There is nothing like self-awareness to fix any problem with the self, be it chronic, acute or just slightly annoying.

And don’t get me started on big pharma, they are evil. And directly responsible for the over medicated responses to psychiatric phenomena.

This is something we have known for quite awhile. There have been many studies, since the 70′s, comparing the efficacy of various treatments and CBT usually comes out as very effective.

For depression, CBT and SSRI’s appear to be equally effective; however, their effectiveness varies based on the severity of the depression. For people with severe depression, biological treatments are more effective. However, for people with mild to moderate depression, CBT is more effective.

Also, MLH’s (#21) point about CBT being different from MBCT is very valid. The text describes CBT, yet the article is actually about MBCT. Let’s not confuse the two.

Just want to second that while both Cognitive Behavioral Therapy (CBT) and Mindfulness Based Therapies are both shown to be effective in treating many disorders, they are two different approaches to therapy. The first is based on systematically applying logic to thoughts that are not effective or that are likely to lead to unnecessary anxiety or depression where the second combines the basic principles of CBT with aspects of Zen and Theravadan Buddhism. Both are empirically based, but each seem to work through slightly different mechanisms.

For those interested in empirically supported mindfulness and acceptance based therapies you may want to look up:

Acceptance and Commitment Therapy
Dialectical Behavior Therapy
Mindfulness Based Stress Reduction

Each of the above therapies has several very good introductory self help books available. Burns’ book is also an excellent CBT resource.

Anonymous, thank you for explaining what it feels like – it sounds horrible and tends to bum people out, but I think it’s important for people to know what it’s like in order to empathize.

a dogmatic One True Wayer

I think of her as endearingly stubborn, like me.

The hardest part for me is the daily grind of up at 5 to exercise, the hour commute in DC (even on the Metro), 9+ hr days and then the hour+ home, fix a decent meal etc. “and” add in meditation, reading, etc. I miss my kids, but am glad I don’t have their care on my plate too (though the child support/alimony of $24K means I can’t easily change my work situation, the court owns me).

And I was genuinely thinking I needed help; I can only imagine how easy it would be to fake it and get Ritalin or something just for the high. I’m sure many people do.

However I don’t think the doctor was bribed or part of a conspiracy. More like too busy. They don’t have time to figure out what might really be wrong.

In the doctor’s defense, I was in fact referred to a therapist after the drugs didn’t help.

Unfortunately I gave in to repeated suggestions by a GP to take anti-depressants years ago during a very low phase in my life. The drug was Efexor and when it didn’t really do all that well, the remedy was apparently to double the dose.

Looking back it seems ridiculous, but if one’s on a real prolonged low, any advice by anybody with some supposed authority on the matter feels like something that’s at least worth trying.

It took me several long term attempts to get off that stuff again, since the withdrawal symptoms can only be described as severe.

The fact that I eventually could find hundreds of people online with exactly the same symptoms, yet concerns were often simply rejected by several GPs since it wasn’t in their info material (a lot of the studies ARE funded by the pharma industry, no?) made me pretty cynic about the whole process.

Anyway, I’m not suggesting that anti-depressants are flat-out bad, after all I can only go by a study of one subject, but I’m certainly glad they’re not-to-be-repeated history for me.

Trying one of the different therapy approaches mentioned in this thread with a reputable professional should probably be the first line of defence before trying anything else.

Now, sorry to rain on the parade of some, but there are different kinds and levels of depression and different people need different solutions.

To my afflicted relative the AA like help groups were utterly unacceptable, specially when they began the “lets pray” nonsense or any other new age mumbo jumbo.

This person also tried countless therapy methods and had many false starts.

The only thing that gave the necessary stability was Prozac. Yeah, side effects and all, I know all about those and about the worst ones rumoured to be associated with the drug. But it worked for this person, which allowed to continue looking for other kinds of help until a workable solution was found.

Anybody advocating silver bullets on this thread is utterly wrong, fortunately somebody pointed very insightfully that psychology and psychiatry are not sciences (or exact sciences if some prefer this description) in the strict sense of the word, so treatment may involve lots of hit and miss, specially for people dealing with this problem for decades, not as a one off …

Beyond that clarification, I have little argument that will convince you where others here have not. The reason you and I clash, which I suspect is why you are clashing with so many other commenters, is that you are unwilling to allow others their experiences. I have my own opinions about why what worked for me worked, but I also acknowledge that different things (drugs, therapies) work differently for different people; that perhaps the right placebo is exactly what some people need, even though “cure by placebo” contradicts my ideals. However, it seems you are not willing to allow others their experiences. Perhaps you doubt our perceptions of reality, perhaps you are just totally convinced by your own viewpoint, perhaps you have some other reason. Either way, debating us will do little: you won’t learn anything from me because you refuse to take me seriously, believing instead that I am simply deluded, and I won’t learn anything from you because I’m not convinced I can trust you, someone who seems primarily interested in converting others beliefs on this, because if you haven’t seen fit to take me seriously, I doubt you have seen fit to take others seriously which makes me question where you could have ever come to such conclusions.

