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Does It Make Sense to Treat Depression with Drugs?

By Bruce E. Levine, AlterNet. Posted August 15, 2008.


Depression is rooted in overwhelming emotional pain. Talk therapy is a successful, commonsense antidote, but pushing pills pays more.

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Both research and experience have long informed mental health professionals of a strong link between depression and relationship dissatisfaction. So why is psychiatry losing that awareness? One major reason is the disappearance in psychiatry of psychotherapy (talk therapy), in which it becomes obvious just how important our significant relationships are to our mental health. According to the August 2008 Archives of General Psychiatry article "National Trends in Psychotherapy by Office-Based Psychiatrists," the percentage of patient visits to a psychiatrist involving any psychotherapy fell to 28.9 percent in 2004-2005 (from 44.4 percent in 1996-1997), and the percentage of psychiatrists using psychotherapy with all their patients dropped to only 11 percent in 2004-2005.

Psychiatry has increasingly replaced psychotherapy with something called "medication management," which largely consists of symptom assessment and prescription updates. Medication management typically takes 10 or 15 minutes and is scheduled every two to three months.

When doctors only offer medical management sessions every couple of months, they can neglect to ask about a patient's marriage; and even if they do ask about it, they are likely to accept at face value a stoic patient's reply that "my marriage is fine." A competent psychotherapist knows that patients, initially, often avoid acknowledging an abusive or neglectful relationship, the pain of which may be too overwhelming; and that it can take a great deal of time and repeated gentle questioning to discover important truths.

In quality psychotherapy, a mental health professional takes the time necessary to create trust, which is required to effectively explore a patient's relationship life. Miserable significant relationships or the absence of any significant relationships are common sources of depression. And major antidotes to depression are genuine friendships, satisfying intimacy and supportive community.

The Interactional Nature of Depression (1999), edited by psychologists Thomas Joiner and James Coyne, documents with hundreds of studies the interpersonal nature of depression -- and its interactional vicious cycle. In one study, the best single predictor of depression relapse was found to be the response to a single item: "How critical is your spouse of you?"

In another study of unhappily married women who were diagnosed with depression, 70 percent of them believed that their marital discord preceded their depression, and 60 percent believed that their unhappy marriage was the primary cause of their depression.

Depression is fueled by overwhelming emotional pain, and an unhappy significant relationship is one common source of such pain. Other common sources of pain that can fuel depression include workplace alienation, poor physical health and financial difficulties. People use a wide variety of "compulsions" (actions one feels that are not freely chosen) to shut down overwhelming pain or to distract from it. Depression is one of those compulsions (others include substance abuse, overeating and gambling).

In a vicious cycle, the pain of an unhappy marriage can fuel a wife's or husband's depression; then that depressed wife's or husband's negativity can result in their spouse's negative reactions; these negative reactions can make the marriage even unhappier; and the pain of that increasingly unhappy marriage can serve as additional fuel for depression.


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See more stories tagged with: therapy, happiness, psychology, relationships, depression, addressing depression, benefits of psychotherapy, intimate relationships, psychopharmacology, psychotherapy, self-actualization

Bruce E. Levine, Ph.D., is a clinical psychologist and author of Surviving America's Depression Epidemic: How to Find Morale, Energy, and Community in a World Gone Crazy (Chelsea Green, 2007).

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View:
Meds are not demons...but also not always the answer
Posted by: odie-wan on Aug 15, 2008 12:47 AM   
Current rating: 5    [1 = poor; 5 = excellent]
I was on antidepressants for a year...various drugs as after a while I ended up reacting to each one of them. The last one I was on (and the one I was on the longest) was Cymbalta.

Let me state this first - I do feel that my meds helped me through a very difficult time. I had so much to cope with that I needed a form of emotional insulation (is the closest I can describe it) to get me through the worst of it.

However, coming off the medication was a nightmare. I've been off everything for about six weeks now and I still have lingering side-effects. The first two or three weeks were the worst though. For about half that time I was unable to work and I felt so sick I wanted to die. In fact, I had to battle thoughts of suicide. Since then I've discovered that thousands of others suffered through the same hell when coming off Cymbalta. I wish I'd known this before taking the medication.

I won't trash antidepressants because I think they have their place but that is just it...they have a place, they are not the complete answer. From now on I will certainly be much more selective and careful about what I use to manage my depression.

[« Reply to this comment] [Post a new comment »] [Rate this comment: 1 - 2 - 3 - 4 - 5]

...
Posted by: emmas on Aug 15, 2008 2:16 AM   
Current rating: 5    [1 = poor; 5 = excellent]
It does suck that so many psychiatrists are no longer providing talk therapy (they're not even getting trained in it, much of the time). What also sucks is that, where I live, the majority of psychologists seem to be foaming-at-mouth CBT zealots, who are convinced they have THE way; the ONLY way.

Medication helps some; therapy helps others; a combination of those probably helps more. I'm so fed up, though, with people who have no experience with major depressive disorder, and so on, insisting that medications are *always* unnecessary, when they wouldn't have a clue. What's that saying - 'everyone's an expert'?

