The question: I have suffered for many years with suicidal depression, which I've controlled with antidepressants. I have retired from a very stressful job and moved to a more peaceful community. I would like to discontinue the antidepressants as they have unpleasant side effects, but my husband fears my suicidal depression will return. I don't know what originally caused my depression (I'm hoping it was my preretirement life). Do you think it would be possible to wean off the medication?
The answer: For most people, clinical depression (or major depressive disorder) is the result of a complex interplay of multiple factors: genetic predisposition, early childhood experiences, life events, personality, current stressors, and existing social supports. The way we think about the world (our thoughts, or cognitions) and they way we cope with stress (our actions and behaviours) also play an important role in whether – and to what degree – we will manifest the emotional state of depression.
There is little empirical support for the predominant view that depression is exclusively caused by a biochemical imbalance.
This does not mean that biochemistry does not play a role. In fact, there are particular biochemical changes associated with depression: serotonin, dopamine, and norepinephrine are the neurotransmitters strongly implicated in depression. There is also evidence that other hormones such as glucocorticoids and thyroid hormones play an important role.
For some people, antidepressant medications – which operate on one or more of the brain chemicals – will improve the subjective state of depression, as well as the associated physiological symptoms such as sleep or changes in appetite. Individuals who receive other types of evidence-based, non-pharmacological treatments such as cognitive behavioural therapies will demonstrate positive changes in their biochemistry as their depression lifts. So, there is a correlation between depression and biochemistry, but not necessarily a clear, unidirectional causal relationship.
Lifetime reliance on antidepressants is not necessary for a large percentage of patients. In fact, an extended duration of time during which mood is consistently stable, combined with significant changes in psychosocial circumstances as you have described, is often an indication that antidepressant dosages can be reduced, if not eliminated altogether. It is important to underscore that any reduction of medications should be done in close consultation with a physician so that side effects of both the reduction in medication, as well as close monitoring of suicidality and other symptoms can be conducted.
As you wean off the medication, you should also enlist the support of a mental health professional who can offer insights into the psychosocial factors that played a contributing or exacerbating role for you. He or she can also help build a depression/suicide relapse prevention plan for you. I would strongly recommend involving your husband in the process both so that he can support you and feel confident about your treatment plan moving forward.
Dr. Joti Samra, R.Psych., is a clinical psychologist and organizational & media consultant. She is the host of OWN: Oprah Winfrey Network's Million Dollar Neighbourhood and is the psychological consultant to CITY-TV's The Bachelor Canada. Her website is www.drjotisamra.com and she can be followed @drjotisamra .
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