Nowadays, moderate depression responds well to psychotherapy, but antidepressants may be helpful to those who suffer from moderate to severe depression. Usually, the combination of drugs and psychotherapy works best. Medications help to quickly eliminate or alleviate the symptoms. Psychotherapy allows the patient to learn how to solve problems on his own and get rid of depressive feelings and thoughts.
Cognitive behavioral therapy
Beck’s cognitive theory of depression gave rise to this method. This is the most common method of psychotherapy for depression. The focus is made on the thoughts of the patient. The hypothesis is that people with a predisposition to depression perceive negatively themselves, the world and their future (this is the negative cognitive triad). They are also prone to a certain disturbance in thinking.
For example, a patient with depression may come to the therapist and state that he is a jerk, because yesterday when the whole family celebrated his son’s birthday, it started to rain. The task of the therapist is to teach the patient to recognize negative beliefs, question them and replace them with more realistic thoughts. The therapist can discuss with the patient yesterday’s birthday of his son and, in the process of conversation, push him to the idea that his opinion is irrational and his pessimism has no basis. Between sessions of therapy, the patient sometimes performs the “homework” suggested by the therapist.
This is the cognitive part of therapy. Its behavioral aspect is to teach the patient new skills: for example, the ability to solve problems (that is, identify the problem, find several possible solutions and choose the most suitable), self-control (that is, set weekly goals for yourself, then take active action and reward yourself for achieving these goals) and the so-called behavioral activation (that is, to be active in difficult situations, and not to avoid them).
The main goal of behavioral therapy is to involve the depressed patient in actions that bring him pleasure and give a sense of his own competence. This increases the number of positive emotions, and also distracts the patient from unnecessary thoughts about еру feelings and problems, which only exacerbate the depression.
Cognitive-behavioral therapy is relatively short-term and usually requires 4 to 14 sessions. But the course is likely to be longer for those who have a long history of rigid dysfunctional thinking. Patients with long-standing and deeply rooted inadequate beliefs are taught to see that their problems are largely due to these beliefs, and not just negative life events. In other words, the cause of the patient’s depression may not have been caused because she broke up with her boyfriend 6 months ago, but in constant and inappropriate thinking about it.
How effective is cognitive behavioral therapy? It is effective enough. This method of psychotherapy was investigated more often than other means of treating depression. It turned out that it is not less or even more effective than other methods of psychotherapy. It is comparable in effectiveness to antidepressants. In addition, those who underwent cognitive-behavioral therapy to the complete disappearance of the symptoms of depression (that is, to “complete recovery”) were less likely to experience relapses or episodes of depression in the future.
If you are depressed, then most likely you have at least one relationship problem. For example, you have lost a loved one, your marriage is bulging at the seams, you are experiencing a personal crisis. Interpersonal therapy is partly based on Freudian psychoanalysis but uses a variety of methods borrowed from other methods of psychotherapy. For example, if the therapist relies on a medical diagnosis, the patient with depression is considered sick and his illness should be treated.
The therapist assumes that depression is not the result of a weakness of character features. Moreover, as well as family therapists, psychologists working in the framework of interpersonal therapy help the patient to work on himself and solve problems in relationships, remain optimistic and show that this can improve the situation and at the same time alleviate the symptoms of depression. Finally, like cognitive psychotherapy, interpersonal therapy focuses on the “here and now” and not on the “excavations” of some unconscious causes of depression in childhood.
The course of therapy takes 3-4 months. During the sessions, current interpersonal relationships are discussed: conflicts in the marriage, caring for a sick child or losing a friend. The therapist’s strategy depends on the type of problem. For example, if you are most concerned about the conflict with the mother-in-law, the therapist will discuss with you the nature of the relationship with her, the specifics of the conflict and what you want in this situation. He will help you recreate the situation so that you can look at it from a new point of view. Then the therapist will discuss with you all possible solutions to the problem that you may not have seen before due to depression. You can conduct a role-playing game to rehearse possible strategies, for example, what and how to say during the next conflict with the mother-in-law.
Studies show that interpersonal therapy is very effective in treating depression. Its effectiveness is not inferior to the effectiveness of drug treatment, and it is much better than medications to improve social functioning. If you think that this type of psychotherapy suits you, it can really be very useful.
Like psychologists working in interpersonal therapy, family therapists recognize that depressed patients often have problems in family relationships. Indeed, if you are married and depressed, then most likely you will have problems with your marriage. If you are depressed and you have children, you will most likely have difficulty bringing them up. Severe depression can cause pain. The family members may also suffer from this dysfunction.
Can you say that depression provokes family problems? According to the stress-generation theory, which many family therapists follow, this is not 100% true. Depressed patients create stress in interpersonal relationships in a variety of ways. This stress can aggravate their depression. For example, women suffering from depression are more negative and pessimistic about their partner, they are less consistent in raising their children, they have more tense relations with teenage children and they tend to avoid conflicts. Because of all these factors, depression further complicates their family problems.
On the other hand, marriage problems (infidelity or the threat of divorce) and parenting problems (constant conflicts with children) increase the risk of depression or aggravate depression, if it already exists. This vicious cycle where depression leads to problems that exacerbate depression, which creates new problems, can be solved by a family therapist.
The two most common and most successful types of family psychotherapy for depression are behavioral family therapy and training for parents.
Behavioral family therapy is a relatively short-term course. The therapist regularly meets with a depressed patient and his partner. In the first phase of therapy, the therapist works with the most serious problems in the relationship and helps the couple to establish a more positive interaction. The therapist can give homework to partners — for example, remember what they liked to do together in the past and start doing it again. If this phase is successful, the patient is already feeling better, and both partners begin to express more positive feelings towards each other.
