Good Ways To Treat Depression: And Why People Don’t Do Them or Give Up Trying

Depression sufferers are often told to embrace what I call the three “G”’ Trifecta: Get therapy, Get on antidepressants and Get some exercise.

Each of these tactics has empirical support. So there’s a lot to recommend about them. But as I will discuss later, lots of people have a hard time embracing these approaches or sticking with them. First, let’s take a peek at what’s good and promising about these three treatment routes.

Why these approaches are Effective

-Therapy

Many studies show that ‘talk therapy” helps folks with depression. In particular, cognitive behavioral therapy; a form of counseling in which a psychologist compassionately confronts a depressive’s pessimistic thinking and tries to teach him or her more optimistic an productive ways of thinking about their. Research has shown that there’s a powerful connection between pessimism and depression: the more negative your thoughts, the more likely you are to get sucked down into the well of depression. Other studies show that lawyers are much more pessimistic than the general population. As such, CBT is a very good treatment option for many in the legal profession.

-Medication

Antidepressant medications are often an effective way to treat depression for lots of people. It seems to alleviate the brutal physical symptoms – – loss of appetite, inability to sleep and chronic fatigue – – so that one can benefit from therapy. It’s tough to get much insight from therapy when you’re feeling so crappy.

However, recent research has discovered that it often takes two or three attempts before the right medication is found that will relieve a person’s particular depression.

-Exercise

Sweating it out has been proven to lift not only one’s general mood, but alleviate depression. Probably the best book I’ve read on the topic is Spark by Harvard physician, John Ratey, M.D. who writes:

“Antidepressants are curious because we think we’re changing brain chemistry when we take them. The science shows us that exercise does the same thing. By exercising, we’re improving the brain’s plasticity. And while it’s hard to get depressed people to get up and move because, well, they’re depressed, you have to sell them on the value of it. Once they get it, they go with it.”

Why People Don’t Do These Things, or Don’t Stick With Them

If these remedies are so effective for so many, why don’t more people who struggle with depression do them, do them more often or stick with them?

– I Don’t Want to Talk About It.

There are lots of reasons why educated and intelligent people don’t go to therapy.  Here are a few of them:

People (lots of them men) don’t go because they just don’t want to talk about what ails them. Culturally, men are often not given permission to be vulnerable and emotive. There’s a limited range of feelings that the culture says are okay for men to vent: anger, irritability and humor. –

Sufferers sometimes can’t find the right therapist and give up.

Those around them do not believe in therapy. I know a lawyer with depression whose wife thinks therapy is a bunch of hand-holding baloney and a rip-off at $125 per hour (Buffalo rates, mind you). As such, he feels discouraged, doesn’t want to hear his wife complain about the cost and doesn’t go.

People are just too fearful of what the consequences would be if they admitted they had depression: “Will I lose my job?” As such, they often deny to themselves or others that something is wrong. – Procrastination: “Maybe it will go away”.

Shame: people feel they will be labeled “defective”, “weak” or “mentally ill.”

Or, for many, they just don’t know any better. The misery they endure is their “normal”. They can’t see how their maladaptive, pessimistic thoughts about life could be anything other than reality – – “That’s just the way life is.” They may even feel bitter when they see others having fun or being happy. They feel cheated. Why can’t I have more happiness in my life? They may feel that happiness is something doled out by the unseen hand of God or lady luck. However it is dished out, they’ve feel they’ve been given a pittance. Not surprisingly, they have no confidence that they have the capacity to create happiness within themselves. “No”, they think when they imagine to themselves that they have good things to look forward to, “That’s not how my life seems to turn out’. This disempowered state is a vicious circle that can only lead to more depression.

 -Antidepressants: The Flip of the Coin?

There’s a billion dollar debate going on whether antidepressants work or not. On one side of the aisle are the folks in lab coats – the bespectacled researchers who look at brain tissue through microscopes; pharmaceutical executives in blue suits who smoke big-ass cigars; and the psychiatrists – the high priests of all that ails the depressed mind – – who advocate taking medication to treat clinical depression.

On the other side are patients who swear that the meds did nothing to help their depression and just screwed them up and made them feel like zombies. On the other are holistic practitioners who believe depression isn’t caused by a chemical imbalance in the brain, but by lack of proper nutrition, diet and balance (check out Dr. Andrew Weil) and my psychiatrists who believe that medications, while useful, are over-prescribed.

