A 30 year old young male, diagnosed with depression (major), asked if he could overcome it without medication and by willpower? I have some friends around me who have this disease who take medication all year round, I think if I had this disease I would never take medication and rely on willpower, he replied. I see, your understanding of depression is not strong enough willpower. First of all, let me tell you that depression is not a lack of willpower, although depressed people will behave in a diminished will and lazy behavior because of the disease, but this is the result of depression, not the cause of the disease. Depression is not the ups and downs of normal human mood; it is a pathological depression that is persistent, painful, and affects social functioning. Let’s take a look at what are the causes of depression? i. Genetic factors: genetic markers associated with depression include chromosomes 5, 11 and X; ii. Biochemical studies: reduced levels of 5-hydroxytryptamine and noradrenaline produce depression; iii. Neuroendocrine studies: alterations in the hypothalamic-pituitary-adrenal axis and hypothalamic-pituitary-thyroid axis; iv. Neuroplasticity studies: depressed patients have reduced numbers of neurons and keratinocytes, which may be associated with neuronal cell atrophy, decreased cytogenesis and increased apoptosis. Fourth, psychosocial factors, such as divorce, earthquake and other negative life events. Therefore, this is a disease of unknown etiology, with multiple factors at play. Psychosocial factors are only triggering factors, individual biological sensitivity is considered to be the endogenous factor, and internal and external factors interact with each other to develop the disease. In other words, love loss is the trigger for the onset of depression. So many people fall out of love, why only a small percentage of people will be depressed? A large part of it is the susceptibility of the individual. Depressive episodes are classified into 3 types according to their severity: mild, moderate and severe. For mild depression, single psychotherapy is possible in some cases, but for moderate to severe depressive episodes, medication is required. In your case, I suggest you to use antidepressants + psychotherapy. The mechanism of action of antidepressants is to increase the level of neurotransmitters such as pentraxin and norepinephrine in the brain, and long-term antidepressant treatment increases neurogenesis in the granule cells of the dentate gyrus. How can you not take medication? Also, you talk about strengthening your will, which also needs to be affirmed, for the psychosocial factors that lead to your depression, you need some psychological guidance, we work together to create a strong psychological immune system for you, enhance your psychological “engine”, improve the ability to cope with the unexpected, such as love loss, anxiety, depression, etc., and become happier We will help you to become happier and more joyful. At the same time, insist on exercising 4 times a week for at least 30 minutes each time, so that your body and mind can promote each other and restore your health. In addition, you have excessive worries about diseases, treatments, medications, etc. Although I have explained it to you last time, you have to ask for proof, ask and express it again and again, which is one of the symptoms of depression: psychotic anxiety. So, I hope you understand the urgency of treatment. I understand, and I will go back to take my medication properly. Health education is a very important part for the patient, and sometimes it is related to the success or failure of the treatment. Although it was pro bono in nature and I was dry-mouthed talking about it, it was a worthwhile thing to do as it eventually changed his perception of depression. After 1.5 months, the patient came to the follow-up appointment and happily said that his mood was much better, he could laugh now, he was willing to go out and deal with people, he played basketball for 1 hour every day, and his sleep and appetite were better. The acute phase treatment was effective and I was happy for him.