When do I need to get treatment for depression?

Alice,

I'm a college student who is struggling with the decision on when to see a doctor for treatment with my depression symptoms. I believe that I need to get treated for depression, but I'm just as scared about not getting treatment as I am about starting antidepressant drugs in my current lifestyle. As far as I can tell, I'm exhibiting the classic symptoms of depression, and have been for a while — frequent crying fits, days where I lose all motivation, and sometimes, even thoughts of suicide. But I drink frequently, almost every weekend, and use marijuana occasionally, and I am quite unsettled by the possible interactions between antidepressants and these other substances. In my day to day life I do very well — I hold a good GPA, have good relationships and a good social life, function well most of the time, and stay in shape for sports. I don't intend to change my lifestyle significantly to make room for depression treatment. But when do I need to get help? I don't want to force an unnecessary change on myself, but I don't want to put myself in danger from depression, or even worse, from the drug interactions between antidepressants and alcohol or weed. What is the tipping point?

— Regular guy who might need help

Health topics
Substance Use and Recovery
Mixing Substances
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Mental and Emotional Health
Blues and Depression
Mental Health Conditions and Treatment Options
Answer

Dear Regular guy who might need help,  

You’re not alone in wondering what to make of depressive symptoms or how to seek relief. You may find it comforting to know that there is no minimum threshold before a person can seek treatment. All sorts of people seek support from mental health professionals, whether or not they have a diagnosed mental illness. If you’re concerned about depression, you could seek support at any point. That being said, if you’re having thoughts or intentions of ending your life, it’s advised you call on a friend, coach, family member, or health care provider for support. You can also call the 988 Suicide & Crisis Lifeline (just dial 988) at any time, day or night, to get connected to free and confidential support. When you feel ready, a mental health professional can assess your symptoms and propose different treatment plans tailored to your specific needs. During your visit, it's okay (and it's a good idea) to be honest about your drug and alcohol use, as well as your concerns about how treatment will fit into your life. Together, you can discuss treatment options that may be most appropriate for you, which may or may not include medication. The final decision about how to move forward is up to you.  

Knowing more about the interaction of substances and depression, as well as potential treatment options may help you better inform that forward momentum. For young adults such as yourself, depression may occur alongside substance use such as increased use of alcohol and other substances. For example, research supports a significant link between marijuana (weed, pot, etc.) use and depression, but the evidence about the specifics of the relationship is inconclusive. Alcohol and marijuana both fall into the category of depressants, which could exacerbate feelings of depression for some people. It's also possible that the tendencies to smoke weed and experience depression share the same trigger, perhaps genetics. Whatever the case may be, recreational drugs such as alcohol and marijuana tend to have negative interactions when used with antidepressant medications. Mixing alcohol with antidepressants called monoamine oxidase inhibitors (MAOIs) can be especially risky since they affect blood pressure.  

There’s a large menu of treatment options for depression, only one of which is medication. Each treatment option has its own risks, benefits, and commitment levels, and a treatment plan may involve one or more options, including:  

