (Warning:  if you stop using this medication without doctors consent, you may have suicidal tendencies.)  I did a lot of drugs when I was younger and can honestly say that the first few days were like taking ecstasy but only a bad trip.  I wanted to stop taking it because I felt chittert and high all the time.  Then the effects subdued.  I didn’t care about anything anymore so nothing bothered me.  It was hard to care about studying for test too but I got through my semester.  It was better than trying to study and go to work without sleep and not eating all day.  I was an advocate for antidepressants for that very reason. 

    But my problem was never solved.  After the cause of my depression was a distant memory, the same cycle started again.  I was depressed all over again with the same symptoms.  I was a little older and tired of the cycle so I did some research on my own.  I self-diagnosed myself as codependent and started therapy, exercising, and group therapy.  Exercising was great but the effects are not instantanious like you would expect.  It took time for my adrenaline levels to reach their peak, like weeks.  Then I felt great.  I was strong physically and mentally.  (And I looked great too.)  People started to notice the change which made me feel better .  Likewise, therapy helped me treat the problem, not just the symptoms.  

    I still get sad, angry, and frustrated but each episode is shorter and less intense than the last.  My most frequent lasted only one afternoon.