What isn’t wrong with this picture? First of all, how do we make a decision like that in three minutes? Hippocrates said, “First, do no harm.” So you don’t want to use drugs that have very real side effects for the majority of people who take them. That’s been documented over and over again.

What kinds of side effects?

GI [gastrointestinal] symptoms, upset stomach. Agitation. Many people who take these drugs feel agitated. At least 10, 15, 20 percent and maybe more. Sexual side effects are very prominent, with 60 to 70 percent experiencing these in most of the studies. They lose their libido and the orgasms they have are not very satisfying. There’s a lot of weight gain. The percentage varies widely, but it’s a common side effect of antidepressants.

I’ve had patients who experienced major weight gain on antidepressants and had great difficulty losing it.

That’s been my experience, too. And while it’s not talked about so much in the medical literature, patients will say, “I just didn’t care as much.” On antidepressants, the lows may not be so low, but there aren’t too many highs, either.

It’s like the old Eagles song, Desperado, about “losing all your highs and lows, ain’t it funny how the feeling goes away.”

You have all these physical side effects, which are distressing in themselves, and then you have a kind of psychological or emotional numbing, which is not exactly what I would call a wonderful result. First, I don’t think any drug should be prescribed without a very careful assessment of what the benefits and hazards are. Second, in the studies on antidepressants that have been done, when you look at all the studies, including the unpublished ones (presumably not published because the drug companies don’t want to publish those that are unfavorable) as well as the published ones, the advantages of antidepressant drugs over placebo (that is, an inert pill given to people) are very, very small.

So whatever benefit there is, is very small, and the side effects are generally quite significant. I mean, there are some people that benefit but it’s not a very significant number according to the published studies. Beyond that, the other thing is that when people are depressed, they want to talk. So if somebody is writing a prescription right away, they may be trying their best to be helpful but they’re not responding to the deep need that the confused, troubled, depressed person has, to share what’s going on with them. That’s primarily what they want from their physicians. And they’re not getting it. They’re getting a message that says, “No, we’re not going to talk about this. I’m going to give you a pill.”

What have you found to be the value of exercise for depressed people? What kinds do you recommend?

There are perhaps three crucial aspects of working with depressed people. One is being there for them, listening, being present with them. Second is giving them hope that depression is the beginning of a process of change which is, in essence, what the whole of Unstuck is about. And the third, I would say, that should be part of every depressed person’s therapy, is exercise. The evidence for its importance in treating depression is very significant. In many of the studies, it is at least as good as antidepressants and perhaps better.

Without the side effects.

Without the side effects and with many positive effects because it’s good for your general health and it makes you feel better about your body. Instead of the body being just a source of pain or discomfort, it becomes a source of pleasure and satisfaction. And because exercise also very clearly says to people who are depressed that there’s something you can do. Get up and go for a walk or a run or a swim and this will make a difference to you. There are plenty of scientific papers but you don’t have to look at the scientific papers. Those may help encourage you, but the evidence is right there in the way you feel after you exercise and the way you feel after days and weeks of exercising regularly.