Pet Belief -

[kyburg]

You don't need drugs to kick depression; though, I do wonder if in a lot of cases, cognitive work and medication need to be used together for best effect.

"On the whole, these findings do not support the current American Psychiatric Association guideline, based on the TDCRP (the Treatment of Depression Collaborative Research Program) that 'most (moderately and severely depressed) patients will require medication,' " the study authors wrote.

"It appears that cognitive therapy can be as effective as medications, even among more severely depressed outpatients, at least when provided by experienced cognitive therapists," they wrote.

The report doesn't specify findings when medication and cognitive work were used together; it's my understanding that combination is the most successful of all.

Medication alone is cheaper; but it certainly doesn't appear to prevent future depressive periods. But cognitive work does not require a therapist once you've got it down - in my case, I have my books and I can add a pad of paper and a pencil at any time. Cognitive therapy is also not a two year, once or twice a week session obligation. *thinks* I was once a week for two months at my worst, and then nine months of once a month - and really, I cancelled out of the last three months. Too busy. My therapist was good with this - he preferred not to hospitalize anyone as he believed that "life is what happens to us while we're busy planning for other things."

*looks at study* 16 weeks. That's about right.

I'm also not of the mind, even more so now, that SSRI's should be considered "replacement" therapy - yes, depressive illnesses tend to cluster in families, but anyone dealing with dysfunctional families knows that there are a ton of landmines you have to deal that are learned behaviors. Mom does it; her mother did it too. Oh, and great-granddad was a winner. You ought to see the fallout....

You ought to see the history in the men in my family, particularly on Dad's side of the family. They've self-medicated for generations - the result has been a history of substance abuse that only one male member of my family has escaped in five generations. Dad died of an accidental overdose of barbiturates in 1967 (some people did NOT survive the sixties, sadly), but his father died of stomach cancer after being a fifth-a-day alcoholic, just like his father. And my brother's children, all three of the boys have police records related to drug possession and use. (Older brother seems to have escaped - but there are days I wonder. He also has my aversion to medication, which might explain it.) Younger brother got nailed, but has been in recovery for over 8 years now.

There are a lot of reasons people get depressed. There are also more than a couple of ways to deal/treat the depression.

And I'm sorry - just prescribing medication for the rest of your life is dumb-ass lazy. At least in this case, I think the research supports that stance.

(Paxil. "Usually." Wonder if they have any specs on the suicides attempted....)

Comments

[secanth.livejournal.com]

First thing I'd want to know was what they were using as their 'definition' for depression. I'm assuming they treated depression as a discrete disease, in a rather 'pure' form. Most of those I know who suffer depression also suffer from more than simple depression, including such things as bipolar disorder, neurotic behavior, self-infliction of pain, ect, ect. Did they also include cyclic depression, situational depression, seasonal disorders, ect, ect. From the article, the parameters of their study aren't clear, and there's no way to make a personal decision based on the results until one knows the parameters involved.

This isn't to say that *some* forms of depression don't do well with therapy only, or with medication AND theraphy. The probably I have with articles like Forbes' is they tend to sweep with a very broad brush.

[secanth.livejournal.com]

'problem I have'...sigh...I'm not fully awake yet.

[technoshaman.livejournal.com]

Hot damn, somebody who sees both sides of it, and better yet, comes up with synthesis.

I think the key here is a competent MD who also gives a damn. Sometimes you need one, sometimes you need the other, sometimes you just need a little boost to get you far enough up out of the hole you're in that you can see the green grass all around... but I get the feeling that at least some of them have the attitude of "here's your drugs, now get out of here, I've got a tee time..."

And don't get me started about school systems ordering bright, bored kids onto the stuff...

Of course, the flip side of this whole rant is that when life throws you a dot-bomb, ships all your jobs to India and generally makes you feel worthless, you will damn well get depressed, and the only thing you can do is downsize your life and figure out how to make a living without a keyboard, or similar drastic measures. Hmmm. I smell a post coming on.

[zyrc.livejournal.com]

having been on the med-go-round, i do think it's most effective to use meds and therapy together. having said that, i have also noticed that when i get into the gym on a regular basis, or am consistent in some kind of physical activity, my mental state generally improves, even if i am neither on meds or in therapy.