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» RE: ... Posted by: Grinty
» RE: ... Posted by: annekarina
» RE: ... Posted by: emmas
» RE: ... Posted by: DogMa
» RE: ... Posted by: picker
There is no cure for depression.
Posted by: HughScott on Aug 15, 2008 3:36 AM   
Current rating: 5    [1 = poor; 5 = excellent]
Feeling blue is a necessary part of the human condition. Without downers, we would never appreciate the highs of life. The problem comes when downers are persistent, lasting weeks, months, even years.

Sometimes medications work. For other depressed people, talk therapy and group support meetings are the answer. But this I know from personal experience and a family tree infected with bipolar disorder. Depression is an insidious disease that can linger beneath the surface of healthy personalities.

You might call depression a "cancer of the mind." When the symptoms becomes apparent, the malady must be treated as soon as possible. The trick is finding out what works.

Fortunately in my family, a combination of medication, talk therapy and old-fashioned love has produced the happiness human beings seek.

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It's more than depression.
Posted by: SpiderWoman on Aug 15, 2008 3:45 AM   
Current rating: 3    [1 = poor; 5 = excellent]
It's bipolar, schizophrenia, attention deficit, borderline personality. All of these are conditions - some probably nothing more than diagnoses for people who don't fit in or irritate those in power - that are routinely treated with drugs.

The current paradigm in medicine says that these conditions are the result of genetics, physical differences in the brain, and/or chemical imbalances. The reality is that not one of these so-called causes has any basis in fact. They are all constructs invented by pharmaceutical corporations, and then accepted by an all-too-willing bunch of doctors, so that drugs to "fix" them can be sold. It's pure corruption of the worst sort - preying on people in need.

A previous writer says that s/he needed drugs to get through a difficult time. However, the description of what they did - provide a "form of emotional insulation" - should horrify us. It's a form of drug-induced lobotomy, a separation of personality and self-awareness from one's self. This isn't a fix - it's merely putting off dealing with the problems of life.

These drugs are used routinely in nursing homes to keep residents placid, so they're easier to maintain - as if they were stock on shelves, not human beings. They are being used in children for questionable diagnoses, ones used to define children who are difficult, in spite of the fact that they cause brain damage - not just some of the time, but nearly all of the time.

Consider the so-called side-effects. They're horrific, and rather than being rare, they're typical. Movement disorders. Rapidly-developing obesity. Diabetes. Heart disease. Even the conditions that they're supposed to treat are caused by them. Then, consider the fact that what they're supposed to do is, in itself, destructive. The definition of effectiveness is apathy and the destruction of self-awareness.

Peter Breggin is a psychiatrist who has refused to go along with the current psychiatric drugging paradigm. If you question anything I've written, take a look at his books, which are full of references to studies that document what he says.

The truth is that the psychiatric profession has become little more than a shill for the pharmaceutical industry. People can draw their own conclusions about why this is.

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» OH MY GOD YOU GAVE ME A 1! Posted by: mjabele
medication saved my life.
Posted by: Grinty on Aug 15, 2008 3:50 AM   
Current rating: 4    [1 = poor; 5 = excellent]
I have been on antidepressants for over half of my life, and am prepared to remain on them forever if need be. They allow me to function normally. I have heard many, many people refer to psychiatric medications as a "crutch," as though taking medicine in order to function is somehow cheating in life.

Antidepressants certainly don't work for everyone, nor are they a panacea (I still have "blue moods" occasionally), but at least now, I don't feel like death is preferable to life.

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» RE: medication saved my life. Posted by: souffrantfleur
» RE: medication saved my life. Posted by: SarahRamone
Three Problems With The Article
Posted by: The_Curmudgeon on Aug 15, 2008 4:06 AM   
Current rating: 3    [1 = poor; 5 = excellent]
The article ignores three realities in therapy and the use of medication.

First, the real culprit is for-profit health insurance companies - especially HMO's - whose entire business model is based on not providing treatment. Absent hospitalization, it is nearly impossible for patients with depression and related issues to obtain sufficient treatment through talk-therapy.

Second, far too many GP's prescribe anti-depressants for patients rather than referring out to a psychiatrist who is in a much better position to judge what treatment a specific patient requires. GP prescription rates distort the studies such as the ones quoted in the article. In fact, the vast majority of psychiatrists practice their craft ethically and professionally, and typically use a combination of talk therapy and - when required - medication.

Third, for some patients medications are not necessary or effective; for others, they are life saving. Despite advances in medicine's understanding of how the brain works, prescribing meds for depression is as much an art as it is science.

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» A response pt I Posted by: LMNOP
» A response pt II Posted by: LMNOP
Medication plus therapy saved my life
Posted by: Angela Hayden ART GODDESS on Aug 15, 2008 4:36 AM   
Current rating: 5    [1 = poor; 5 = excellent]
I've never been to a psychiatrist who hasn't recommended a psychologist.

I did go off of my meds for major depression after I was in therapy for eight years. I figured I was cured. I followed the medication guidelines of cutting back slowly and was monitored by my psychiatrist.

I had a nervous breakdown and was suicidal for two years.

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90 % of depression is normal
Posted by: Bobsays on Aug 15, 2008 4:48 AM   
Current rating: 4    [1 = poor; 5 = excellent]
And only 10 % of cases need the intervention of psychotropic or balancing drugs to help the person. Depression is just part of the human condition as much as is love, hate, passion. All of us naturally feel depressed when something doesn't go our way, or when we make a big mistake, or somebody in our life, dies. To chemically anaesthatise somebody is doing them a disservice.

