Beyond Blue

Beyond Blue

Depression: Medicate, Meditate, or Both?

Thanks to Beyond Blue reader, Ellen, who wrote this on the combox to my post “If Your Depression Is Triggered By Stress, Should It Be Treated With Medication?”:

Surely if a depression is caused by stress, the first step should be to look at the stresses in a person’s life? That’s just common sense. To say that medication is just as likely needed as not just seems ridiculous to me and pandering to a drug industry in whose interest it is to medicalise all human problems. I have a real problem with that.

I agree with you to some extent, Ellen. I do think the starting point is to look at the stresses in a person’s life, and you’re right sometimes medication is doled out prematurely. 


I think you all know where I stand with regard to medication and depression. I believe medication is a tool that allows us to do the hard work of psychotherapy, meditation, and cognitive-behavioral therapy. I believe for such illnesses as bipolar disorder and schizophrenia, it is irresponsible not to take meds. However, I certainly don’t believe you take a pill and are fixed. If any of you have had that success, could you please tell me what you are taking?

In my view, tons of hard work goes into recovery, which is why I appreciated Elisha Goldstein’s post called “Depression: Medicate, Meditate, or Both?” To get to it, click here. The only part that I disagree with (and he would probably concur with me) is that for some mood disorders–and especially for bipolar disorder and schizophrenia–medication does have to be part of the long-term plan. I have excerpted a few paragraphs below:


The Psychiatric field has found medications that increase the flow of certain neurotransmitters in the brain that can help relieve these feelings of depression. However, because of the relapse rate, the American Psychiatric Administration had to come up with three phases of treatment with medications, acute, continuation, and maintenance. Acute medication treatment was aimed at relieving symptoms during a depressive episode. Continuation treatment was for prescribing medication for 6 months after the episode had passed and maintenance was to prescribe for up to 3 years. So what’s the problem here? What happens after 3 years? What about the people whom medication doesn’t agree with or unable to take? 

Medication can be a wonderful support; however, it’s important to also cultivate the skills to work with the potential relapse of depression moving forward. This is a more effective long term strategy.


Based on Jon Kabat-Zinn’s Mindfulness-Based Stress Reduction (MBSR) program, Zindel Segal, Mark Williams, and John Teasdale developed Mindfulness-Based Cognitive Therapy (MBCT) for depressive relapse. Teachers of this program support participants in cultivating mindfulness meditation skills to foster the ability to be more nonjudgmentally present to thoughts, feelings, and sensations in daily life. In doing this, people learn a new way of relating to their distress; rather than avoiding it they learn to approach it and live in the midst of it. This has profound consequences for what follows. When we spend our time hating and cursing our distress it’s as if we are sending negative energy into a blob of negative energy. What happens? The negativity we’re sending is food for that blob and it only grows. We don’t realize that the way we are relating to our depression, adds to it. It’s difficult to grasp this concept if we’re in the depression and that is why this approach is best when the episode is lifting or has lifted. Here is where medication can be supportive.

To continue reading, click here.

  • Elisha Goldstein

    Thanks for the commentary on this Therese. I absolutely agree, as will most in the mental health field, that bipolar disorder and schizophrenia should be supported with medication for those who are able to do so and then supplemented with a longer term strategy of life skills training as part of a more effective long term strategy.

  • Susan

    This is the biggest topic for me of all. After going through an extremely traumatic series of events in my life I became very ill with depression, along with a constellation of symptoms related to complex traumatic stress disorder.
    I was astonished, shocked and grief-stricken by the number of so-called friends who deserted me when I needed them most, some actually heaping more grief and trauma on me as they stormed out of my life.
    I know how much energy it takes to drag myself up to the daily smiley face performance that the world demands of me. I know how far I fall back into the pit once the smiley face performance is over each day. And when I can’t put that smile on my face, when I am physically incapable of even getting out of bed, I am told I don’t try hard enough.
    The “don’t ask, don’t tell” way that the military mistreats their gay service men and women is very similar to the way society mistreats those who are ill with a mood disorder. We dare not reveal our diagnosis due to stigma, ignorance and prejudice. We dare not show our pain, or we will be punished for it. There are no telethons for us, no walkathons, no milk cartons with our faces on them when we go missing in the black hole of depression.
    I desperately want the medical community will come up with something less subjective and disempowering than “mental illness” to describe these “dis-eases”. They know enough now to stop separating psychological illness from physical illness – mind and body are one. It is not a moral or character failing to have asthma or diabetes, or cancer. It is not a moral or character failing to have depression or have bi-polar or other brain chemistry disorders.
    Until the medical establishment acknowledges this, and matures in its approach to patients with these illnesses, the rest of the world won’t. And the author of the article is absolutely correct, we will have to continue to adjust OUR expectations. But I say, let’s adjust those expectations here and now – let’s raise them!
    Here’s to you and to me, who are taking life a minute at a time or a day at a time, but do not have to be alone in this courageous journey.
    Blessings to all,

