I Have My Doubts About Treatments for Depression

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Reader’s Question

How do I go about treating depression? In the morning it takes immense effort for me just to roll out of bed. Every day there’s not much I’d like to do, and I feel like sleeping more because I’m still tired. Usually I just play video games; they’re sort of my retreat from reality but even they don’t help much anymore. I have very little pleasure in anything, and it feels as if I’m just going along for the ride in life; like I’m just viewing a movie on the big screen. It’s so bad that I don’t even feel any pleasure sexually: there’s just no feeling at all. I don’t know what to do, so I’m asking you. What should I do? I know that the usual course of treatment is therapy and anti-depressants. But I have serious doubts about their effectiveness, and concerns about the side effects of medication.

Psychologist’s Reply

You have listed some symptoms that certainly can be part of depression, such as the loss of interest in formerly pleasurable activities (anhedonia), fatigue despite enough or even too much sleep, and sleeping too much (hypersomnia). Sad or irritable mood, difficulty concentrating, excessive guilt, and appetite or weight changes can also be part of depression. To determine whether you have what would qualify for clinical depression, it would be best to meet with your doctor or a mental health specialist.

He or she can also talk to you about your concerns regarding what could help. It seems as if you are ambivalent about pursuing treatment. You mention that medication and therapy are the most common treatments and you are right, but you also mention that you do not want to seek treatment. Your concerns about the effectiveness and side effects of medication are very common. Sometimes people find that the benefit they receive outweighs the side effects, but this is a personal decision.

With regard to the effectiveness of therapy, you may already know that there is a movement within psychology to do empirical research to obtain evidence regarding therapies that ‘work,’ or are effective. The therapies that are supported by this research are called ‘evidence-based’ therapies or ’empirically-supported’ therapies. In reality, this does not mean that other types of therapy do not work as well, only that they have not yet been supported by research. But because you are skeptical about the effectiveness of therapy, you may feel more confident embarking on a type of therapy that has some ‘evidence’ behind it. A caveat is that just because a therapy is empirically supported does not mean it will work for everyone. However, it may be a place to start.

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Two such therapies are Cognitive Behavioral Therapy (CBT) and Interpersonal Therapy (IPT). Cognitive Behavioral Therapy is a process of becoming an investigator with regard to your own thoughts, behaviors, and feelings, and engaging in experiments to see what behaviors and thoughts you can choose in order to improve your mood or feelings. One example of what you might do in CBT is rate your mood (e.g. from 0 to 100) prior to an activity that you think might be fun or pleasurable, such as video games. You would then engage in the activity and rate your mood after. If you find that your mood is the same or worse, you would then work to find other activities that resulted in a higher mood rating. In addition to identifying behaviors or activities that improve mood, you would work with the therapist to identify patterns of thinking that contribute to depression. If you were to approach depression as a problem to solve systematically with your therapist, you might find that you can actually make choices regarding thoughts and behaviors that will result in improved mood.

Interpersonal therapy, on the other hand, is a treatment that focuses on the interpersonal or relationship issues that can be components of depression. Although relationship issues do not cause depression, they may continue or worsen depressive symptoms. So with IPT, you might work with your therapist to identify interpersonal events such as conflicts, changes and losses that have contributed to depression. Over the course of a short-term therapy (e.g. 20 sessions or fewer), you would work to resolve issues and increase your social adjustment.

I hope I have given you a bit of information about what you might encounter if you were to pursue treatment for depression. Remember, diagnosis is the first step. A thorough physical exam and discussion with your doctor regarding what you are experiencing and for how long will be a first step to finding the right treatment.

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