The best approach is to talk it through with somebody you trust, and in the case of life's problems like debt, getting fired etc., to draw up a plan to solve the problem by stages (so not to overwhelm yourself and slip back into depression).

As for the 10 %, yes there are people who are a danger to themselves and to others. Drugs play a role in stabilising them as part of a treatment programme. And some people will have to be on these drugs for their entire life.

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» no, bob... Posted by: JoshuaLudd
Question
Posted by: edgar1 on Aug 15, 2008 4:56 AM   
Current rating: Not yet rated    [1 = poor; 5 = excellent]
All of the comments so far are helpful, mature and thoughtful. Clearly, depression is complex, with no one definition or treatment.

I have read somewhere that nearly half of patients treated with a wide variety of medication "families" do not respond to any of them. Is this true? Does anyone have any data?

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» RE: Question Posted by: Karina
» Drug overview I Posted by: LMNOP
» Drug overview II Posted by: LMNOP
» RE: Question Posted by: emmas
STUNNING OMISSION OF RANGE OF "DEPRESSION" CAUSES...
Posted by: wellaware lec on Aug 15, 2008 5:22 AM   
Current rating: 5    [1 = poor; 5 = excellent]
The word depression in our culture is now a word that is used to even describe one day of feeling really awful about something...we have pathologized sadness, grief, great disappointment, etc.---all NORMAL reactions to life circumstances and most surely when we try and stay awake to the realiites of a global community in much transition...
The word itself, like the word cancer, has taken on a hex quotient---it pulls one down or disempowers onr just to attribute it to oneself, so be careful about easy useage of that word.
Also, THERE ARE NUMEROUS other causes behind the symptoms that often get described as depression, such as low magnesium, low serotonin, low B12, life force stagnation, dehydration, brain damage from so many different chemicals present in the food and liquids that are NOT food, traumatic brain injury, side effects to medications being taken for other reasons besides depression, sleep deprivation, adrenal fatigue or burnout, thyroid depletion, poor nutrient absorption from low hydrochloric acid in stomach or inadequate enzyme production, etc., etc. Several of these health challenges are rampant in our culture and around the world at the present time, and receive almost no coverage where most people could easily see it.
This article did a great disservice to the subject of depression through omitting ALL these other factors...wake up folks. You may have much more power in your situation than you realize...and yes, the antidepressants DO actually change the brain so that it's extremely difficult to get back off the meds. The best option is to NOT get on them in the first place. And you can't EVER go off them cold turkey without some very, very heavy prices!!!

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SELF TALK WITH TAPPING IS BETTER THAN ANYTHING!!!
Posted by: caru on Aug 15, 2008 5:46 AM   
Current rating: Not yet rated    [1 = poor; 5 = excellent]
try this stuff called EFT, emofree.com ... really amazing stuff to change the brain without paying anyone!!! DO IT YOURSELF!!

try searching for how to videos on youtube, search EFT, BRAD YATES, TAPP OF THE MORNING or GOALS ...


much much better than talk therapy OR big pharma ...

tapp on acupressure points and reset your system ...

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» ANCIENT CHINESE SECRET Posted by: caru
Author missed some other factors.....
Posted by: mjabele on Aug 15, 2008 6:11 AM   
Current rating: 5    [1 = poor; 5 = excellent]
1) Not enough mental health providers in the system.

Talk therapy requires having providers available to do it - MORE providers than we currently have available to prescribe medication, given that it's a more "time-intensive" activity.

As it is, though, it doesn't seem to me that we have enough providers. Certainly we don't in my neck of the woods, given that as a general internist who frequently refers people for psychiatric care, I'm finding that even in severe cases it takes months for my patients to get appointments. In that context, proposing to shift the paradigm to MORE talk therapy and less drug prescription, however medically appropriate that may be, without addressing the shortage of providers, strikes me as an incomplete argument.

2) Too many depressed people.

Considering how "well-off" Western societies are, why do we have so many depressed people? I've heard lots of explanations - social / financial pressures on the poorer segments of society, excessive work stress and a lack of meaningful relationships and "life experiences" for the richer folks - and there may something to them. But the point is, perhaps we should address those underlying socio-economic-cultural causes in an effort to reduce the prevalence of depression in our society, rather than having to send so many people for any type of psychiatric care in the first place.

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» Prevention and its limits Posted by: JakobFabian01
Overuse of Antidepressants Among US Workers
Posted by: drricklippin on Aug 15, 2008 6:52 AM   
Current rating: 5    [1 = poor; 5 = excellent]
Thanks Dr.Levine;

US workers are often suffer from tyranical bosses, erosion of benefits, job loss itself or chronic fear of job loss.

So they overutilize antidepressants in my opinion.

I was interviewd by Dr. Jay Cohen of Medication Sense.Com in 2004 on this topic. See my interview on this subset of the broader topic of antidepressant overuse/overprescribing.

