To get help, or not to get help? Help!

Originally Published: January 15, 2010 - Last Updated / Reviewed On: October 18, 2013
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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 symptons 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

Dear Regular guy who might need help,

Each year in the US, about 12 million adults struggle with depression. Although each person handles depression in his or her own way, at some point everyone is faced with the choice of if and how to get help. This decision is entirely up to you. It's good that you are doing well academically and socially, but thinking about suicide is a big red flag that the "tipping point" or moment to seek help has arrived. This is the time to call on a friend, coach, family member, or health care provider for support. When you feel ready, a mental health professional like a counselor or psychiatrist can different treatment plans that may suit your needs.

Like you, many people with depression also use drugs and/or alcohol. For example, researchers know there's a significant link between marijuana use and depression; they just aren't sure how the two go together. Depression may lead to toking up, or vice versa. Alcohol and marijuana both fall in to the category of depressants — could these substances be exacerbating your feelings of depression? 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 like alcohol and marijuana don't mix well with antidepressant medications. You can find more information about the interactions between these drugs in the related Q&As below.

Thankfully there are several other treatment options besides antidepressants, each with its own risks, benefits, and commitment levels. To decide when and how to tackle your depression, you may need to ask yourself some tough questions. Is it worth it to drink less on the weekends if you will feel happier and more motivated on antidepressants? Are you willing to cut back on smoking weed and try yoga or meditation as a healthier way to relax? Can you find time in your schedule for weekly counseling? In the end, the intensity and direction of your treatment is entirely up to you. Here are some options to consider:

Antidepressant medications
Antidepressants are one of the most popular and effective treatments for moderate to severe depression. These medications work by altering the balance of natural brain chemicals to moderate your mood. All antidepressants are not created equal. Each one has its ups and downs, and the same medication can affect people differently based on one's brain chemistry, genetics, and lifestyle characteristics. It can take four to twelve weeks for antidepressants to do their job; so don't be discouraged or go off the medication if you feel like it isn't working immediately. Similarly, your dose may need to be tweaked up or down to find the right balance for you. 

Psychotherapy
Also known as counseling or talk therapy, psychotherapy is a powerful and proven course of treatment for a variety of mental health issues including depression. Counseling comes in different forms, and is often used in combination with antidepressants. Counseling usually involves talking with a psychiatrist or clinical psychologist about the roots of your depression, how the illness affects your feelings and relationships, and ways to replace negative thoughts or behaviors with happier and healthier ones.

Alternative or complementary treatments
Treatment options for depression don't end with medication and talk therapy. Some people use complementary techniques alongside antidepressants and psychotherapy, while others prefer to use alternative therapies in place of medications. Although you don't need a prescription to use alternative or complementary treatments, it's wise to talk with your provider about their risks and benefits.

Physical Activity
That's right, the simple act of moving your body can do wonders for your 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 exercise can lift your mood. Although researchers aren't exactly sure how this works, exercise 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 exercise, 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 have had strong side effects from antidepressants. Keep in mind that the U.S. Food and Drug Administration (FDA) does not regulate dietary supplements, so ask your health care provider about their risks and benefits. It's also important to note that dietary supplements can cause serious interactions with other drugs — always a good idea to keep your primary care provider clued in to what you are taking in addition to prescription medications.

Mind-body techniques
This third category of alternative depression therapies is based on the idea that the physical body and the mind must be in sync for you to be healthy and happy. People use a variety of techniques like meditation, guided imagery, yoga, massage therapy, and acupuncture to strengthen the mind-body connection. Although research in this area is not conclusive, mind-body techniques have existed for centuries. As with any alternative or complementary therapy, check in with your provider about your plans. 

As you can see, there is a large menu of treatment options for depression. Mental health professionals are trained to assess your symptoms and tailor a treatment plan to your specific needs. Students at Columbia can make an appointment with a counselor at  Counseling and Psychological Services (CPS) (Morningside campus) or the Mental Health Service (CUMC). During your visit, it's OK (and important) to be honest about your drug and alcohol use as well as your concerns about how treatment will fit into your life. Together, you and the counselor can discuss treatment options. The final decision about how to move forward is up to you.

Making room in your life for depression treatment may require some trade-offs, but getting help will put you in charge of your recovery. A counselor can point you in the right direction, and then you can decide what steps to take next. Good luck!

Alice