Treatment of Depression
When pursuing treatment, you’re faced with lots of different options each with its advocates. It can be pretty confusing for many people. Let’s sort it out…
Treatments for depression are typically categorized as either primarily biological (medical) or psychosocial (therapy) in their approach. Treatments in both domains continue to evolve as new understandings about depression emerge.
It’s important to say that many different treatments for depression can provide relief. As there are many different pathways into depression, there are many different pathways out of depression.
It’s a curious discovery in the depression research that depression has a high response rate to placebo-based interventions (treatments with no active antidepressant components). This highlights how much one’s beliefs and expectations can influence one’s response to a particular treatment.
Thus, it is essential to learn to distinguish treatments that help people feel better from those that actually help people be better. How might we do that? Beyond the necessary short-term symptom reduction, one especially important measure is the recurrence of depressive episodes (called “relapses”). Ideally, treatment should not only help people feel better but also lower their vulnerability to relapses.
There are many who think of depression as a “disease,” a biologically based problem requiring biologically based solutions. As a result, many biologically based treatments have evolved over time to address presumed culprits in the brain and body.
By far, though, the most common biological treatment is the use of antidepressant medications (ADMs). They are the most common form of treatment in many countries around the world, including here in the United States. ADMs have grown to be so popular for a variety of reasons: the plausible rationale that they correct a presumed “chemical imbalance” causing the depression, the tempting ease of believing that you can take “a pill a day to keep the depression away” without having to change anything in your life or learn any new skills, and the belief that these drugs are safe and effective in addressing depression.
However, the science tells us a different and less flattering story about the ADMs as new and better studies that aren’t funded by the pharmaceutical companies become available. Here’s just a sample of several recent studies that cast a shadow over the commonly held belief that depression is cause by genetics and a chemical imbalance in the brain resulting in a shortage of the neurochemical serotonin.
Other Biological Approaches
- WBCT/Ketamine Therapy (There are Intravenous (IV), Intramuscular (IM) and nasal spray applications. Only the nassal spray is currently FDA approved for depression and requires medical supervision)
- Psychedelics (Psilocybin, the “magic mushroom” and MDMA or “Ecstasy” are currently the most popular but they are experimental and not yet approved for depression by the FDA)
- Transcranial Magnetic Stimulation (TMS) is a brain stimulation technique that utilizes magnetic fields to induce an electric current in specific parts of the brain.
- Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT) or simply Accelerated Neuromodulation Therapy (an accelerated type of TMS)
- Whole body cryotherapy (WBCT) is a treatment that immerses a person to extremely low temperatures.
- Anti-inflammatory medications such as aspirin/paracetamol, statins and antibiotics have been used to address the symptoms of depression based upon evidence suggesting that inflammation in the body contribures to major depression.
- Electroconvulsive Therapy (ECT) is another type of treatment that sends electrical currents to parts of the brain but is typically done in a hospital under sedation and considered a last resort treatment.
In 2009 I wrote a popular book called Depression is Contagious. I made the point that various strands of research, including genetics, epigenetics, and epidemiology all pointed to the recognition that depression isn’t a biological disease in most instances.
Instead, depression spreads as a social contagion (not a biological contagion such as a virus). Through the things we learn (or don’t learn) from our families (such as values and priorities), our teachers, our community, and our culture, depression can easily evolve when one faces challenges or circumstances they are simply not well equipped to deal with.
I have been making this point for decades: depression is far more a social problem than a medical one. The evidence has grown exponentially for this perspective.
Consider this: In the last 2-3 years, the COVID-19 global pandemic has forced many changes on all of us. We have, in essence, been in a “living laboratory” exposed to not only a biological threat to our well-being but the psychological stresses of striving to create personal safety and avoid infection. We were encouraged to quarantine, stop going to the places we enjoy, forego travel to favorite destinations, isolate at home as much as possible, wear masks indoors and out, change our work and school schedules, deal with economic pressures from job losses or new expenses (such as caretakers for kids who can’t go to school), suffer the grief from loved ones being sick and even dying, and on and on. The pandemic gave us a whole new level of understanding about depression when the rates of both anxiety and depression soared around the world. The World Health Organization (WHO) stated that the rates of depression at least doubled during this time. What does that suggest to you about our vulnerability to depression when our life conditions change so profoundly and so quickly requiring us to do our best to adapt?
What may interest you, though, relates to a point made earlier: why didn’t everyone get depressed during the pandemic? Why did some people actually thrive during this challenging time? I think everyone should be curious about these questions because it leads us in the direction of identifying what factors comprise mental health. I have had this as my professional focus all along, interviewing countless people in-depth who might well have succumbed to depression in the face of adversity but didn’t. I (and many other allied experts, too) came to recognize that there are specific skills that some people have, usually at levels in themselves they’re not even aware of, that serve to insulate them from the despair and pain of depression. We can identify and teach these skills through the process of psychotherapy.
The skills I refer to cover a wide range of life experiences and are too many to name here. However, I can name some of the key skills that can reduce vulnerability to depression, reduce the frequency and severity of episodes when they do arise, and reduce the vulnerability to recurrences.
Here’s a partial list of some of the skills worth developing if you want to feel good. Therefore, these are the skill you should be seeking help with in therapy.
- Realistic hopefulness about the benefits of expending sensible effort
- An ability to “reality-test” by asking yourself/others for evidence for your beliefs
- An ability to distinguish accurately what is and isn’t within your control
- A wide range of social skills that give rise to supportive, healthy relationships
- Problem solving skills that generate effective solutions
- Positive coping skills for managing stress well
- Frustration tolerance to be able to stay with something even when difficult
- A tolerance for uncertainty/ambiguity given how much of life is uncertain
- An ability to think ahead to prevent problems from arising whenever possible
- Developing greater flexibility to explore alternatives when feeling “stuck”
- Knowing to get help before things get worse
The term “psychotherapy” is an umbrella term for many different models of human behavior each with their own philosophy and associated techniques. Some therapeutic approaches have been subjected to greater analysis and research and carry the label “empirically supported,” meaning there is research evidence that the approach can work in most cases.
When we consider the research evidence in therapies for depression, three approaches have fared quite well. They are:
1. Cognitive-behavioral therapy (CBT),
2. Interpersonal therapy (IPT), and
3. Behavioral activation therapy (BA).
These are general labels and there are scores of therapeutic approaches with other names that fall under their umbrella, so it would be best to understand the general aim of these approaches. Simply put, here’s what each model strives to teach:
- thinking clearly (as taught in CBT approaches)
- behaving effectively (as taught in BA methods)
- relating positively to oneself and others (as taught in IPT interventions)
- managing your emotions (as taught in all these approaches)
This description is very general, of course, but you can click on the link beow for how to choose a therapist and I’ll offer some advice that can help you navigate the maze of seeking treatment.
What you should understand first is that there are specific skills you can learn that can literally turn your life around. These are the things you can and should expect to learn in any effective, action-oriented psychotherapy.
Diet and Exercise
A healthy lifestyle is necessary for maintaining your well being. So it should come as no surprise that diet and exercise are critical components to managing and even preventing depression.
It may seem ‘too simple’ but regular exercise (several days a week for 30 minutes or more, even broken into 10-15 segments) has been shown to be as effective as antidepressants in addressing mild to moderate depression.