Thanks for your interest,

Dr.Rick Lippin
Southampton,Pa
ralippin@aol.com

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Talk therapy
Posted by: maxfactor on Aug 15, 2008 7:13 AM   
Current rating: 2    [1 = poor; 5 = excellent]
is just that - talk. Fighting a disease with talking is pure shamanism and that`s where psychoanalysts rightfully belong. Of course Pfizer and others are making a buck with therapeutical medication, why not? Business does not have a very high moral treshold - so they market the same drug compound even to children.
Psychiatrists are whores and they get kickbacks from the pharmaindustry. As an informed consumer - separate bull and hype.

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There is Blue, Then There is Depressed
Posted by: Renee from Madison WI on Aug 15, 2008 7:17 AM   
Current rating: 3    [1 = poor; 5 = excellent]
Clinical Depresion is real. I have been diagnosed with Major Depressive Disorder and, like many with mental health issues, I figured I did not need my medication any longer so I weand myself off it. I ended up bottoming out and spending a few weeks not able to get out of bed. I have now resolved that I need the anti-depressants probably for the rest of my life!

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Brave New World
Posted by: Godfather89 on Aug 15, 2008 7:26 AM   
Current rating: 2    [1 = poor; 5 = excellent]
You take the soma and we get rich off it.

Please, refuse the soma and stop trying to artificially improve your life and actually try to improve your life.

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drugs for depression
Posted by: coachsappho on Aug 15, 2008 7:49 AM   
Current rating: 5    [1 = poor; 5 = excellent]
Please take my remarks below under the context or bias of my past training and experience which is as a clinical social worker and relationship coach:

I think the author raises a worthy point. And the comments so far on the article are, on the whole, thoughtful and pertinent to the issue.

I think patients 'collude', if you will, with the system too. It is often easier (and, is that so bad?) to take a pill for one's problem rather than face it head on.

Some argue it is bad when people are taking pills instead of 'working out' a problem. It may be true - do we become better people when we 'tough out' our problems? I think sometimes it's true - afterall aren't the pills sometimes just another distraction?

Then again - it's perhaps also true that, when a person has an emotional disorder - there needs to be enough patience and time to help them really 'deal' and many times therapists are overwhelmed and too busy to deal themselves. We underpay therapists (social workers, counselors, psychologists) terribly in our society. We don't give them nearly the training, money and support we give medical docs such as psychiatrists. And then we wonder why the really great ones leave the field.

There is a bias in the world still that psychiatrists just automatically make better therapists than non-psychiatrists. That's false - there are some very good non-psychiatrist therapists out there. People need to understand that. Many times the type of person who is drawn to psychiatry as a career is not the best communicator/people person anyway. Many psychiatrists are good medical technicians and may find their talents better used working from the drug angle anyway.

Again - what the article doesn't address is that there are TONS of non-psychiatric therapists out there practicing, so, perhaps that is another reason why psychiatrists are now working more on the BIOLOGICAL aspects of mental illness. This is a REAL intervention point and one that needs to be considered in virtually every client's case. Afterall, if there is a treatment alternative available and the client isn't aware of it, is that fair either???

I don't think psychopharm is all bad - surely in most systems there is corruption. As a therapist, I work to help the client who has free will, if at all possible, to decide the fate of his/her treatment. Sometimes tho, a therapist or doc has to take more aggressive action - when he/she thinks a persons life is in danger. And, often, drugs are a part of 'getting control of' a crisis situation.

So, to end at this point - I don't think the answer is to damn all drugs at all times. This is not to say I am naive and don't think there is some 'chemical lobotization' going on that may be of lower quality than what is ideal. There is - but, I don't know the solution to that problem.

I think we have to place MUCH MORE value on alternatives to drugs if we hope to improve the situation. Relationships DO take work - including the one between clients and their therapists. So people have a choice...at least if they are educated that they do - and that is a sine que non of treatment - that we do our best to get 'informed consent'. Perhaps it all goes back to empowering the consumer. As long as the financial decision-making for who pays for care is left in the hands of the insurance companies the consumer is less powerful. Now, if a consumer had the utmost control of his/her healthcare dollars perhaps we'd get that additional support for therapy....Again there are many obstacles to this ideal - including the fact many clients don't want to take charge anyway....they want to be taken care of!

Again - great article and discussion!

Barb Elgin, MSW, LCSW
http://www.coachsappho.com

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» RE: drugs for depression Posted by: coachsappho
» RE: drugs for depression Posted by: coachsappho
I know
Posted by: maxfactor on Aug 15, 2008 7:54 AM   
Current rating: 1    [1 = poor; 5 = excellent]
and the talkies have their businessmodel. Subtle dependencies make this very profitable for your rent-a-friend. Seriously folks nobody, and there are studies that show this, has ever healed from depression through talking. It`s all anectodal my friends...
Getting the right prescription eases you through those couple of years of depression and talking at some point might help or agravate the situtation - it is really 50/50. But believing that talking to a biological process gone wrong is helping is really a bit much!

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» RE: I know Posted by: DogMa
depression and a stressful society
Posted by: carrotwax on Aug 15, 2008 8:06 AM   
Current rating: 5    [1 = poor; 5 = excellent]
When people talk about depression, it's usually seen as an individual thing. That one person has emotional problems - and they should get help.

However, I view the large number of depressed people as systemic. We've made our society chalk-full of stress, denial of human desires, and not built for human comfort and desire. Every day many people repress emotions and what we want to do in order to keep that job.

The result of that stress is pretty naturally depression. It's about time we started remolding our society and economics so that the goal is human happiness rather than a higher GDP.