There currently are no tests, other than trial-and-error, to determine what type or types of medication will prove effective for a particular person. It’s really trial or error. Our family owns a big fat rodent. Did I say he was really fat? Anyway, he is black and white and lives in a large cage in a back room of our house. The colors make him look like a magician in a tuxedo. Hence, his majestic name – – Houdini. I felt like Houdini when my psychiatrist tried different medications on me in a quest to get the right one – a lab animal in which he tried this and then that. Some were real duds; some outright blunders. But I stuck with it. And I’m glad I did because the “right meds” were eventually found for me.

People won’t take medication because of the stigma attached to it. Or, they give up on it before the right medication, dosage or combination is found. Even when the right one is found, folks often stop talking it because of the side effects. I know depressed lawyers who would rather drink or drug rather than take antidepressants.

-Why We Won’t Get Moving

People find it hard to exercise because depression screws up their ability to sleep leaving them unmotivated and just too tired to get to the gym. Years ago, when I first was diagnosed with depression, I recall being bone-tired at the end of a work day and falling asleep a 9 p.m., sleeping on and off throughout the night, getting up at 3 or 4 a.m., shaving, getting dressed and driving to an all-night coffee shop to slurp coffee, get ready for work and wonder “Just what the hell is wrong with me?” But I didn’t have any answers back then. In retrospect, truthfully, the only thing that helped me survive it was to keep walking.

Three Quick Things to get you on the Right Track

1.    If you’ve never been to a competent psychiatrist, remind yourself that you can just go for a consultation and hear what they have to say. Whatever their recommendation, you don’t have to agree with it or follow it. But why not get an opinion from someone who has treated hundreds of people with depression and could tell you whether or not you have it and what your options are? You can also get a second opinion. There are “Depression Centers” around the country where you can go for such a consultation and then return to your treating psychiatrist who can prescribe the recommended medication and monitor you. Bring a friend or family member to the appointment. Sometimes, when we’re depressed, we might not truly hear when the psychiatrist has to say. What does your loved one or friend think the doctor said?

2.   If you don’t want to go to a therapist, you really have to ask yourself why not. I usually recommend that people call friends to ask for recommendations for a couple of therapists. Go visit a few for a 1 hour consultation to see if you click with that person. Remember, if you give into your depression, you will tend to isolate yourself and “suck it up.” What you really need to do is talk to a therapist who has treated hundreds of folks with depression who can give you some ideas about whether you can benefit from therapy. A good friend can listen and give you their love and compassion. But, they can’t do what a good therapist can do.

3.   Make it easier to exercise. Here are three quick ideas. First, always keep your gym bag in your car – EVERY DAY. I’ve found that I’m much more likely to exercise at the gym, if only for 20 minutes, if it’s in the car. Second, don’t shave or shower when you get out of bed. Get dressed like you normally do for work and go get a coffee if you like. I find that I have to work out because I now HAVE TO GO to the gym if I want to get a shower and shave – it’s too late to go home now!

Up

 

The cure for unhappiness is happiness, I don’t care what anyone says – Elizabeth McCraken

Most folks describe depression as a weight they carry around: dumbbells lodged in their pockets that drag them down body, mind and soul into a stinking swamp.

There’s no humor in this bayou; no levity, no sense of the sweet exuberance life can bring. Instead, there’s a collapsing inward, an inertia in which we can’t imagine . . . well . . . anything good happening to us.

We have a yearning to be free of depression; a deep desire to cut our losses and spit in its eye.  It has cost us enough heartache – no more, we think.  We pine for a way out of it, but sometimes don’t know the way.

But if we are to recover, we need to think about a different kind of life for ourselves.  One where we take the “UP” to happiness escalator instead of the “DOWN” one to depression.

Imagining a Life without Depression

Envisioning freedom is part of the journey out of the dark woods.  So often, depressives imagine a future with uninterrupted bouts of depression.  This sorrow is what leads so many to a state of hopelessness. We need, with the help of wise others, to begin to imagine what our life would look like without depression and walk, step by step, that way. 

I used to say to my therapist when depressed, “Why am I being punished?”  It was as if I had done something “bad” and was a “bad person” (though I didn’t know and couldn’t articulate whatever that was) and now the Karmic Universe was going to dish out the punishment I thought I surely deserved. 