[kyburg.livejournal.com]

They're quoting from a study published in the April issue of Archives of General Psychiatry - snag a copy and see!

[kyburg.livejournal.com]

I grew up in hospitals. I know good from bad, and I tolerate nothing but excellence in my doctors. I am a colossal pain in the ass; know it, mean it and don't see any reason to change it.

I also got a lot of cognitive training in my first two years of college - strangely, enough. They called it "health training."

Being able to roll with the punches is the key to getting by in life - I don't care about the size of them.

However, as I found out on April Fool's Day, I am very susceptible to pranks based on bad news. Bad news I always believe; good news is never taken for granted. Strange.

[kyburg.livejournal.com]

Which says you need lifestyle modifications - not drugs. And you need to know that's acceptable, okay and fun.

Cognitive work at its best.

[secanth.livejournal.com]

Maybe if I get down to Columbus in the near future, or can find it online/interlibrary loan. I'm not exactly in the big city here. (wry smile)

[zyrc.livejournal.com]

sheesh. i never put it together that succinctly in my mind, always attributing it to endorphins. but you just framed what it as it really is.

thanks!

[elfwench.livejournal.com]

I think that part of the problem with the over-reliance on medication for depression is that so many insurance plans have very limited coverage on mental illness, like ours has 30 visits a year and only after a referral from your physician, and it's good insurance (UHC) - that's just over two visits a month and I can remember times I needed once a week and even twice a week for months at a time.. Therefore, you end up with a lot more primary care physicians medicating their depressed patients without the benefit of therapy.

I hope this is making sense. I'm trying to type while music is playing and am still working on shaking loose the last of the cobwebs from my brain on top of that.

[bigbigtruck.livejournal.com]

Wow, so I'm immoral AND lazy.

Sigh.

[terredancer.livejournal.com]

*frowns* A doctor informed me that Paxil was an antianxiety medication.

I'm fairly anti-medication when it comes to things like that, though, and I think being on Paxil one day more or less proved out why I'm the way I am on the subject. Anti-medication, and anti-therapy pretty much.

Always thought there had to be other and better ways for me, even though I have yet to find a good solution.

My personal experience...

[tomlemos.livejournal.com]

has been that medication and therapy have been the best course for myself.

So much so that I don't need either at this time, but I am quite aware of how well the combination works, so should I need some help in the future, when things get that bad again, at least I know that I can get back to my old self eventually.

[cecerose.livejournal.com]

Your post is very timely...I'm looking into some form of cognitive theraphy... I've been on prozac for over 10 years and I recognize it won't cure my depression, but it keeps in check and from becoming emotionally intense or physically overwhelming as it may be. After two hospitalizations, I'm not taking any chances...

[bigbigtruck.livejournal.com]

Exercise has been really good in staving off the worst of the menstrual cramps, and lifting the general blanket of depression... but as soon as the endorphins wear off, I crash down into a terrible sadness for an hour or so. :/

[lordindra.livejournal.com]

Medication can work wonders, if used properly. It does require traditional talk therapy work to really help- I've known several people who have used psychiatric drugs. Those who made the biggest gains were those whos doctors used the drugs to push the door open so talk therapy could make some gains. The ones that were just handed the drugs, their slide downwards was slowed a bit, but they certainly did not improve.

[fufaraw]

The Husband suffered from depression for years. It began as situational, and was amplified by repressed anger with himself, but he spent years in denial. Both offspring have my tendency to introspective spiral, leading, if not dealt with, to constant low-grade depression. Doctors wanted to slap both kids on antidepressants, but aside from clinical intervention twice in suicidal crises with one child, we managed with cognitive therapy and no drugs, except for sporadic self-medication with alcohol. Both of them are past that now, and well able to self-examine and deal with situations which would set off the downward spiral.

For my own mental health I've relied on professionals off and on, and done extensive reading and practice.

I finally convinced DH to talk to his doctor (who is a marvelous whole-body sort with degrees up and down the walls, but who also is willing to try alternatives to tradtional western medicine) about short-term medication, just to break his habitual depression. The doctor told him, "I'm not putting you on medication, but you need to deal with your rage. You don't have a depression problem, you have an anger problem." It was enough of a wakeup call that it snapped him out of his habitual mindset and he's actually been doing some reading and self-therapy, and has made significant improvement.