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Non-drug alternative to psycho-therapy?
Posted by: bingahaba on Aug 15, 2008 8:11 AM   
Current rating: Not yet rated    [1 = poor; 5 = excellent]
I've been using a psychological technique, other than psycho-therapy, developed by Ilan Shalif over ten years, and have had very good results - can anyone point me at good papers checking the efficacy of his technique in general - i.e. whether I'm a false positive ;) or if it is really generally effective? Alternatively, which (academic) search engines might be most relevant? Links to papers or their abstracts would really be appreciated.

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» sorry, above is ambiguous Posted by: bingahaba
Talk Therapy is Overrated
Posted by: FoonTheElder on Aug 15, 2008 8:22 AM   
Current rating: 5    [1 = poor; 5 = excellent]
Talk therapy is overrated. It is nothing more than a short period of questions & answers that can help, but rarely cure a major psychiatric problem.

While drugs are over prescribed, due to the push from drug companies to very receptive doctors, they can be very helpful in the right situations. Too often, doctors prescribe the drug of the month for temporary problems and without proper follow up and at too high a dose. Too often the patients don't understand what the drug is supposed to do and expect from it. Patients have side effects and these are not handled.

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I agree!
Posted by: aida1200 on Aug 15, 2008 8:27 AM   
Current rating: 2    [1 = poor; 5 = excellent]
Depression may be repressed anger or the reaction to deep unahppiness, but it's also the result of a chemical imbalance in the brain. I've suffered from recurrent bouts of depression for most of my life but have now been on anti-dpressants for quite a few years, and they make a world of difference. Crutch? Maybe, but why not?

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alternatives to drugs for depression
Posted by: coachsappho on Aug 15, 2008 8:37 AM   
Current rating: 5    [1 = poor; 5 = excellent]
yes, there are alternatives to drugs to helping the client benefit from talk therapy - you can encourage client to exercise, for example. this is of course dependent on the person's physical condition and their medical doc's recommendation/opinion that exercise is not, as they say, 'contra-indicated'. many times it's not a question of exercise, it's a question of what sort of exercise. obviously, moving is necessary to sustain life!

however, in reality, it has been my experience (both working as a clinician and working on the side of the insurance co overseeing care), it is not often realistic to expect a person to address their 'lack of motivation' for therapy that way. sometimes it works, for others, sometimes drugs does a better job.

as far as dietary alternatives - there is still in my opinion not enough research and evidence to support any one dietary regimen for 'treating depression'. now, of course, i suggest to my clients that they 'eat a nutritious diet' and 'get at least 7 hours of sleep' a night and we often tracked it. but often improvement doesn't come soon enough for people's desires.

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barb@barbelgin.com
Posted by: coachsappho on Aug 15, 2008 8:42 AM   
Current rating: 4    [1 = poor; 5 = excellent]
again - i think there needs to be a respect for the medical understandings the medical field is beginning to make about mental illness. obviously the solution is not to trash all meds (and see a 'conspiracy' in the pharmaceutical industry), but to continue to weed out the negative aspects that plague the pharm field as best we can and continue to support the research going on that hopefully one day will be able to pinpoint and treat 'diseases of the brain'. you do accept the possibility that there may be diseases of the brain, right? now it may be that 1,000 years from now when we've transcended the paradigm of 'disease' and gotten more intelligent about helping the body heal itself, that we won't need pharmaceuticals....that will be a great day indeed!

Barb Elgin, MSW, LCSW
http://www.coachsappho.com

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good therapist is needle in a haystack
Posted by: Tonya on Aug 15, 2008 8:56 AM   
Current rating: 4    [1 = poor; 5 = excellent]
I agree that talk therapy can be very helpful, but trying to find a therapist that can actually say things that help you is tough. I had one once who would say almost nothing the entire hour - I told him my best friend was more helpful than him and quit.

**The best therapists help you get a more objective perspective on your situation and help you root out destructive thought patterns.**

I had a wonderful therapist many years ago named Kevin Austin who helped my recover from my mother's suicide. He really helped me change the way I think, and that is helpful even now so many years later.

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Coordination of care
Posted by: DaBear on Aug 15, 2008 8:59 AM   
Current rating: 5    [1 = poor; 5 = excellent]
The NEJOM published a piece a while back about the lack of coordination of care between physicians as a leading cause of mistreatment in the U.S. system (then cited the private insurance bullshit we all suffer under as the no. 2 problem).

So when I see a piece by a psychotherapist about the problem with Psychiatrists doing medication management, my suspicions go up and I'm looking for conflicts of interest right off. Bruce Levine is infamous and on the record about his anti-drug mindset.

That said, he's right about the money angle and the problem with that, and he's right about the distancing psychiatrists are making from "talk therapy" even though that's officially still supposed to be what they do. But what's missing in Bruce's analysis is the real damage that is done when psychotherapists don't communicate with psychiatrists and vice versa. They place that burden on the patient but the patient, being clinically depressed, isn't often able to do that sort of self-coordination of care.

