• Quote of the Day
    "I was always looking outside myself for strength and confidence but it comes from within. It is there all the time."
    Anna Freud, posted by Daniel

Cin

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The therapist iam currently with, recently revealed to me that he adementally believes that every type of depression has a cause and is not down to biological causes what so ever. He argues that depression cannot be treated by a pill (which i agree with), but that therapy is needed for all cases. I persoanlly disgree with this to a point. Has anyone got any views on this? I would love to hear your replies.
 

David Baxter

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I have to say that his opinion is contradicted by the available research.

First, this research tells us that treatment of major depression is more effective with a combined approach using medication and psychotherapy that with ewiyther medication or psychotherapy alone.

Second, the benefits of medication as a treatment do not require that the depressive episode is "caused" by biological factors. In many cases, it isn't possible to determine whether the imbalance in neurochemistry causes the depression or whether the depression causes the imbalance in neurochemistry. However, the two co-exist so either way part of the treatment requires that the neurotransmitter levels be restored to normal limits.

Third, the best guess is that certain people have a vulnerability to depression, perhaps for bilogical/genetic reasons in some cases, for reasons having to do with diet in others, and for reasons having to do with life events and developmental history in others. There is probably not one single cause for depression. But either way, the most effective treatment will involve the use of medication AND psychotherapy together.
 

Nigel H

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Causes of Depression

Hi Cin

As the good Doctor says, it is a hotly debated subject and there are many schools of thought on it.

I personally go for the 'mind running the body' argument that would dictate that the neurotransmitters measured and then treated with drugs are caused following mental thought processes and hence by dealing with the thoughts causing the depression the chemical imbalance will right itself.

I know many people who do work with depressed people and we get such good results with this methodology. I also think it may often come down to what you believe, since we are all suggestible beings.

One reason I prefer to work on the Mind being the cause is that it puts the individual back in control - whereas if it is a chemical biological imbalance at the cause they perceive there is nothing they can actively do - "after all it is just my biology mucking me up ......."

If the person created the problem at an unconscious level (NOT deliberately) then this gives them power to un-create it, with the right help.

All the best

Nigel
 

David Baxter

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As I said previously, one doesn't need to get into the issue of what causes what at all to determine the most effective treatment.

There may be debate about the nature and causes of depression. That doesn't alter the fact that the consistent finding in research on treatment of depression is that the most effective and enduring treatment of depression involves the use of BOTH medication and psychotherapy, especially cognitive behavior therapy. It really doesn't matter what theoretical biases you or I or anyone else might bring to this debate -- those empirical data speak for themselves.
 

Heather

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Nah I don't agree, there are biological causes as well but the other is true as well and as much as I do not agree that giving someone a pill will fix depression I do believe it helps but you need more than just that but it certainly helps.

Just my opinion.

Heather...
 

David Baxter

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I don't think what you just posted and what i just posted are in disagreement at all, HJ. I think we're saying the same thing.
 

Nigel H

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David - I was about to disagree with you and then thought to hold my comment. Whilst browsing I found another thread of yours with the following note:

DO MEDICATIONS WORK?
It is important to recognize that medications most often manage, but do not cure psychological problems or mental illness, as is the case for other types of physical problems. For example, if you have an infection and take an antiobiotic, the infection typically goes away. However, if you have diabetes, you may need to take insulin for the rest of your life.

Most medications for psychological problems or mental illness do not cure the illness but relieve it and make it easier for the person to manage, often with the help of psychotherapy. As mentioned, there are some mental illnesses for which mediations are very necessary (schizophrenia and some depressions for examples). Research tells us that medication and psychotherapy work better than either medication or psychotherapy alone in managing some types of psychological problems. Some types of problems might even be better managed with psychotherapy alone.

My own feeling is that sometimes pure medical doctors prescribe drugs too easily because they do not have the necessary network of therapists to refer to for situations where it would be relevant. It may work differently in the USA, but in England this happens all to often. Many people do not need or want the drugs, but would rather work with someone to help them through the issues. Drugs can just 'mask' the symptoms and as you have said, not offer a cure. I hope that one day the medical profession will start listening to those therapists that are getting good results with so many different problem issues, to allow a free flow of information, without so many boundaries as exist today...... this will help those suffering, which is all our ultimate goal surely.

Best regards

Nigel
 

comfortzone

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Nigel,

I have a large number of clients who were incapable of understanding the words I was using with them because their minds were overwhelmed by the symptoms of depression. They were seen by their doctors and were subsequently able to hear what I saying to them. (One client told me that when she was severely depressed that what people said sounded much like the teachers did on Charlie Brown cartoons).
Then they were able to explore their issues and were able to explain how they felt. I have a client who does not want to go to school, or anywhere for that matter...she could not focus on the words I was saying. Thus, I recommended that she go to her doctor to obtain medication to treat her severe depression. The medication will help her to received the needed therapy.
 

David Baxter

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I'm not sure where that post is but it was most likely an article written by someone else - the citations and link back to the original article will be in the post - rather than necessarily expressing my own opinions.

Either way, note two things even in the part you just cited:

Research tells us that medication and psychotherapy work better than either medication or psychotherapy alone in managing some types of psychological problems. Some types of problems might even be better managed with psychotherapy alone.
Note it says "some types of problems" - my personal belief is that MOST instances of depression are better treated with both medication and psychotherapy. That doesn't mean that I bully or pressure any client into taking medication if they are uncomfortable with that, but I will let them know my opinions on the issue and i will tell them about the research findings on efficacy.

there are some mental illnesses for which mediations are very necessary (schizophrenia and some depressions for examples).
That in my experience is absolutely true - there are some depressions that will not respond to psychotherapy alone and there are some people who suffer from depression who absolutely require medication as part of their treatment.

Drugs can just 'mask' the symptoms and as you have said, not offer a cure.
I don't think they "mask" symptoms. However, if the depression is caused by a life situation (relationship, work, other interpersonal issues, unresolved historical issues, etc.), it's hardly reasonable to expect medication to do the whole job. For example, if feeling trapped in your relationship or your job is triggering depression, medication isn't in itself going to change the job or the relationship and sooner or later that issue will need to be addressed.
 

Cin

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In my opnion, drugs can only be detrimental to the patient if they are mis-used, for example; given out and not monitored or supervised, or the patient misusing the medication themselves. I do agree that in the UK, there are good and bad doctors (as is everything in this world); some that don't care and some that do and will supervise your treatment adequately.
In some cases medication does pave way for therapy to take place. It depends on the individual and how thier case is treated. There are so many people out there with depression who are drugged up to thier eyeballs because they are taking what the doctor is giving them, which in turn sometimes makes therapy usless by the time they get it. I just think that both treatments can work along side each other, and are most effective in certain cases when used properly.

I dont mean to sway the conversation, but i wanted to know your thoughts on the idea of going the other way,i.e. putting forward the idea that some therapists are capable of finding "causes" to the depression which may not possibly be there? And disproving them?
 

comfortzone

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Hi Cin,

It has been my experience that most of my clients are not over medicated. I would say there are a few who have some difficulties but many times it is due to a missed dose or infrequent use. I did have one client who was over medicated but thankfully her doctor listened to reason and discontinued that medication.

I am not quite clear on the last couple of questions. Please provide more details. Thanks...
 

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