This is not to say that any of us might not have benefitted from chemical intervention, but it isn't always needed, or even the first choice of treatment. I prefer knowing how I deal with hurdles, and learning methods and mechanisms to deal in more healthy ways.

"Bad news I always believe; good news is never taken for granted."

This isn't strange at all. I hate surprises, because I'd really rather *not* "live in interesting times."

[kyburg.livejournal.com]

Oh ye of little faith. Go google up the journal and see if they can't send you a copy or have it online -

[inagawayuu.livejournal.com]

Actually, medication can and does work when used right. Sadly, not many medical health plans will cover long-term therapy to go along with the medication, or limit you on which therapists you can see, so it's easier for the doctors and cheaper for the insurance companies to just put someone permanently on meds.

Medicine works best I've noticed in the short term. It stabalizes your mood long enough to learn other ways of managing the depression. I know for me it kept me lucid enough to allow for the therapy to work. Now I'm off meds, but I still use the techniques I learned in therapy to manage my depression.

However, there are some kinds of depression which are caused by a genuine chemecial imbalance and the maitenece meds are nessecary. It's not true for every kind of depression, but I know my grandmother had to be on medication for her whole life because when she was not on her meds, she was both physically and mentally unable to function at all. (I wish I could remember her exact diagnosis/illness.)

But it takes a long time to determine who honestly needs long term medication and who needs it for a short time or not at all. HMO's just want to take the easy way out, hence they just stick you one one kind of generic drug and send you on your way. it took me almost a decade to finally find the right doctor and therapist to actually treat me, and not just assign me a maitenece med like many others had before.

[kyburg.livejournal.com]

It's amazing how acceptable it is to be male and angry, but not male and happy, isn't it?

I'd have to second that - at 18, I was told the same thing. "You aren't depressed. You're angry. Feeling angry is normal."

Now, at the time, they had me slugging pillows and screaming, which didn't treat any of the underlying attitudes - but it was incredibly refreshing to have someone acknowledge that I had some feelings in a lot of matters that had never been addressed.

I've also been told, when I explain how well cognitive therapy works for me, that I've simply found something that works for me - and is only one of many things that can be tried.

Frankly, it's cheap, chemical-free and self-contained. How can you lose, if it works?

[kyburg.livejournal.com]

I'd have to ask where that crash begins - because if it begins with "That was fun - but the fun's over now, ARGHISUXXOR" - it gets easier to see why it happens.

One thing, once I learned to look for it, was identifying what I was thinking, in exact words and phrases, when I was depressed - I wasn't having "moods" - I was causing them. Unaware, unintentionally - and most of it was really bad habits. And bad habits are tough to break!

Oh, and being around family members only reinforced the bad behavior - I used to call it being around land mines. You do develop behaviors to cope - in a lot of cases, you only develop something out of ignorance of something more effective.

That's where therapy comes in - it's education, practice and healing in one package.

[kyburg.livejournal.com]

You're dead on-key. I think this IS the reason so many people end up on medication, remaining depressed and having larger problems - even though they've been told the medication is going to do it for them.

[kyburg.livejournal.com]

No, it's lazy work on the part of GPs who put the hausfraus on Prozac and never do anything else.

They used to give them methamphetamine in the sixties for the same reason.

(Wow, taking responsibility pretty quick there, weren't you?)

[kyburg.livejournal.com]

Yeah, they tell them that. It's primary side-effect is paranoia (at least in my experience). Ew. It works wonderfully well in a lot of cases, don't get me wrong - but when applied to someone with situational depression, it has created problems insteading of resolving them.

http://dogbert.abebooks.com/servlet/BookDetailsPL?bi=447281746

Get the book - read it, but most of all, do the exercises in it. At first you'll think you're wasting your time. Until it begins working. Trust me.

Re: My personal experience...

[kyburg.livejournal.com]

I'm there, too. Last depressive episode was in 1988 - so, what? Almost twenty years? When I began having them at age 9, and never went ten years without a BIG relapse (and never really functioned well inbetween)?

I also know now that I can be sad and angry without it being a pathology. Believe it or not, that's priceless.