Major depression is one of the most prevalent mental disorders worldwide, along with those in the anxiety category. In parallel, the use of antidepressants is becoming more common in society.

The increased demands in many areas of life, the tough economic crises we have had to face and a long list of other circumstances have made a decisive contribution to this.

In this article we will look into the question of whether depression can be cured without medication , which necessarily implies knowing in advance how this common mood disorder manifests itself.

What is depression

First of all, it is important to note that depression and sadness are not two equivalent realities. The first describes an emotion that belongs to the normal range of human experience, and which has been forged throughout the evolution of our species by its adaptive properties. Depression, however, is a relevant clinical phenomenon that can deeply compromise the quality of life of those who suffer it. They are, therefore, different.

The core symptoms of major depression are sadness and anhedonia (severe difficulty experiencing pleasure), and one (or both) must be present for a diagnosis to be made. The person suffering from it feels emotionally depressed most of the time, which coexists with a substantial loss of interest in engaging in activities that were previously rewarding or meaningful.

It’s relatively common for people with depression to occasionally think about taking their own lives, or for a series of thoughts related to death or dying to burst onto the scene of their mind. A persistent fatigue can also be observed that lasts for most of the day , and that is related in a reciprocal way to the difficult emotions that characterize this psychopathological alteration of mood.

Some people even refer to alterations in executive processes such as attention or concentration, all of which depend on the activity of the prefrontal cortex, which ends up manifesting itself vehemently through the obstruction of the capacity to make decisions. Likewise, rumination can be frequent (obsessive thoughts that are perceived as intrusive) and with contents consistent with the state of mind (guilt, failure or pessimism regarding the future).

Finally, important changes may arise in habits that are necessary for the care of the body , such as eating (which may lead to weight gain or loss) or sleeping (due to excess or deficit). On a psychomotor level, there are occasionally some additional alterations, perceived as slowing down or accelerating movement and/or thinking, which can have an echo in the way we interact with others.

These symptoms must be maintained for two weeks or more and alter the person’s quality of life, or cause deterioration in the areas of functioning that are relevant to the person. Likewise, it is important to confirm that no previous manic episode was ever suffered , otherwise the appropriate diagnosis would be Bipolar Disorder Type I (whose treatment requires stabilizers or anticonvulsants). With this knowledge at our disposal, we can go into the initial question: can depression be cured without medication?

And so… can depression be cured without medication?

Pharmacological treatment and psychotherapy are the two great tools we have to combat depressive disorder. The efficacy of both has been extensively studied in the scientific literature on the subject, and even comparative studies have frequently been carried out to try to elucidate which of these modalities provides greater benefit to people who decide to opt for them in a case of need.

The most recent studies on the subject, including the comprehensive meta-analysis by the National Institute for Health and Care Excellence (NICE, 2017), indicate that the effect of antidepressants is slightly superior to that of placebo ; this is one of the most frequent measures of the therapeutic quality of a chemical compound. However, numerous criticisms have been made by different authors regarding the interpretation of these results.

The use of psychotropic drugs should generally be chosen for severe cases of depression, allowing a more efficient balance between the benefits and harms that may result from their use. They are not usually recommended for minors ; and extreme caution should be taken in pregnant women, epileptics or people with clear suicidal ideas. The latin locution primum non nocere (the priority is to do no harm) is used to represent the search for this balance.

Monoamine oxidase enzyme inhibitors (MAOA), practically in disuse , reduced depressive symptoms significantly but increased the risk of hypertensive crisis when combined with the intake of tyramine-rich foods (through an abrupt increase in noradrenaline). Tricyclics, considered the most effective in reducing the symptoms of depression, generate a long list of side effects associated with the blockade of cholinergic muscarinic, histamine and adrenergic receptors.

The selective serotonin reuptake inhibitors (SSRIs) were the first antidepressant drug synthesized specifically for the purpose of acting on mood, since in the previous ones this therapeutic application was discovered by mere chance. The SSRIs are a family of six different drugs that have better tolerability and adequate efficacy, but are also associated with side effects on sexuality and gastrointestinal activity (since these are two functions regulated by the neurotransmitter they affect).