After this, the second phase of therapy begins, the purpose of which is to rebuild relationships, for example, to teach partners to communicate more effectively, solve problems and interact day after day. At the same time, a couple may sign a behavioral “agreement”. It indicates which aspects of their behavior the partners agree to change. If this phase is successful, the partners feel more open and more responsive to each other’s needs. They become closer and are able to cope better with difficulties.
Finally, in the third phase, the therapist helps the partners to prepare for stressful situations that may occur in the future. The success in therapy is explained by the fact that a couple loves and cares about each other. Interestingly, behavioral family therapy is at least as effective as individual therapy for treating depression. But it has an additional advantage: it increases satisfaction with marriage. Indeed, many studies show that increasing the level of satisfaction with marriage (or positive changes in marriage) is the main reason for the effectiveness of family therapy.
Unfortunately, family therapy has one serious disadvantage: in order for it to be successful, both partners must participate in it. One of the partners sometimes refuses to do this because consider this therapy shameful.
An alternative solution is to start therapy with training for parents because depressed patients often have difficulties in relations with a partner and in raising children. Compared to family therapy, parenting training is safer. It is less likely to cause resistance and does not require the participation of both parents.
There are different types of training for parents. Usually, at such training courses, parents are taught parenting skills (for example, how to use reinforcement and time-out in communicating with children), help to understand how parents unconsciously reinforce children’s problematic behavior (for example, paying attention to what they don’t like), learn to express love, teach effective communication skills and strengthen self-confidence. This is useful for both young and experienced parents. Such trainings help to deal with parenting problems and reduce the intensity of depression symptoms.
It is difficult to find a person who would not know about antidepressants. Such drugs have been used to treat depression for almost 50 years. The most famous of them – Prozac, but there are many others, and they can be divided into several categories:
- The first group includes the most common antidepressants called SSRIs. These are the “superstars” you probably heard about: Prozac, Zoloft and Paxil.
- The second category is a new generation of drugs, such as Wellbutrin and Effexor.
- The third and fourth categories include more traditional antidepressants, which are still considered effective but have more side effects. These are tricyclic and MAO inhibitors.
The popularity of antidepressants is constantly growing. In 2005, antidepressants ranked third among the most common medications. Their widespread use has caused a lot of discussions and very different opinions. Some argue that Prozac will not hurt anyone, even relatively happy people, while others fear that its uncontrolled application can result in horrible consequences.
Properly selected antidepressants improve the condition of 60–70% of patients with depression. But for the full effect manifestation, they need to be taken from 3 to 6 weeks. If one drug does not work, many patients soon find a different one that helps them.
On the other hand, antidepressants do not help at all or cause intolerable side effects for many patients. It is necessary to choose drugs very carefully. Look for what is right for you. Someday, thanks to a new field of science called psychopharmacologic genetics, it will be easier for us to do this by matching preparations with our unique genetic patterns.
While it is not easy to choose suitable antidepressants, a psychiatrist can help navigate the information and select the type and dosage of the drug that is most suitable in each case. Each class of antidepressants has unique features; different drugs affect different chemicals in the brain (serotonin, norepinephrine, or both), have different side effects, interact in different ways with other medications, and require different dosages and mode of application.
For example, Prozac is taken once a day, and the dosage hardly changes during the course of treatment. It is believed that this green pill increases the amount of serotonin in the brain. It has almost no side effects, but at the beginning of treatment, it can cause nausea, insomnia and nervousness. There may also be problems with sex life. Another disadvantage of Prozac is that it can reduce the effectiveness or provoke side effects from taking other medications (for example, drugs to treat cardiac disease, migraine or epilepsy) to a greater extent than other antidepressants of its class (for example, Zoloft).
In contrast, the antidepressant Wellbutrin affects the level of norepinephrine and dopamine (but not serotonin). Therefore it can be effective for those who are not helped by Prozac. The most common side effects of Wellbutrin — insomnia, increased anxiety, tremor, and headache — are also different from those of Prozac, and its reception does not affect the sexual sphere. However, it must be taken up to 3 times a day. It causes seizures more often than other antidepressants. Fortunately, a newer version of Wellbutrin, called Zyban, solves some of these problems. Zyban causes seizures much less frequently and is only taken twice a day.
Effexor is another antidepressant that has a completely different biological mechanism of action. In small or moderate doses, it increases the level of serotonin. With a large dosage, it increases the level of norepinephrine. Some studies show that for patients with more severe depression, Effexor is more effective than any other drugs in its class.
More traditional antidepressants are rarely used today as they have more side effects. However, they can be very effective for certain types of patients, especially when other drugs do not contribute to relief. In general, there are many options for the pharmacological treatment of depression, and it is difficult to choose suitable drugs. Approximately every third patient does not fit the first of the selected drugs. But the great diversity in this area is encouraging, and the psychiatrist can try different approaches. The most obvious step is to switch to another antidepressant, but you can also increase the dosage or duration of treatment, add another drug that is not an antidepressant, or take two different antidepressants at the same time.
Patients often ask how long they will have to take medications and whether depression will return as soon as they stop doing it. Most often, antidepressants are taken for 4–9 months (fortunately, they are not addictive), after which medication is withdrawn for 1-2 months. In severe, recurring depression, if there are other depressed patients in the family, and if it started before the age of 20, doctors often recommend taking medications all the time even after all the symptoms of depression have disappeared. It is recommended to prevent the recurrence of depression.
Today, antidepressants help millions of people, but many of us still do not have reliable information in this area. For example, some claim that these drugs provide only “artificial” relief. They believe depressed patients should solve their own problems and cope with depression, without any artificial means. Others argue that antidepressants do not allow a person to see the true source of their suffering. In response, I can say that depression is a disease and needs to be treated. If this is not done, the symptoms of depression can last for weeks, months, or even years.
Tags: depression, depression treatment