Jim Phelps also talks about this and he talks about alternative therapy combinations and evidence based therapies. As someone with a family who got too much of a genetic good thing (depression and mania are actually adaptive genes that, when extant in smaller quantities, are really vital things and that's why there is so much in the population today, ecological crisis=species adaptation...but it's so much easier for the non-adaptive humans to label the adaptives as mentally ill *sigh*) the real problem is not merely medical management, private insurance malfeasance or even lack of coordinated care by physicians, it's the abject lack of evidence based care period.

You cannot hope to treat depression with CBT, drugs, or both if you do not track the evidence of their affects, and you certainly cannot do so without the inclusion of the biological alternative treatments such as light/dark therapy, etc.. I bet a beer that the average psychotherapist and the average psychiatrist alike does NOT know how to teach a patient to create data that can be used to refine therapeutic paths to balanced mental health. Now THAT's a problem.

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If it weren't for the ban of Cannabis, Big Pharma wouldn't have had the "free" upper hand.
Posted by: jwverez on Aug 15, 2008 9:08 AM   
Current rating: Not yet rated    [1 = poor; 5 = excellent]
You know, when we the sheeple can go out of our ways to get rid of "gun control", we sure as hell can do the same for Cannabis and let it compete with all those petroleum manufactured Big Phrma bullshit for a change.

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The Delusion Revolution- We're on the Way to Extinction and in Denial
Posted by: veggiegrrrl on Aug 15, 2008 9:18 AM   
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just above this article is another one called "The Delusion Revolution- We're on the Road to Extinction and in Denial." How utterly ironic. If we're all gonna die, who cares if we use drugs to fight depression?

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The trouble with medication...
Posted by: JingleFae15 on Aug 15, 2008 9:37 AM   
Current rating: Not yet rated    [1 = poor; 5 = excellent]
Is that it doesn't cure anything. All medication does is manage, suppress and control. It can't get to the true cause of the issue; which is necessary for true healing.

Symptoms are an indication that something isn't right. Deal with the cause, and the symptoms begin to disappear.

If we suppress an issue for too long, it begins to devour us. We have to dig deep within ourselves and find the true root of the cause. Then, and only then, can we begin to truly heal.

I've been studying/practicing something called the LifeLine Technique for about five months now. It is a holistic healing technique developed by Dr. Darren Weissman that addresses ALL aspects of our well-being, from our mental and emotional health, to our physical and, yes, spiritual health and well-being.

After receiving LifeLine treatments from my own therapist, who is a practitioner of the technique, I found it to be so profoundly helpful, insightful and inspiring that I decided to begin studying it myself, and now my goal is to become a certified practitioner.

I highly recommend checking out Dr. Weissman's website, infiniteloveandgratitude.com

If you're skeptical, go buy/borrow Dr. Weissman's book, The Power of Infinite Love & Gratitude (you'll find it on the website), or if you're fortunate enough to have a LifeLine practitioner near where you live, look them up, and schedule yourself for a session.

You'll be amazed.

To your health and well-being...
Infinite Love and Gratitude. ;)

-- JF

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Keeping the Wolves at Bay
Posted by: azima on Aug 15, 2008 12:07 PM   
Current rating: 4    [1 = poor; 5 = excellent]
Here's what's helped relieve my depression

Write the letter "p" as instructed in the Vimala Alphabet.
http://www.iihs.com/vimala-alphabet.html

Consume ginger
Journaling
Add stabilized oxygen (from the health food store) to water
Eat concentrated greens like blue green algae, Barleans Greens,Spirulina, Green Vibrance. These come in capsules or tablets. Most others come as loose powder, which tastes gross.
Jump on a trampoline or rebounder.
Do kundalini yoga, especially the DVD called Yoga Bliss Hips by Ravi Singh and Ana Brett.
Meditate on light and ecstasy. Pir Vilayat delivered some inspiring ones, available on www.theuniversel.net.
Walk in nature.
Continuum movement or read the book that is its “Bible”: Sensitive Chaos by Theodore Schwenk
Essential oils: bergamot, mandarin, rose, rosewood, jasmine, patchouli (I haven't used them for this purpose)
Eat potatoes before bedtime, as per the book Potatoes Not Prozac.
Inspirational readings
Full spectrum fluorescent lighting
St. John's wort
5 HTP
Sleep
Avoid negative self-talk (Read Soul Without Shame by Byron Brown for pointers)
the emotional freedom technique (emofree.com),
holographic repatterning (now, I think it's called resonance repatterning),
massage
co-counseling
bioenergetic therapy...

"Don't do anything that would make your conscience feel guilty."

Staying tuned in to my heart and listening carefully, observing the flow of energy, the beat, the light and heat. This is a non-verbal space, great for quieting the mind.

Living slowly enough to take in the miracles of existence.

HigherAwareness.com has a free series of 16 emails about living in joy.

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This is same as Viagra.
Posted by: cindyn on Aug 15, 2008 12:10 PM   
Current rating: 2    [1 = poor; 5 = excellent]
Men don't need Viagra, they need a partner that turns them on. This is the wisdom of the penis; if you're not getting an erection, it's most likely beacause you're not really into your partner.

Men have been brainwashed that it's THEIR problem - that THEY"RE not performing, when it's actually that their partner is not turning them on.

Find a partner you're into, and the need for Viagra goes out the window.

Ragarding depression, the Unabomber said it best: we give people drugs so they can tolerate conditions that are untolerable. Dump your wife, job, friends, or whatever is unhealthy for you and the depression lifts. The need for SSRIs vanishes.