  • Antidepressant medications: These are common and effective treatments for moderate to severe depression. They work by altering the balance of natural brain chemicals to moderate your mood. Each types has its positives and benefits, and the same medication can affect people differently based on brain chemistry, genetics, and lifestyle characteristics. It’s good to keep in mind it can take four to eight weeks to feel the full effects of antidepressants, so it’s best to give it time and speak with a health care provider before stopping. Over time, they may also tweak your dosage or recommend trying another option.  
  • Psychotherapy: This is a type of therapy (sometimes called counseling or talk therapy) that is a proven course of treatment for a variety of mental health issues including depression and may be used in combination with antidepressants. It usually involves talking with a mental health professional about the roots of depression, how the illness affects feelings and relationships, and ways to replace negative thoughts or behaviors with happier and healthier ones. Different forms of psychotherapy for depression include cognitive behavioral therapy (CBT) and interpersonal therapy (IPT).  
  • Physical activity: The simple act of moving the body can do wonders for mental health. Physical activity is also one of the most common complementary techniques to the treatment of depression. As an athlete, perhaps you've noticed that physical activity can lift your mood. Although researchers aren't exactly sure how this works, physical activity may trigger feel-good neurotransmitters and endorphins, relax your muscles, lower levels of a stress hormone called cortisol, and help you sleep. To get the most out of a physical activity regimen, you may need to break a sweat for 30 minutes a day three to five times a week.  
  • Dietary supplements: The herb St. John's wart and omega-3 fatty acids, for example, are sometimes taken to relieve symptoms of depression. These substances may be appealing to people who’ve had strong side effects from antidepressants. It’s also worth noting that the U.S. Food and Drug Administration (FDA) doesn't regulate dietary supplements and they may cause serious interactions with other drugs.  
  • Mind-body techniques: This practice is based on the idea that the physical body and the mind must be in sync to be healthy and happy. People use a variety of techniques including meditation, guided imagery, yoga, massage therapy, and acupuncture to strengthen the mind-body connection. Although research in this area isn’t conclusive, mind-body techniques have existed for centuries. 

Alternative or complementary treatments such as physical activity, dietary supplements, and mind-body techniques may be used alongside antidepressants and psychotherapy, or in place of medications. To decide when and how to tackle your depression, you may need to ask yourself some tough questions. What would it be like for you to try out other options for relaxation, such as yoga or meditation? In prioritizing your mental well-being, how can that priority be reflected in the way you schedule your week to make time for meeting with a health care provider or make time to try out a relaxation technique that doesn't include substances? What sort of support would you need? What questions additional questions would you want answered before choosing a way to address your depression? In the end, the intensity and direction of your treatment is entirely up to you. A health care provider can help provide support, guidance, and if needed, appropriate prescriptions to help you on the road to where you want to be. 

Although each person handles depression in their own way, at some point everyone is faced with the choice of if and how to get help. While the decision to seek help may be overwhelming, many people find getting depressive symptoms under control to be a weight lifted off them. It's good that you’re doing well academically and socially, but that doesn’t detract from how you’re feeling and whether your symptoms are interfering with your life. Making time and space for depression treatment may require some trade-offs, but seeking support helps put you in charge of your recovery. Wishing you the best in whatever you decide to do.  

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Summary of informative links

Related Q&As: 

  •  What’s going on? Am I depressed? 
  • Readers are reassured that it is perfectly normal to be concerned over whether one has depression or not. Process of being evaluated as well as symptoms are listed. Alternative reasons for the reader’s feelings are suggested. The reader is encouraged to not be afraid to seek help. 
  •  Sick about going to counseling 
  • The reader is comforted by being told that it is normal to feel uncomfortable with such a big step. Possible reasons for meeting with a counselor are given. Potential benefits for these visits are listed and explained. Resources for finding therapy as well as advice are given.  

  

Source 1:  

SUMMARY 

This source runs through key information about depression. To be diagnosed with depression, one must show symptoms for at least two weeks. An extensive list of symptoms, which include hopelessness, decreased energy, and more, are given. If one thinks they have depression, healthcare providers make recommendations to mental health professionals (psychiatrist or psychologist). 

 
Depression can vary by how it looks depending on age. For younger adults (which the reader is), symptoms are more commonly irritation, weight gain, and a strong sense of negativity. Substance use disorders are also common. When looking for treatments, one should remember that this looks different for everyone. A list of treatments are as follows: 

  • Psychotherapy:  
  • Cognitive Behavioral Therapy: helps challenge and change bad thinking patterns and behavior to relieve depressive feelings 
  • Interpersonal Therapy: focuses on life events that may impact mood negatively. This treatment heavily prioritizes communication skills to deal with issues adding to depression 
  • Medication: Important to note they can take 4-8 weeks to work! Patience is key. After a while, one can discuss with their therapist options for new medication. Do NOT stop taking the medication abruptly (withdrawal effects!). 
  • Brain Stimulation Therapy (not explained) 
  • Electroconvulsive Therapy 
  • Transcranial Magnetic Stimulation 

 
Advice on how to care for oneself during the treatment process is given. Examples are physical activity, establishing a sleep schedule, etc. 

