Appendix (4): Good Mood: The New Psychology of Overcoming Depression

Good Mood

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Good Mood:
The New Psychology of Overcoming Depression

Introduction

cont.

Afterword For Those Interested in the Scientific Evidence

The experimental evidence for the success of cognitive therapy in helping depression and other miseries has been mounting up. For thirty years now, a variety of studies have shown cognitive therapy to be helpful. And in 1986 the National Institute of Mental Health of the U. S. Department of Health and Human Services completed a tightly-controlled three-university study lasting six years (and costing ten million dollars!) comparing a) encouragement only, b) drug therapy, c) Beck's Cognitive Therapy, and d) Interpersonal Psychotherapy; both these latter psychotherapies emphasize the key element of altering one's own thinking and behavior. The results at the conclusion of treatment showed that the active psychotherapies were as successful as the standard drug imipramine in reducing the symptoms of depression and improving the patient's ability to function. Drug treatment produced improvement more rapidly, but the active psychotherapies caught up later. Severely depressed and less-severely depressed patients both benefited from the active psychotherapies.(7)

These findings are extraordinarily impressive because drug therapy has been the favorite of the medical establishment in recent years. And cognitive-behavioral therapy has none of the side-effect dangers, physical and psychological, that accompany drugs. Furthermore, as noted earlier, the drugs control rather than cure depression. Hence, even if drugs are to be used, psychotherapy is appropriate in combination with the drugs in order to root out the underlying causes and move toward real cure.

Afterword About Drug Therapy for Depression

Neither I nor anyone else can give you authoritative advice about whether drugs are right for you. It surely makes sense to hear what one or more physicians has to say to you about drugs. Finding a wise physician, however, is particularly difficult when the ailment is depression. The problem is, as two noted psychiatrists put it, that depression "may arise from a biological malfunction, from actual losses, deprivations, or rejections, or from personal limitation. The difficulty in sorting out such causal fact is a source of enormous confusion in the diagnosis and treatment of disorders of mood."(2) And as two other reliable psychiatrists put it, "depression is almost certainly caused by [many] different factors", and hence "there is no single best treatment for depression."(3) Your best bet is listen to medical advice, and also advice from one or more psychologists, and then make your own decision about whether you want to try drugs first, or psychological therapy first, or both together.

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Perhaps the most important piece of knowledge is that, contrary to what some physicians will tell you, drugs are not an all-purpose cure for depression. Perhaps the only major exception is the case of a person who has suffered real tragedy from death or other great loss, and is slow in putting the tragedy behind her/her. A sprained brain is very different than a sprained ankle. An out-of-order brain is very different than an out-of-order kidney or pituitary gland. Even if drugs relieve the depression while you are taking the medication, you almost surely need to straighten out your thinking so that the depression will not recur after you stop the drugs, and so that you will know how to fight off depression if it does recur.

Depression is not likely to be caused simply by a biologically-induced chemical imbalance that a drug can neatly restore to balance. As Seligman4 puts it, "Does the physiology cause the cognition, or does the cognition cause the physiological change? ..the arrow of causation goes both ways.." And as another psychiatrist has recently written, "Drugs do not cure the illnesses, they control them."(5)

Only psychotherapy offers true cure in most cases of depression. And as the official statement of the American Psychiatric Association judiciously puts it, "All depressed patients need and can benefit from psychotherapy,"(6) rather than relying upon medication alone. Patients treated with cognitive-behavioral psychotherapy as well as drugs have fewer recurrences than patients treated with drugs alone, in one study.(5.1) Miller, Norman, and Keitner, 1989

I do not intend to suggest, however, that drug therapy may not be appropriate for you. Modern anti-depression drugs offer hope to some people who are otherwise doomed to misery for long periods of time. I myself probably would and should have tried such drugs during my long depression if they had been as well- established as they now are. Drugs are particularly indicated when the depression continues for a very long time, because "One thing seems sadly certain: the person who remains chronically depressed over time has a reduced chance of recovering."(8) What I am suggesting is that you should not only consider drugs, and that it might be wise to try cognitive therapy first. You can read more about anti-depressant drug therapy in Chapter 00.)

bntro 9-148 depressi February 19, 1990

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