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» RE: This is same as Viagra. Posted by: GuitarBill
» RE: This is same as Viagra. Posted by: movieluddite
» RE: This is same as Viagra. Posted by: kberner
Neurofeedback
Posted by: Catwoman on Aug 15, 2008 12:11 PM   
Current rating: Not yet rated    [1 = poor; 5 = excellent]
Has anyone ever heard of neurofeedback? I have this treatment once a week for debilitating nearly daily migraines (which are thought to be causes by imbalances in the same neurotransmitters implicated in depression.) It has helped me tremendously and has also helped many others with depression, ADHD, migraines and seizures, among other problems.

Essentially, neurofeedback teaches you to calm your own brain, to make it more stable through a visual image of your EEG (which measures your brainwaves.) Hence, you can train your brain to do what these drugs do chemically. This is the cutting edge and the frontier of medicine.

I still have migraines, but they are no longer daily and more responsive to pain meds and relaxation techniques.

I started neurofeedback when all I was getting from the Drs were prescriptions for antidepressants andd antiseizure drugs. These are VERY powerful drugs with potentially dangerous side effects and I just would not take them. I understand that many with severe depression feel they have no choice but to take these drugs, but having severe and daily migraines is enough to make you jump off a bridge and so I know desperation. And yet, I would not take the drugs.

That said, I respect an individual's right to put any drug into their body, but please look into neurofeedback as an alternative.

I will say that many insurance companies will not pay for neurofeedback because it is expensive, as opposed to drugs which are pushed by the legal dope dealers - big pharma. I do manage to get it covered because my therapist happens to be a neurofeedback practitioner. Lucky me.


I encourage anyone with depression, or for that matter migraines, ADD etc.. to do some research and check it out.

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» RE: Neurofeedback Posted by: girlnumbertwenty
» RE: Neurofeedback Posted by: azima
Non-depressed people underestimate depression
Posted by: twinnixon on Aug 15, 2008 12:40 PM   
Current rating: 5    [1 = poor; 5 = excellent]
I have struggled with depression for over 15 years. Most of that time, I was not on medication. I have had good days and bad days, and major depressive episodes, that have required medicine in order to prevent me from harming myself. I have seen in that time how confusing depression is for people who have not been through it. They assume you are feeling "blue", that if you just get up and get moving that you will feel better, but this is just not the case for those who suffer from major depression. Depression is like having something poking in you in the eye, all day, every day, painful and fixed. Depression is like burning yourself on the stove and feeling the pain of it for days and days. It obsessing and feeling unable to cope. It is believing the worst about yourself at all times. It is the emotional equivalent of seeing your lover in another person's arms.

And so if you are depressed, there are trade-offs to be considered when considering treatment. I have a wife and a young child. Depression pulls me away from them emotionally, and threatens to do so physically when I feel in over my head. I worry that I will hit a breaking point where I will see suicide as a better option then the mental anguish. I desperately don't want this to be the case. And so I choose to be on medication when I need it, and so become available to the relationship, able to fulfill both my responsibilities and my heart's desire. When I'm not in a major episode, I prefer to be off meds, but I still continue with talk-therapy.

And so I think of course medications are over-prescribed. How is that news? Doctor's over prescribe in every field of practice. I'm all for reigning in over-zealous pharmaceutical companies, but not at the expense of those who have a legitimate need.

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Grrrr. this pushes my buttons
Posted by: abrunvand on Aug 15, 2008 12:47 PM   
Current rating: 5    [1 = poor; 5 = excellent]
In another study of unhappily married women who were diagnosed with depression, 70 percent of them believed that their marital discord preceded their depression, and 60 percent believed that their unhappy marriage was the primary cause of their depression.

This nonsense really pushed my buttons. My spouse just walked out on me a month ago, blaming me for his depression because, he said, our marriage is so unhappy.

But in fact, he's the one who withdrew emotionally and then essentially spent the past three years (!) lying naked on the couch staring at the Internet while nurturing his depressed feelings and insisting that he didn't need any kind of therapy or treatment because his behavior was a completely normal response to being in such a miserable relationship.

Marital discord is solvable. Unhappiness is solvable. But total social withdrawal in combination with a fabricated story that places all the blame on another person? That's pathological.

There really is such a thing as feeling blue, but that's not depression. Depression is that naked guy on the couch blaming everyone around him for his misery but unwilling to lift so much as a finger in order to try to feel better. Depression is the thought-warp that convinces a depressed person that there is no possible solution to his problems.

From my experience trying to take care of an obviously mentally ill man for so many years, I think Depression is the home-wrecker, not having a "critical" spouse (though the spouse no doubt becomes critical trying to cope with the irational depressed person). There is no possiblity of a happy marriage once a spouse becomes depressed unless that spouse is willing to stop casting blame and take personal responsibility to try to feel better.

The unhappy-marriage-causes-depression hypotheses is easy enough to prove. Did these same women get undepressed once they got divorced? or did they just have to find somone else to blame for their own unhappiness?

