Beyond the Pill: What I’ve Learned About Treating Depression in Real Life

 As a practicing psychiatrist, one of the most common questions I hear from patients is:

“Do I have to be on medication for the rest of my life?”

The concern is understandable. There’s a lot of fear and stigma surrounding antidepressants—many believe they’re a crutch, or worse, a lifelong sentence. But over the years, my experience and the evidence have both taught me the same thing: medication is just one part of the story when it comes to overcoming depression.

How Far We've Come: From Old-School Pills to Modern Antidepressants



Nearly 70 years ago, patients with depression who were prescribed  older-generation antidepressants like monoamine oxidase inhibitors (MAOIs) improved. These drugs, while revolutionary at their time, came with restrictive diets and uncomfortable side effects. Thankfully, we’ve come a long way.

Today, SSRIs (Selective Serotonin Reuptake Inhibitors) are the mainstay of pharmacological treatment. They’re safer, more tolerable, and highly effective for a wide range of depressive disorders. In my practice, I’ve seen countless patients respond positively to SSRIs—often within just a few weeks.

Take Amina, a 28-year-old teacher who came to me last year unable to function at work due to persistent low mood, sleep disturbance, and loss of interest. After starting her on a low dose of escitalopram and combining it with cognitive-behavioral therapy (CBT), she reported a major improvement by the third week and was back in the classroom a month later.

But here’s the important part: Medication wasn’t the whole answer.

Psychotherapy: The Underrated Game Changer



For some, medication gives them the boost they need to function. But for long-term recovery, psychotherapy—particularly CBT and psychodynamic therapy—often makes the real difference.

One of my patients, Sami, struggled with depression that stemmed from unresolved childhood trauma. Medication helped stabilize his mood, but it was during his psychodynamic therapy sessions that he began understanding his thought patterns and emotional triggers. Over time, he developed a healthier relationship with himself and others. Today, he’s off medication and doing well—because the root causes were addressed.

There’s strong evidence for this. Treatments like:

  • Cognitive Behavioral Therapy (CBT)

  • Behavioral Activation Therapy

  • Psychodynamic Psychotherapy

…have consistently shown lasting benefits. They don’t just treat symptoms—they help patients build insight, coping skills, and emotional resilience.

Are Antidepressants Forever?

This is a critical point I always explain to patients. For most people with a single episode of depression, antidepressants are not needed for life.

Research shows that continuing medication beyond a year in such cases does not significantly improve relapse prevention. In practice, once a patient has remained stable for 6–12 months, we often begin a gradual taper—always with support and monitoring.

In fact, Sara, a 35-year-old executive, feared she’d be “stuck on pills forever.” But after a year of combined therapy and medication, we tapered her dose slowly. She’s now two years medication-free and thriving—while continuing regular therapy sessions and mindfulness practices.

So, Is Medication the Only Way Out?

Absolutely not.
Medication is often a helpful stepping stone. But the real transformation, in my experience, happens when patients engage in therapy, make lifestyle changes, and build meaningful support systems.

There’s no shame in taking medication. But there’s also no single path to recovery. Some people may never need medication. Others may benefit from it temporarily. And for those with recurrent or severe depression, longer-term treatment may be necessary—but it doesn’t define them.

Final Thoughts

Depression isn’t just a chemical imbalance. It’s a whole-person issue that requires a whole-person solution. As a psychiatrist, my role isn’t just to prescribe—it’s to guide, empower, and walk with my patients as they find their unique path to wellness.

If you’re struggling with depression, know this: you’re not alone, and you’re not powerless. Whether through medication, therapy, or both—recovery is not only possible, it’s highly likely with the right support.


Dr Zoheb Raj, MD

Comments

Post a Comment

Popular posts from this blog

The ADHD Dilemma: When Symptoms Overlap and Tools Mislead

Image
In recent years, there has been a noticeable surge in patients walking into my practice convinced they have ADHD. This trend isn't entirely surprising. The internet is flooded with ADHD content—TikTok reels, blog posts, self-assessments—and, most importantly, freely available screening tools that lack appropriate disclaimers or guidance. While these tools can serve as a useful starting point, they often lead to self-diagnosis without the critical clinical context. One major issue is that many symptoms of ADHD—such as difficulty concentrating, restlessness, irritability, and forgetfulness—can also be present in anxiety disorders, depression, trauma-related conditions, and even sleep disturbances. When taken at face value, a symptom checklist can easily generate a "false positive," especially when used outside of a structured clinical evaluation. ADHD is a nuanced neurodevelopmental condition. While symptom checklists might suggest the possibility of ADHD, they cannot dif...
Read more

The Invisible Scars: Growing Up with a Parent with OCD and the Lingering Echo of Abandonment

Image
As mental health professionals, we strive to understand the intricate web of experiences that shape an individual's well-being. We recognize the profound impact of mental health conditions not just on the individual, but on their entire family system. Yet, there's a vital piece of this puzzle that often remains in the shadows: the emotional world of children growing up with a parent battling Obsessive-Compulsive Disorder (OCD). In my own clinical practice, a consistent and heartbreaking pattern has emerged. I've witnessed firsthand how children of parents with OCD often grow up feeling neglected, carrying the heavy burden of anxiety and depression, and, perhaps most profoundly, a persistent and chronic sense of abandonment that takes root at a very young age. This holds true even for individuals whose parents received treatment much later in life, long after the foundational years of childhood had passed. Consider the recent case of a 22-year-old patient. Diagnosed with Bo...
Read more

Breaking the Silence: Finding Your Perfect Therapist Match

Image
 It's brave to take that first step toward addressing a mental health concern. As a psychiatrist, I've seen firsthand how challenging and overwhelming it can be for my patients. One of the biggest hurdles they often face is simply figuring out who to turn to. It's a deeply personal journey, and finding the right therapist is paramount to successful healing. So, how do you choose the guide who will help you through this important process? Here are some key considerations, drawing from my own experiences in practice: Leverage Your Network (and the Internet!) A personal recommendation can be incredibly powerful. I remember S, a patient who had been struggling with anxiety for years. She finally decided to seek help after a close friend raved about her therapist. "Knowing my friend had such a positive experience made it feel less scary," she told me during our initial consultation. She found comfort in that shared success. While peer recommendations are gold, don...
Read more