CBT and/or Medications for Depression?

Reader’s Question

I am and have been depressed for years now. I don’t know how long it’s been. It seems to come in spurts but at the same time it really never ends. I started really paying attention to my moods some months ago. I would watch myself go from feeling great and beautiful one day, the next day, unsure how I felt about myself and my image and feeling kinda iffy, then the third day, not even wanting to get out of bed or answer my phone. The third day meant that I was there. Full blown depressed. I would try to backtrack and see if I could figure out why I felt so horrible. Why I did not want to talk, see anyone, cook or clean. I barely wanted to take time out for a shower. My hair would be a mess, the house ridiculous, for no reason whatsoever. I resented every moment. I would get angry when I felt tired because I did not want to go to sleep.

I struggled through college for two years and did great. When I say I struggled, I was severely depressed the entire time. I noticed it get worse as semesters went by. By the last two semesters, I was on another level of depression. It was something new and I really knew that I was not okay now. I noticed that my thoughts would be interrupted by other thoughts and on and on again. I would think about what I was going to do next and the thoughts would keep going to the point that I would feel physically and mentally exhausted and I would find a quick resting place and sleep. I had a terrible time focusing on the smallest tasks. I don’t know how I graduated with a 3-point-something GPA. I really don’t know how.

I graduated about 9 months ago. Since then, I have gotten terribly worse. I can’t focus for long periods of time on anything. I sleep and never really feel rested. My thoughts wear me out. My emotions are all over the place. I can’t get anything done. As soon as I start to make plans for something, anything — job hunting, cooking, cleaning, you name it — I get stressed and my breathing becomes shallow, and every task is an impossible one. I was not like this before. I was the most positive, loving, talented, creative, hard working, determined person. I don’t know what happened to me. I have gone through agony in silence for years because I didn’t know what it was. To me everything and everyone was the problem.

I had recently gotten to the point where I thought that I should consider medication. I have lost weight recently, and I have been so on edge, I can’t calm myself down unless I am asleep, and my moods swing like crazy. I find myself doing normal things like watching TV, or conversing and I can hear something or see something and my mood will switch immediately as if someone turned off the light. Really that fast. I realized this about maybe 2 months ago (how my mood is affected by things around me and it really shouldnt be). Although I realized this, I didn’t know the next step.

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I accidently came across a site about CBT. While reading about it I began to cry because I knew that I had found an answer. I had never heard about it at all. I was very afraid of taking meds and I would rather not still. From what I read, it’s short intensive therapy and usually has great results. Why havent I heard of this before? Why is it that we see so many commercials for antidepressants and nothing about therapy where drugs don’t have to be introduced?

I do believe that my way of thinking has changed due to some traumatic event that I experienced. I’m not sure exactly which one, but my mom suddenly died some years ago and it was traumatic for me. I really did lose my mind and broke down for a short time when I received the news. Maybe it was when this happened? I don’t know, but I really do feel like CBT may be what I need to improve my life and get out of this rut that I have been in. I know that I am still talented and creative and I have the ability to achieve my goals. I have some dreams, I do. I feel better today than I have in a long time because I made an appointment with the therapists at the CBT clinic and I am going to give it all I have. I really need my life to be normal again. I want balance. I have lost that. I know its going to take some work, but I am ready to try.

Can you tell me if drugs are usually apart of CBT or not?

Psychologist’s Reply

The best way to recover from a long-standing, moderate-to-severe depression is a combination of antidepressant medication and CBT/therapy. As you describe, severe depression creates a combination of physical symptoms (fatigue, thought racing, mood swings, appetite/sleep problems, poor concentration, etc.) and problems with thinking/attitude. For effective treatment and recovery — both sides of depression must be treated. CBT is an effective treatment for depression that is made more effective when combined with the use of an antidepressant medication. I’d recommend reading two handouts on my website entitled Understanding Depression and Chemical Imbalance at www.drjoecarver.com. You might also contact your family physician who can refer you for medication or provide an antidepressant. Using both, I think you’ll see light at the end of the tunnel.

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