As depression author Dorothy Rowe writes,“Depression is a prison where you are both the suffering prisoner and the cruel jailer.”  Start to see, just a little bit at a time, that depression is not just happening to you.  It’s an inside job too. This took me years to learn. Our thoughts and style of thinking help create and sustain depression.  When we feed it with negative ruminations, it grows larger – like an algae plume. Withhold this noxious nourishment — and it can, slowly, wither away or at least become more manageable. 

Happiness Skills Can Help

Before even imagine the promised land of happiness, however, we may need medication to lift the more onerous physical symptoms of depression to give us enough focus and energy. No doubt, antidepressants aren’t the only way to do this.  Many have accomplished the same results with exercise, nutrition and/or psychotherapy.

In her book, The How of Happiness, Sonja Lyubomirsky, Ph.D., writes:

“Even the most the most severely depressed individuals can improve by doing a simple daily happiness-increasing exercise such as taking time to recall three things that went well each day.  Although the exercises are not designed to ‘cure’ depression, if you are depressed, trying one or more of these activities affords a strong chance of lightening the burden and darkness of depression and producing positive feelings.”

We can also look back further than just what went right on a particular day to increase our sense of happiness.  There is a powerful connection between how we view our past and present day happiness says Rick Nubert, Ph.D. In a study of 750 people, he found that highly extraverted people are happier with their lives because they tend to hold a positive, nostalgic view of the past and are less likely to have negative thoughts and regrets than their neurotic counterparts.  Howell says that while it may be difficult to change one’s personality to being an extrovert, he found that savoring happy memories or reframing past painful experiences in a positive light could be effective ways for people to increase their life satisfaction.

Other ideas offered up by Dr. Lyubomirsky include avoiding overthinking – a big problem for lawyers: “Very happy people have the capacity – even during trying times – to absorb themselves in an engaging activity, stay busy, and have fun.  To practice this strategy, pick a distracting, attention-grabbing activity that has compelled you in the past and do it when you notice yourself dwelling [on the bad stuff and your problems]”.  Check out her other ideas in her blog.

You deserve to be happy.  You don’t have to keep riding the down escalator.  While going up to the second floor, just wink and wave at your depression as it goes down into the bargain basement.

 

Newsweek Gets It Wrong: The Debate About Antidepressants

I yearned to get better; I told myself I was getting better.  In fact, the depression was still there, like a powerful undertow.  Sometimes it grabbed me, yanked me under; other times, I swam free. – Author, Tracy Thompson.

One study estimates that 19% – – or about 200,000 of this country’s 1 million lawyers – – suffer from depression.  This isn’t just some statistic; this is about people – folks who happen to be lawyers for one reason or another.

Just what are these people supposed to do about their depression?  Many if not most law students, lawyers and judges that I know have taken or are currently taking antidepressant medications. And they seem to be in the majority of people in this country who do so.

The ranks of the medicated are swelling.  The number of Americans taking antidepressants doubled in a decade, from 13.3 million in 1996 to 27 million in 2005. One in ten Americans are prescribed these drugs making them the most prescribed medications in the country.  By comparison, 18 million people take Lipitor for high cholesterol. 

The biggest reason lawyers take these drugs?  Like everyone else, they’re hoping want to feel better, but equally if not more importantly, attorneys want to return to their pre-depression levels of productivity at work.  A profession that doesn’t suffer fools well and demands a lot out of mere mortals.

But is medication effective in treating depression and achieving this objective?

Late last week, I was walking down an icy sidewalk minding my own business.  I could see the usual cast of characters in my peripheral field of vision; clusters of lawyers yucking it up on their way back from lunch, a judge lost in his own thoughts and a corporate lawyer I know (not particularly well) who once told me privately that he takes antidepressants, his lawyer wife  did as well and  five other lawyers in his firm did.  I guess he felt comfortable telling me this because of my public disclosure about my own struggles.  I often feel like a priest in a confessional; I hear about lawyers most private of struggles.  Then, like such disclosures never happened, the curtain is opened and we each walk our own ways.

Walking by a newsstand late last week, I noticed the current cover story of Newsweek Magazine which read, “Antidepressants Don’t Work:  The Debate Over the Nation’s Most Popular Pills”.  The large print seemed to stick a proverbial finger in modern psychiatry’s eyeball and toss the question –along with people who suffer with depression- up in the air. 