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Antidepressants and Placebos
Posted by: girlnumbertwenty on Aug 15, 2008 2:53 PM   
Current rating: 4    [1 = poor; 5 = excellent]
Don't know if this has been raised yet, as I haven't had time to slog through all the comments, but recently there's been an important meta-analysis done with surprising results: except for severe depression, antidepressant medication is no more effective than placebo. And this is using the drug companies own data. Here's a link to a decent look at this study, including a link to the study itself:

linked text

Of course, this raises all sorts of worms in all sorts of cans, but the most interesting to me is that this seems to imply:

Placebo is as effective as antidepressants.

I'm all for placebos. Sometimes in conversation someone will say "Oh, that's only placebo effect", and I'll say, "So what? If it works..."

And as others here have pointed out, antidepressants have documented side-effects, getting off them means enduring withdrawal, and really, the dogma about seratonin uptake is dangerous, as there has been no proven causality between it and depression.

Just some fun stuff to think about.

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Meds Can Provide Essential Help
Posted by: kberner on Aug 15, 2008 4:06 PM   
Current rating: 4    [1 = poor; 5 = excellent]
I am so sick of good lefties letting their (justified) antipathy to the pharmaceutical industry blind them to the reality that depression is a disease, often (if not always) based in chemical imbalances that often requires chemical intervention.

By making a blanket statements like "depression is fueled by overwhelming emotional pain," Bruce Levine perpetuates the myth that depression is the same as "having the blues," caused by circumstances in life and that talking about such circumstances leads to cure.

I am in a wonderful, fulfilling, long-term relationship (10 years yesterday!). I have a great job that I look forward to going to every day. I am blessed with the financial resources I need to live comfortably. I have had a couple of rounds of talk therapy that have given me enormous insight into myself and how I interact with the world.

Yet, when my meds aren't working, the lovely circumstances of my life are overwhelmed by a depression that has no apparent rationale. And when the meds are adjusted successfully, the cloud lifts and I am able again to enjoy my great fortune.

I would never advocate that a depressive be treated without any talk therapy. But I also wouldn't go to a psychiatrist for that therapy -- psychologists and social workers of various types fulfill that need very well. And neither would I tell anyone with a chemical imbalance in their body or brain that "talking about it" is necessarily enough to solve the problem.

Progressives ought to care about more than bashing the bad guys in corporate America. They should also have the compassion to support their fellow human beings in using legitimate products of corporate America that allow them to live happy and productive lives.

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» Drop dead Posted by: LMNOP
» Drop Dead (second try) Posted by: LMNOP
I needed drugs, not talk
Posted by: Gitaiba on Aug 15, 2008 6:27 PM   
Current rating: 3    [1 = poor; 5 = excellent]
I started with both meds and talk, and after the meds kicked in, I really didn't feel the need to talk anymore. I didn't honestly have anything to be sad about. It was all chemical. I'm still on the meds, and still doing just fine, no talk.

However, couples therapy fucking saved my marriage.

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Depression stems from social isolation
Posted by: nfamous on Aug 16, 2008 8:43 AM   
Current rating: 2    [1 = poor; 5 = excellent]
Depression is made up to sell antidepressants just like ADD was made up to sell Ritalin. Why do all humans have to behave alike? We are all different and those differences should be embraced and celebrated, not classified as a disease or a disorder. If you have been sad for a long time then there is probably a reason in your life for it, not a reason in your head. Depression assumes backward causality. Drug companies say it's your brain that causes depression. Wrong. It's what happens to you and how you perceive it that alters your brain hormones and produces what they call depression. Screwing around with brain hormone levels is a bad idea. The human body is wonderfully resilient. People just need some friends these days. There was a study that showed Americans have three or less people that they can confide in. That is woefully pathetic and I'm one of them. I just have a low tolerance for stupid people that just want to be good consumers without questioning anything and ever having a deep thought, especially when American Idol is on.

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Meds Help
Posted by: rider3 on Aug 18, 2008 11:50 AM   
Current rating: 3    [1 = poor; 5 = excellent]
Not only does being on the generic version of Zoloft for depression help me function -- literally get out of bed and have a life -- but I'm also on it for back pain after major disc surgery, and it's kept me going -- not to mention alive. Depression is hereditary, and it ran on my father's side. All four of my siblings are on the same med due to depression -- that should tell you that it's hereditary. Meds, coupled with talk therapy, is wonderful, but unless you've ever experienced real depression -- and I mean the DEPTH of depression and suicide -- you have no clue how much meds help. You cannot just "snap out of it." Sure, some people probably shouldn't be on them. However, for those who need it, no one should question their choice. You don't know what someone's going through. People need to have some empathy, a trait that is very rare these days.

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» RE: Meds Help Posted by: picker
What, was this article written by
Posted by: Homoousia316 on Aug 20, 2008 11:37 AM   
Current rating: Not yet rated    [1 = poor; 5 = excellent]
a Scientologist or something? I mean despite the hard-hitting chemical neuroscience you deployed to show that hormonal imbalances do not ever, ever cause depression (just kidding: you're a joke), it seems somehow to me that certain chemical problems cannot be solved just by not worrying and being happy.

Alternet quality continues to degrade. At least it isn't as bad as the nuclear power article.

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travelertaylor
Posted by: travelertoo on Aug 21, 2008 8:52 AM   
Current rating: Not yet rated    [1 = poor; 5 = excellent]
Big Pharma is the biggest dope peddler in the world. I've had a couple of relatives who killed themselves and had been taking anti-depressants.

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