Psychologists’ Views and Experiences of Antidepressant Treatment for Depression

Abstract

Research has raised doubts about the effectiveness of antidepressants, particularly for mild to moderate depression, as well as concerns about associated adverse effects of the medication. Despite these concerns and the relative efficacy of psychotherapy, antidepressant use continues to rise while the use of psychotherapy as a treatment for depression has declined. This qualitative study aimed to investigate psychologists’ views of antidepressants arising from their experience of working therapeutically with depressed clients. In particular, it sought to understand the experiences that influence psychologists’ views about antidepressants, any dilemmas they experience in regard to working therapeutically with depressed clients, and the approaches (including decision-making) they adopt in relation to antidepressant treatment and psychotherapy for depression. Sixteen clinical psychologists, with a minimum of five years’ experience, were recruited via an advertisement. Six of the psychologists were male and ten were female. Primary employment was distributed evenly across the public mental health system and private practice. The psychologists participated in semi-structured interviews focussed on exploring their experiences and views of working therapeutically with depressed clients, specifically those who have used or are using antidepressants. A process of thematic analysis, guided by an interpretive approach, was conducted on the data. The results of the thematic analysis showed that psychologists’ views of antidepressants are influenced by a number of experiences. These included the dominance of the medical model in the mental health system; their work context – private or public; their observations of the impact of antidepressant treatment and therapy on client wellbeing; and the influence of factors relating to the client. The subsequent approaches adopted by psychologists in relation to antidepressant and/or psychotherapy treatment for depression centred on client wellbeing and involved balancing a desire to empower the client with the importance of being pragmatic. Overall, antidepressant treatment was deemed useful to the extent that it improved client wellbeing; however when it disempowered the client and/or prompted disengagement from therapy it was viewed as compromising recovery by preventing clients from addressing the underlying causes of depression and acquiring coping skills, which could help prevent relapse in the future. Whilst holding these views, the psychologists ultimately respected clients’ choices and approached the treatment of depressed clients on a case-by-case basis. A model is proposed to represent these influences on psychologists’ views of antidepressants and the approaches they adopt when working with depressed clients. This study contributes a new and important perspective on client antidepressant use and psychotherapy to the field of research on depression, and considers implications for psychology/psychotherapy practice and future research directions.