  • David Ebaugh

    One of the biggest obstacles to practicing positive self-talk is the canned and programmed nature of positive self talk. But what people fail to consider is that if they are not using canned positive self talk, they are likely using canned negative self talk, programmed over years of living with beliefs passed to us by others. I teach clients how to manage their stress, anxiety and depression through accepting positive self talk, and practicing it until the positive thoughts come more easily than the negative thoughts. It takes time, persistence and repetition, but that’s not surprising since that’s how the old thoughts got into our heads in the first place.

  • Sonia Gallagher

    Thanks for such a great article and for showing us that the United States is opening itself up to the benefits of meditation. The regular practice of meditation can give both mental and physical benefits to the practitioner.
    I have been meditating for quite some time now and can honestly say that it has had a wonderful impact in my life. Not only has it made me a calmer person and less reactive to stressful situations but it has literally changed my life. It helped me realize what is important in life and that I was spending too much time working in something that I was not passionate about. I practiced law for five years and recently left it. I am now a recovering lawyer and am fully dedicated to online publishing about meditation. My mission is to make mediation accessible to everyone including busy professionals (that most can benefit from meditation).

  • Your Name

    Meditation,i agree.

  • joanne

    April 15……. Thank you for your wonderful web site.. I love and learn so much from each one.. Thankyou Thankyou…..

  • Marie

    First, I want to compliment Susan on her comment. She expressed what I and others feel on a daily basis.
    I worked at a community mental health center as a therapist, did substance abuse counseling contract work at night with a local hospital, and I had to take care of my mother’s every need. I was a therapist. I don’t work now.
    When the receptionist would let me know a client was there to see me, more days than not, I’d say to myself, “It’s show time,” in order to meet the needs of my clients 110%. I loved my work, but the failings of the system were extremely difficult to deal with.
    I am on disability now, and I have several ongoing and painful physical problems. My doc finally found a mood stabiizer that caused me to feel ‘normal’ for the first time I could remember. I engaged in several activities, was not depressed at all, and I felt wonderful for about a month.
    Then, I was suddenly struck by a rare and excruciatingly painful neurological disorder. No one here knew how to treat the pain, and pain meds didn’t help. I went to physical therapy after three months and that lessened the pain, but I became house bound for the most point, and, as Susan said, I found that my friends were of the fair weather variety.
    This neuro condition occurred over nine years ago, and for all practical purposes, I’ve had no life since then. I feel I’ve been in solitary confinement except that I’m in a house rather than a prison. Add that to the mix, and you will see how very much such circumstances and exacerbate depression.
    I appreciate all the comments you all have made. It helps to see other people who can understand. My very best to all of you…

  • Your Name

    It is very true that while you are working on issues and stresses that have triggered the depression medication is almost necessary depending ion the stresses. Anyone who says it is not does not know the true nature of clinical depression. Depression stems out of PTSD and child abuse trauma and any other kind of abuse. These are serious things and on e would not know what it is like without actually experiencing this first hand. The meds help u to get up in the morning and actually make u become willing to look at the issues.

  • Ellen

    Wow, thanks Therese for responding to my comment. I love the article on meditation.
    Maybe I’m beating a dead horse, but hey, it’s the internet, I guess I get to respond. I didn’t think your original post, ‘Should you medicate for depression caused by stress’ was as broad a question as ‘Is medication ever necessary’, in fact it seems to be a different question.
    Bipolar and schizophrenia, the argument goes, are caused by structural or chemical problems in the brain, and need medication. I have no personal experience here and will go with people who do and what they say they need.
    Depression caused by stress however seems to be about depression caused by say a job loss, a break up, or other stress. Should this kind of depression be medicated? I just don’t think so, for the most part. Let’s look at coping techniques, talking, CBT, or alleviating some of the stress first. As in the article you have linked to.
    It seems to me as a society we like to reach for a pill first. It’s easier and cheaper than a lot of talk therapy. That’s all I’m saying.
    Nothing could be further from my intention to speak badly of people who need to take medication.
    Cheers! A faithful reader

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