Your comment is deeply arrogant and offensive. You assume that what worked for you in your situation will work for anyone in that same situation if only they apply themselves as you do. Thus, if anyone tells you it didn’t work for them, it means they were doing something wrong. No doubt that explains some failures, but the term ‘depression’ covers a wide range both in terms of severity and of causes. One thing I’ve learned in my experience with a close relative’s mental illness is that there is a remarkable variability in which treatments are most effective for different people.

This is such a good alternative to drugs. Thanks for bringing it up.

(I can’t use it, however. I was taking SSRIs for the pain resulting from Complex Regional Pain Syndrome, and behavioral therapy is harder when there is physical pain.)

PS: saw the therapist about 5 or 6 times….he said his job was to coach me into not needing him, and that’s exactly what I did!

Depression can be learned behavior (the mechanics are described by Seligman’s excellent Learned Optimism. But it’s often the case that the cognitive component of depression is a symptom of the physiological component. It’s also often the case that depression is a second-order effect of a different disorder, like ADHD. In those cases, treating the symptom fails to treat the illness.

As far as the insurance issue goes, it’s true that insurance companies will pay for CBT. Why, my Kaiser plan covers up to 10 therapy sessions a year! The other 42 are up to me.

As to the anonymous poster who said that he got a scrip for Ritalin after a 15-minute conversation with his GP: There’s a reason for this, and it’s not that Big Pharma is making a fortune off of methylphenidate (it’s not). It’s a safe and inexpensive mediation. People with ADHD often respond very well to it. People who don’t have ADHD never do. This makes for a diagnostic tool that’s fast and effective enough that GPs can try it without referring the patient to a psychiatrist. By contrast, if you show up at a GP presenting symptoms of bipolar disorder, you won’t walk away with a scrip for Lamictal, which is too expensive, too tricky to administer, and has too scary a side-effect profile for that to be a responsible or effective diagnostic technique.

“They don’t stick needles into your brain, do they?”

You do realize the nervous system is a larger part of the brain don’t you? Err…kinda.

I work in mental health (interning right now…not licensed), and working on my PhD right now after having my life collapse and rebuilding everything and suffering debilitating depression as a result. I had always had this, but it got out of control once my health took a turn to the south…could no longer play in the bands I was working with, and my side occupation as a university nerd suffered because I just couldn’t think.

Being a nerd, I decided to hack my brain and figure something else out and moved on to these techniques as well…err…with several diversions that just didn’t help.

CBT is most definitely the way to go to fix these things. People don’t realize that most of the time the chemical imbalances are created BY the minds attempt to find stasis, and you are not depressed because of the imbalance. Drugs do nothing to stop this aspect because you will right yourself for a moment, and then quickly start the slide again with much worse competing forces in motion. Drugs, however, may increase the effectiveness if given early and QUICKLY pulled off while performing CBT. It gives a slight edge and a bit more adhesion to the therapy if someone can see results immediately.

All psychologists know this…insurance companies know this too…but as others have said, it is both cheaper and the drug companies have a vested interest in making certain this stays the same. I live within a few blocks of Eli Lilly’s headquarters, and it is one of the largest employers in my city, and the attitudes sicken me when talking to the people there…I almost didn’t feel bad about totaling the some 25 year old blondie drug rep / drug whore’s car (seriously, how does a 25 year old with no background in medicine, but a degree in marketing and a Miss State pageant title have the right to go into my doctor’s offices and push their candy? It should be criminal…BTW…I still don’t know who was at fault for the accident and not claiming responsibility in case corporate lawyers see this). Heck, even in academia it is impossible to avoid these people…they have consistently been a provider of grants to my institution and myself. Personally, I send the grant contact to my lawyer who strips out any wording about review rights and otherwise and they generally okay it.

