Depression’s Many Treatments

Therese Borchard over at Beyond Blue wrote about the disconcerting “either/or” artificial dichotomy that some researchers and doctors set up about treatments for mental conditions such as depression. Medications for depression are either evil and the root cause of all of society’s problems, or they are saviors and rescue people from a lifetime of suffering. Depression is either a problem with living and one’s life, or it’s a biological disease we simply don’t yet understand.

Psychiatrist James Gordon is the subject of the ire, because he’s promoting his new book over in a Newsweek interview suggesting that alternative treatment methods are the preferred treatment approach for mild to moderate (e.g., most people’s) depression. And that antidepressants should only used as a last resort — “There are better ways to do that than taking drugs, which have side effects and don’t address the underlying message that depression is bringing — that our lives are out of balance and significant change is necessary.”

Uh-huh. Yeah, right…

One would assume that before one suggests changing all of the best-evidence clinical guidelines for treatment of the most common mental illness, one might have a couple of meta-analyses or some large-scale clinical trials conducted with adults that show the effectiveness of the treatment program one is recommending.

Alas, Gordon’s research relies on a single published study on 139 war-ravaged teens, and another study “coming out soon.” And while I agree that many of the individual techniques might, individually, have research backing for specific areas, one might be a little more conservative in one’s opinion before suggesting medications are over-prescribed and everyone should just try his New and Improved treatment program. But you can see Gordon is more of a marketer than a researcher by this statement alone:

Individually, these techniques work at least as well as antidepressants for people with mild to moderate depression. Together they are likely to be far more effective.

Sorry, that’s not how research works. You can’t just throw together five of your favorite techniques and assume they will have some sort of magical power of multiplication to become ever more effective just by being combined.

Well, you can, of course, but you shouldn’t then make such pronouncements in national publications without actually having any relevant research data to back you up.

And what’s this misinformation still being regurgitated, and apparently, agreed with by a psychiatrist (who should know better)?

Newsweek: But people with depression do have imbalances in levels of neurotransmitters.

James Gordon: Some people do, I wouldn’t deny that. What I’m saying is that there are many ways to address those changes that do less harm and may be more productive in the long run because they give people the sense of control that comes from helping themselves.

Well, I would deny it only because science has already shown this theory to be incorrect and a useless simplification of brain processes. That Gordon doesn’t know this is telling.

But anyways, back to the point. There is no single method or single magical approach that is going to work for everyone. Cognitive behavioral therapy is not some cure-all panacea, and neither is Zoloft. And while Gordon’s approach may very well effective for some, it probably will not work for a significant portion of people. Why? Because no treatment in the history of depression treatments has ever found to be effective for everyone. None.

Depression is complicated and complex, just like the humans who experience it. It, like us, does not live in a world of black and white dichotomies. It is messy, it often has no reason, and it doesn’t always like to wake up in the morning. If not caused by some underlying biological condition, it definitely has a measurable effect on our brains. And what works for one person’s depression may have no effect on another’s. This is the nature of depression, like most mental illnesses, and has always been.

Dichotomies might be nice to sell a book or one’s new treatment approach, but it has little basis in reality — the data from the research and the front-line clinicians and people who experience these concerns.

We agree with Borchard — depression is very real and not only do drugs help many with depression, they have proven to be a lifeline for some. And while not an ideal treatment, they are one of the tools we have in our treatment arsenal and should not be demonized (or idealized).

Read the full entry: Don’t Get Stuck on “Unstuck”: Depression Is Real, and Drugs Help Me