  

Source 2:  

SUMMARY 

The risks for combining antidepressants with alcohol are made clear in this source. Notable reasons include: 

  • Increased feelings of depression/anxiety 
  • It May seem fun in the short term, but its overall effect leads to an increase in symptoms 
  • Medications may not sit well with alcohol leading to an increase in side effects 
  • Certain medications like Maomine Oxidase Inhibitors can have dangerous reactions 
  • Thinking and alertness will be impaired 
  • Combination with antidepressants will affect this more than alcohol alone 
  • Increased feelings of drowsiness 

 

One should also take caution as depression can lead to increased risks in substance abuse. One should not stop antidepressants to drink as doses require consistent consumption. It is ok to have an occasional drink, but one should consult their doctor to be safe 

  

Source 3:  

SUMMARY 

We will focus on slides 8 to 10. Though marijuana has a low/moderate risk of dependence, CBD in marijuana can cause the number of SSRIs in our bloodstream to increase. This is caused by the CBD blocking our body’s ability to clear the antidepressant quickly. This puts one at risk for serotonin syndrome (too much serotonin in the body) given there are high levels of serotonin in the body from SSRIs. 

 

Source 4: 

SUMMARY 

This source covers how marijuana is linked to disorders like depression, anxiety, substance abuse, and more. While the mechanisms that do so are not fully understood, few associations have been found between marijuana consumption and the development of suicidal thoughts. Likewise, there is a decrease in motivation to work. 

 
The risks of marijuana use are made clear. In the short term, there are impaired cognitive functions, anxiety, and an increased heart rate. Persistent uses can interrupt sleeping habits and bring impaired learning. Long-term use can increase the risks of respiratory disease, other substance abuses, and possibly schizophrenia. 

  

Source 5:  

SUMMARY 

Much of this information is repeated from source 1, but there are a few additions to fill in gaps. The information is as follows: 

  • Given medication does not work for an individual, there is the possibility that one may need combinations of medicine. Once again this requires patience. 
  • Electroconvulsive Therapy involves the passing of currents through the brain to target neurotransmitters that can relieve depression. This is used if medications don’t work or cannot be taken 
  • Transcranial magnetic stimulation involves placing a coil against the scalp to send magnetic impulses that stimulate nerve cells involved with mood and depression 

 
Once again, a few self-care tips are provided. These involve journaling, having company, creating a daily schedule, and more. Likewise, advice is given on how to approach making an appointment to discuss one’s depression. Symptoms should be made clear, information that can explain reasons for depression, and current medications being taken.  

 

 
OVERALL CONCLUSIONS: 

The previous response effectively answers the reader’s question. There are, however, a few spots of information we can add/update. 

 
The opening paragraph should be kept. As per source 1, depression looks different for everyone, so thoughts of suicide may be the tipping point for the reader’s situation. We should add that a proper diagnosis for depression requires consistent symptoms for over two weeks.  

 
The second paragraph should be split for one to discuss alcohol and the other marijuana. Using source 2, we can dive into the possible risks of consuming alcohol on top of alcohol itself exacerbating feelings of depression. By making clear the risks of alcohol consumption if the reader gets treatment, we can encourage safety. Using source 4, we can expand on how depression and marijuana are linked. Using source 3, we can mention the risks of marijuana use during treatment. 

 
The third paragraph is an appropriate transition and should be kept.  

 
For the antidepressant's medication section, we can use source 5 to add the first bullet point in the source summary. For the psychotherapy section, we can use source 1 to expand on the two types of psychotherapy there are. Added treatments should be from source 5: electroconvulsive therapy and transcranial magnetic stimulation. We should not that these two usually occur if nothing else has been working out.  

 
The closing paragraphs are reassuring and provide great advice. They should be kept. 
 

Notes on research: 

Information on this topic was easy to find. Though the mechanisms of substance interactions with antidepressants are still not heavily researched, there is a consensus that substance use should be avoided. 

 

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