Beyond this, the MCBT is even better (and as noted somewhat different than traditional CBT…both retrain the mind)…but then again, I attend a small sangha where several of the participants are psychologists or psychiatrists. They say Buddhism is the original study of the mind. I always feel refreshed after meditation…especially the walking meditations where for a half hour (or more), you quietly experience everything, touching, smelling, seeing, listening…open all the senses up but without assigning values. Just noticing. It was, however, a bit chilly yesterday in the first snow.

I would suggest this for anyone needing a reboot…once it becomes habit, it helps refocus your life on a regular basis. After a while, you do it without thinking about it.

Anyhoo…

As shiseiji correctly notes my comment is straight out of the book. Please notice that I didn’t say quite what you think I said. There is a difference between being responsible for and being responsible to. What I’m referring to is one’s relationship with your program. If the word ‘attitude’ bothers you then substitute ‘stance’ or ‘position’. You are correct that what works for one person may not work for everyone but that wasn’t what I was talking about.

SisterY
“But then, what do I know? I’m just a stupid layperson”

I don’t think you’re stupid, why would you insert that? However I do have my doubts that as a lay person you are in a position to adequately judge the effectiveness of an entire discipline. You’re not a professional in this area and so, with all due respect, your opinion based on a web search doesn’t hold a lot of weight as far as I am concerned.

“Maybe acupuncture only works if you work for it? Why have evidence-based medicine at all?”

How’s that attitude working out for ya huh? As you seem to indicate upthread not so well I take it. I don’t know anything about acupuncture but I didn’t say that _blank_ only works if you work for it. You included the ‘for’ not me. DBT (which is CBT + Mindfulness) is as others have said a toolbox but tools only work if you pick them up and use them for the purpose for which they were designed. That is what is meant by “it only works if you work it”. It’s very pragmatic which is the heart of evidence-based medicine and indeed all science. It would appear to me that based on the passive-aggressive nature of your comments that you have not actually picked up the tools and used them. You’ve left them in the toolbox and then proclaim them useless to you. So just who is being aggressive here?

Therapy can help you deal with the manifestations of the chemical imbalance that causes depression, and, for those who have situational depression, can “cure” it. But for those with chemical imbalances, no amount of cognitive therapy will cure their condition.

I do agree with MichaelRN, though–it’s crazy how hard it is to be able to get coverage for psychotherapy but so easy it is to get free or cheap prescription medication. For someone who is depressed, it’s overwhelming to have to deal with all the insurance loopholes and caveats–treatment plans, referrals, in-network providers, etc–which is really sad.

Depression is a choice. Addiction is a choice. They have biological elements also but for both recovery demands that you make the choice to to be free. There is no other path to healing. – Noen

hey hey hey, hold the hell up there.

Having been diagnosed with the perpetual nightmare of post traumatic stress disorder and borderline personality disorder as the result of deeply disturbing multiple traumas and abuse i find that comment so deeply offensive it’s hard to find the words.

Before my therapy (3 years and still going) I lacked insight into my condition and had isolated myself to the point where no one noticed my bizarre addictive and compulsive behaviour least of all me.

Being in a state of constant uncontrollable stress and overwhelming fear and anxiety, unable to sleep at night, nightmares and the like take a terrible toll on the body, the result of which adds to already deep depression.

Trying to unthink your way out of depression is an impossible task when you’re unable to think due to being spaced out all the time or overwhelmed with fear. The only way out seemed to be suicide, which luckily for me(i think) didn’t work. It feels like it’s never going to end.

Your comments only add guilt into the pile of people already suffering terribly and seem to smack of a ‘blaming the victim‘ perspective to me.

Have you ever had to experience an eight hour anxiety attack with a crushing depression chaser? I doubt it or your comments would reflect more compassion.

In some of the first studies testing whether accupuncture works for pain, for instance, accupuncture was tested against, say, a sugar pill. It appeared to be effective – accupuncture works! Except that later studies tested it against a real control – say, a nurse with no knowledge of accupuncture randomly sticking needles into people – and the effect disappeared. Fake accupuncture was just as effective as real accupuncture.

Some of the studies reviewed in the Am J Psych paper I mention above were trying to study the effectiveness of CBT, but were “controlling” it against, say, putting a patient on a waiting list for treatment. Surprise, CBT looked effective! But later studies that tried to control for the effects of just talking to a person in a therapeutic atmosphere – e.g., the control group got to chat with a social worker or got some other form of counseling – and, with that sort of control, they found no significant difference for CBT in treating depression.

But then, what do I know? I’m just a stupid layperson. I have a friend who is convinced that accupuncture cured her depression. Maybe accupuncture only works if you work for it? Why have evidence-based medicine at all?