Therefore, the use of psychopharmaceuticals is an option that the patient should evaluate together with the physician , taking into account a reflection on the severity of the symptoms suffered and the potential side effects of the compound. This is a balance in which the search for equilibrium prevails, and in which perhaps the use of psychotherapy should be prioritized in those cases where it is possible. However, whatever the choice, psychological treatment should be present (at least as a combination treatment).

How can psychological treatment help combat depression?

Psychotherapy should be the priority in cases of mild or moderate depression, and its use should also be considered in more severe cases by combining it in a harmonious way with the use of the psychoactive drug that the person may require. Ultimately, there is always a percentage of patients who do not respond substantially to one or another treatment strategy , so opting for the use of both approaches at the same time (in severe cases) has proven to be the most effective.

Psychological treatment provides the person with a series of tools for life , whose purpose is diverse (depending on the needs detected): to better understand depression and its causes, to restructure distorted thoughts that could mediate the most difficult emotions, to learn problem-solving strategies, to incorporate pleasant activities into daily life, to promote the use of social resources, to facilitate the expression of discomfort and a long etcetera.

The main advantage of psychological treatment over the use of psychotropic drugs is that, being at least as effective in cases where its application is recommended, it reduces the tendency to relapse much more obviously (which is very frequent in this pathology). It does, however, involve a number of significant lessons that are incorporated into the body of strategies already available to the individual, and which enable him or her to cope with future stress and adversity.

Nevertheless, psychological treatments require active efforts to improve , something that should occasionally be stimulated before and during the intervention, since there are not few patients whose state of physical and emotional despondency makes this disposition difficult. It is also necessary to put into practice a series of tasks outside one’s own practice and be patient with respect to improvement (which may come somewhat later than in the SSRIs, which require two to three weeks to do so).

Perhaps the very fact that the benefit of psychotherapy is not immediate, together with the need to articulate a sustained effort for self-care, has motivated the extensive use of antidepressants in our society and the scarce availability of other strategies in the health system. To enter into the process implicit in psychological treatment (which usually lasts 20 sessions per week), we must equip ourselves with the necessary motivation, which must also be stimulated by the therapist.

Beyond the psychological and pharmacological treatment itself, there are also some recommendations based on healthy lifestyles , which have been shown to be effective in simply improving mood. Below are some of them.

What else can I do to improve my mood?

Scientific literature has found evidence of a number of habits that may be useful for those going through a depressive process.

Some studies have shown that getting involved in prosocial activities, such as volunteering for causes that we feel deserve it, can substantially improve morale. Dedicating time to those people in our environment to whom we have a constructive bond can also be of help, since it would allow us to express the emotions that we harbour and be the object of an attentive and understanding listening .

In case our emotional symptoms are due to the fact that some relevant purpose of our life is not developing the way we think it would, it can be useful to reinterpret objectives to turn them into a succession of small steps more easily attainable, keeping the ultimate goal after the corresponding achievement of the preceding links. With this small reinforcements are introduced that maintain the behaviour and motivation towards the goal .

The practice of physical exercise, especially aerobic (since there is not enough data on anaerobic exercise yet), has also proved to be a powerful natural antidepressant; as well as walks in the sunlight, which stimulate the production of melatonin from the pineal gland (a hormone widely spread in the animal kingdom), helping to reduce insomnia that often coexists with depression.

In conclusion, depression does not imply deficiencies in any aspect of character or manner of being, as all people are susceptible to it at some point in their lives. If you think your symptoms are compatible with it, don’t hesitate to ask a health professional to assess which would be the most advisable therapeutic option (as this is always subject to an in-depth analysis of the person, the intensity of their symptoms, their needs and their circumstances).

Bibliographic references:

  • Cipriani, A., Furukawa, T., Salanti, G., Chaimani, A., Atkinson, L. and Ogawa, Y. (2018). Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. The Lancet, 391, 1357-1366.
  • Morley, J.E. (2017). The Effectiveness and Harms of Antidepressants. Journal of the American Medical Directors Association, 18(4), 279-281.