The article focused on a recent study which concluded antidepressants essentially worked no better than placebos (sugar pills).  Oh, just great, I thought. What am I, who have taken medication for the past eight years, supposed to do now?  Start popping M & M’s instead of Cymbalta?

The writer of the Newsweek piece concluded

“If placebos can make people feel better, then depression can be treated without drugs that come with serious side effects, not to mentions costs.”

This conclusion is the latest in a long line of recent books leading the charge against the use of medication to treat depression. Charles Barber, in his book Comfortably Numb: How Psychiatry is Medicating a Nation, argues that antidepressants are doled out like Halloween candy in this society.  The motive: the big money made by the pharmaceutical industry.  This is an appealing take because Big Pharma is commonly portrayed as the villains in the popular press; guys in black hats and white lab coats stuffing greenbacks into their pockets.

In an article written for Salon, Barber wrote:

“One has to wonder:  Are we really that miserable?  Manipulated might be a better word for the miserable.  If we were to pick one factor that explains the dramatically increased number of antidepressants that now runs through our collective bloodstreams, it would be direct-to-consumer advertising, otherwise known as television commercials for drugs.” This point is well taken, but not surprising.  Pharmaceutical companies are in the business of making money.  Does such a motive make Lipitor any less effective?  Should commercials about it deter us from taking this drug?  I don’t so.

In fairness to Newsweek, they ran an accompanying piece which tried to give the other side of the coin.  It was penned by psychiatrist, Robert Klitzman who framed the question about the study’s conclusions in this way:

“What should we make of the [study]?  First, some facts: antidepressants have been shown to work for serious major depression.  Most evidence shows they are effective for dysthymia: milder but chronic depression that continues for two years or longer.  The question is whether they work for milder depression that may be shorter or less intense.  That’s important, since major depression affects almost one out of five people [in this country] at some point in their lives.  And most people with depression do not have severe forms of it.”

The response to Newsweek’s take on the study was sharp and quick.  In an Op-Ed in the New York Times, Judith Warner wrote this biting retort:

“Happy pills don’t work, the story quickly became, even though, boiled down to that headline, it was neither startling nor particularly true. Yet in all the excitement about ‘startling’ news and ‘sugar pills,’ a more nuanced and truer story about mental health care in America was all but lost.  The story begins to take shape when you consider what the new study actually said:  Antidepressants do work for very severely depressed people, as well as for those whose mild depression is chronic (dsythymia). However, the researchers found, the pills don’t work for people who aren’t really depressed – people with short-term, minor depression whose problems tend to get better on their own.  For many of them, it’s often been observed, merely participating in a drug trial (with its accompanying conversation, education, and emphasis on self-care) can be anti-depressant enough.”

As the article also points out, most people receiving antidepressants aren’t getting them from well-trained psychiatrists, but family doctors who don’t screen well for depression. One wonders how much training they get on  how to probably diagnose depression and whether they can keep up on all the research on the topic.  The result: we are, in some sense, an overmedicated nation; a country too quick to give sad or unhappy people pills that they shouldn’t be taking and don’t need. 

That conclusion, however, does not mean that these medications don’t work for many (though not all) people suffering from true clinical depression.  My take is that a family doctor who treats urinary tract infections and constipation shouldn’t be doling out Lexapro to a patient that he has spent 5 minutes with. Perhaps the problem isn’t just pharmaceutical companys bent on making a quick buck, but family doctors under managed care who don’t have any time to spend with patients and don’t know much about depression and the various medications used to treat it.

People feel ashamed and stigmatized by going to psychiatrists, but it could be a game-changer for many:  either you don’t have depression and shouldn’t be on medication or you do and you could finally get relief from some of depression’s more devastating symptoms.

There is no doubt that exercise, psychotherapy and some form of community and support will help people whether they are suffering from some transitory upset/sadness in their life (by the way, this helps people with depression too). However, for many people afflicted with clinical depression, it’s unlikely that they will have a real shot at containing or overcoming their depression without short-term or long-term use of medication. They won’t be able to muster the energy, commitment and motivation to engage in the other healthy stuff; to go for a walk, to work out their distorted and negative self-beliefs about themselves with a good therapist or join a support group.

Depression has a terrible undertow; its riptides are often unforgiving.  We need as many weapons in our arsenal to deal with it. People with transitory sadness or disappointments don’t need to become patients; they need to connect with other people or change their lives – maybe both.  Therapy or just working it out by themselves with supportive friends and family may be all they need.

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