One the major reasons depression is so poorly understood can be attributed to the misinformation promulgated by the pharmaceutical industry. The ads from drug companies, ubiquitous on TV these days, suggest that individuals become depressed due to a “chemical imbalance” in the brain. Furthermore, they suggest that their medication will be able to correct this imbalance. Did you know there isn’t a shred of scientific evidence to support this claim? In fact, research suggests that people often become depressed on an emotional level following a loss – such as the loss of a job, a divorce, or the loss of a loved one. All of us sink in mood following such a loss. Studies have found no difference between “normal” people and those who get depressed when it comes to that initial dip in mood and energy. The difference is in the ability to bounce back from loss, disappointment and heartache. If depression continues past a few weeks, the body starts of shut down. So it looks like the body, including the brain and neurochemicals, gets depleted AFTER the person becomes depressed. This is an effect of depression, not the cause! Once someone becomes seriously depressed, and is having trouble functioning, they may need a short course of medication to replenish the brain’s neurotransmitters. However, this accounts for only about 15% of the population, and is not required in most cases. In fact, medication can interfere with the natural course of mourning. These drugs tend to dull all of our feelings. Since facing and experiencing our pain and anger are essential to rebound and resolution, suppressing these feelings can backfire.
We are also now finding out that these antidepressants have some serious side effects and are very difficult to discontinue. A recent article in the New York Times reported that, while these drugs were intended to be used as a short term intervention, many are being prescribed these drugs for years and even decades. Trying to wean off them proves very difficult, and rebound effects are common. Furthermore, patients who are treated with medication alone, rather than medication in conjunction with psychotherapy, do poorly in the long run and tend to revert to depression as soon as the medication is removed. So what kind of therapy is best for depression? There is a lot of misunderstanding here as well. For example, there is a good deal of confusion about the relationship between negative thoughts and depression. Cognitive Behavioral Therapy (CBT) is a treatment based on the idea that our negative, critical, hopeless thoughts create depression. Since they contend that these thoughts cause depression, the cure involves challenging and abandoning this kind of negative thinking (often easier said than done!). While CBT is often advertised as the most effective treatment for depression, the research evidence doesn’t support this claim., or the idea that thoughts create feelings.
Neuro-scientic research has established that our emotional brain (the limbic system) registers emotions long before our conscious brain (the neo-cortex) can produce a thought. So our thoughts are the caboose on the train. In other words, our negative thoughts about ourselves, others, and the future are more often the result of depressed feelings than their cause. Of course, it’s easy to get into a loop in which negative thoughts and feelings feed into each other in a downward spiral. Both the depressive’s way of thinking, and the way they handle their feelings, must be addressed in any effective treatment. Therapies that focus on the awareness and regulation of emotion are beginning to show superior results. In particular, Intensive Short Term Dynamic Psychotherapy (ISTDP) has been shown to be effective in cases of treatment resistant depression, in which other therapies, including medication and even ECT, have failed. The latest research on psychotherapy effectiveness suggests that some therapists get better and more consistent results than the rest. They have been referred to as the “supershrinks”. The therapist is a more important variable than the method they practice. That said, the best therapists DO have a model of therapy they are passionate about and masterful in implementing. They are structured, but flexible in their approach, taking the particular needs and capacities of each person into account. This group of therapists tends to be ambitious and will challenge themselves and their patients to face difficult truths and, in so doing, get the best results.
So if you are depressed, find a good therapist! If you are having an “average” problem, like feeling blue after a break up, but are otherwise doing well, an “average” therapist can help you. However, if you are seriously depressed, have a history of re-current depression, and have trouble in many areas, including self care, relationships and your work life, you need to seek out a “supershrink”. Get referrals from people you trust and set up a consultation before committing to treatment. For more information, check out my books and videos at www.istdpnortheast.com. Research on ISTDP and treatment resistant depression can be found at www.istdp.ca.
Dr. Coughlin is on the forefront of clinical research into therapeutic change. Intensive Short-Term Dynamic Psychotherapy (ISDTP) is a scientifically validated method of psychotherapy which dramatically accelerates the process of change, so that patients see measurable results within weeks and months, rather than years.