Dependence, on the other hand, is just physiology. Dependence is a natural phenomenon where your body has a negative, opposite reaction, after stopping a substance. For example, if you stop taking blood pressure pills after years of taking them, we would expect rebound hypertension–an immediate increase in blood pressure that may exceed your baseline, untreated level. 

Dependence can occur with any medication. And yes, dependence is a common symptom in addiction. But dependence alone is not addiction. 

Can you be dependent on antidepressants? Of course. It happens all the time. Can you be addicted? No. It is almost never a concern. There may be other reasons to consider an alternative treatment, but don’t worry about antidepressant addiction. 

[Note: there are some rare circumstances where people snort antidepressants when nothing else is available. That’s usually only people in really desperate circumstances who have already developed the behavioral patterns of addiction with other substances. It really isn’t that rewarding. For the average person with depression, there is essentially no reason to be concerned.]

Unity is different. Unity is a commitment to shared values, regardless of any particular alignment. You can be unified and disagree forcefully. That happens in all healthy marriages, workplaces, and countries. 

Unity asks: What am I willing to give up to make this relationship work? What matters most to us? What is bigger than me? 

Unity isn’t fundamentally moral, but it works best when it embraces noble values. So regardless of what else we believe, it’s worthwhile to be unified around kindness, honesty, accountability, sacrifice, justice, apology, and compassion. 

I’ve felt numb for days. 

In the United States of America, a group of violent insurgents breached the capital while urged on by the president and some of his allies. It’s something that was entirely preventable. He told us he wouldn’t accept the election results–a pronouncement that is completely at odds with the ideals of a democratic republic. 

On a personal note, I’ve never liked the president. His policies don’t align with what I want for my country. I find many of his personal values abhorrent. He has mocked the vulnerable and boasted of sexual assault–things that I don’t associate with men of honor. And yet I have always done my best to understand the many good people around me who would “hold their noses” and vote for him–believing in many of his policies even if they didn’t like the man. I didn’t feel that respect for his unabashed admirers, but chose to honor their right to free speech by ignoring them. I’ve voted for people they may not care for, and I by and large have been treated with the same respect. (Social media has been different, so I avoid placing politics on my feeds.)

We can disagree on just about anything and learn to respect each other. That’s an important principle–especially when people engage in good faith debate. Everyone feels pain when their vote is on the losing side. But we can’t just grab our ball and go home. We have to learn to love the other side and work together. Party over country is the path to misery.

Despite what you might have heard from the president, I’ve met very few democrats who hate the constitution, the flag, American values, the military, and our institutions. Patriots are on both sides of the aisle. Choosing “us vs. them” is usually a false dichotomy. Intolerance doesn’t work that well in a complicated, pluralistic society.

And yet for this nation to stand, we have to have some ground rules. And in a democracy, there is one behavior that we cannot allow: you cannot illegally defy the results of an election. You can pursue every legal means available to you. You can debate election security. You can believe it isn’t fair. But the moment you suggest that anything other than the non-violent will of the people is paramount, you are engaging in revolution. That might be what you want, but you can’t honestly do it under the guise of the constitution, the flag, or the people. We cannot tolerate this and stand as a nation.

And so I’ve been feeling numb, and angry, and surprised, and strangely hopeful. Because the sooner we get back to reality, the sooner we can move forward as a people.

(And no, mindfulness isn’t just a trend. It’s been practiced spiritually for millenia, and secular approaches have been fleshed out and studied extensively over the last 40-plus years. It’s a scientifically validated core skill in “third wave” cognitive-behavioral therapy.)

Mindfulness takes practice, and practice takes time. Meditation has been the traditional means of developing the skill–and it’s something I’ve found very helpful. But for many people, finding periods of quiet to meditate is difficult. And when you haven’t practiced much, sitting quietly with your thoughts for any significant length of time is challenging.

Try introducing mindfulness into routine experiences. Start when you’re on the toilet. That isn’t a joke. It’s a great time to put away your phone and focus on what’s happening in your body. Focus on your breath first; even as you encounter unpleasant smells. Notice the sounds around you–and the sounds you make. Listen quietly to rumbles in your stomach. Observe the tension and relief in your abdomen, bladder, and chest. We’ve made toileting gross, but it’s an inescapable part of our nature. Be grateful for indoor plumbing, shelter, privacy, and a moment of escape. When you’re done, clean up, wash your hands, and re-engage with the world. Don’t worry that your mind wanders; catching a wandering thought and focusing again is a sign that you’re engaged in the process.

If you want to practice non-judgmental observation, it’s nice to start with the icky, smelly, and yet totally normal parts of your life. And it doesn’t take a single moment from your other activities! Win, win, wipe. (And wash-up when finished). 

In most cases, the answer is simple. Therapy and medications produce similar results, and both together outperform either alone. That’s why I tend to recommend that people start with therapy. It has fewer risks and the benefits will likely persist better after treatment than meds alone. If the treatment stalls or the problem is more severe, adding medication may be helpful. 

There are, of course, some situations where the science supporting medication is so overwhelming that starting with therapy is unlikely to be helpful, and may even be life-threatening. Likewise, some problems don’t really respond to medication, and people often find themselves stuck because they haven’t engaged in good psychotherapy.

There are a million more nuances in this line of thought. (Which therapy? Which medication? What does the patient want? What is available? etc.) But even though clinical mental health tends to focus on therapy and medication interventions, almost all actual mental health has very little to do with these interventions. Do you have stable housing? Do you have a job that treats you with human decency and sufficient income? Are you able to experience the natural world? Do you have support from a loving family? Are you safe at home and in your community? Is your voice heard? Are you seen with dignity? What epigenetic changes occurred because you experienced preventable early life trauma?

Now don’t get me wrong: good therapy helps people change the things they can change, appropriate medication can improve overall function, and community mental health programs have brilliant case managers who work hard to connect people with limited resources. But so many problems are beyond the scope of simple “treatment.” Mental health–and physical health for that matter–cannot be fully addressed on an individual level. You can work hard and still be met with systemic barriers. That doesn’t make trying any less worthwhile. It’s an acknowledgment that we need to work together to make change happen.

I’m not prescribing any specific set of changes except this: let’s stop thinking about mental health as solely a personal problem. We are all in this together, and even though we may have different beliefs about how change should happen, the overarching goal must be a better world for all of us.