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Is There Some Way To Deal With Depression Without Meds?

Question:

I have had more and more suicidal thoughts lately and i think i am severely depressed but I don’t want to take meds. i feel like they would warp my brain or change me. My sister takes 11 pills a day and is a zombie. I don’t want that. Is there some way to deal with depression without meds? i really need help finding my way through this.

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  • Dr. Dombeck responds to questions about psychotherapy and mental health problems, from the perspective of his training in clinical psychology.
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Answer:

Depression is a funny sort of illness. It certainly has its biological aspects, but at the same time, it is not a purely biological problem. How you think; how you make sense of your world and the events that happen to you affects your mood in profound ways and can cause depression. Once you are depressed, you can generally get some relief from antidepressant medication (although the latest research suggests that you may need to try multiple medications before you happen upon the best one for you), or you can get relief by learning new ways to cope and to think about your depression in the context of psychotherapy. Depression is thus both a biological problem and a “mental” problem at the same time, and can be caused and fixed by either biological or psychological experiences.

Psychotherapy in general can be a source of effective depression relief, but in recent years, there have been some very specific and focused types of psychotherapy developed specifically for treating depression. These specific types of therapy have been scientifically tested and have been shown to produce very effective and long lasting symptom relief.

The two types of therapy to ask about are known as Cognitive Behavioral Therapy for Depression, and Interpersonal Therapy for Depression. These therapies take different approaches to helping people feel better, but both are worthwhile and known to be effective.

Cognitive Therapy is probably easier to find than Interpersonal Therapy. In cognitive therapy for depression, you learn how thoughts influence emotions, and how to “talk back” to and alter habits of thought that you might have that work to keep you depressed. Cognitive therapy is a very “here and now” practical approach to therapy. The therapist is more like a teacher or coach than a traditional analyst. In this therapy you will work together with your therapist to identify cognitive errors and biases that warp your perspective in a negative direction. Once you have learned how to identify your biases, you learn how to argue with them and to “reframe” them so that your finished thoughts are more reality-based and objective. AS you learn to take control of your thought processes, you also naturally tend to become less depressed. because this therapy works to change the way you cope with depressive thoughts and events, it is long lasting in its effects. You tend to stay less depressed for longer after taking this therapy as compared to, say, taking an antidepressant medication and then stopping it and seeing how long you remain feeling good.

Interpersonal therapy for depression is more “old school” (e.g., psychodynamic) in nature, but really no less effective than cognitive therapy in terms of helping people to become less depressed. The basic idea of interpersonal therapy is that people become depressed when they see no way to manage the interpersonal demands they experience from those around them. The demands may be perceived only and not actually really happening, but are nevertheless felt to be happening by the depressed person. In interpersonal therapy, you and the therapist talk about how you experience your relationships (real and imagined). The therapist helps you to reality-test; to test out the assumptions you may have been making about how your relationships are constituted, and helps you to see and act upon opportunities to alter your relationships so that you are in a stronger more assertive and more insightful position. As you learn how to make peace with your relationships (real and imagined), you naturally tend to start to feel better.

If you want to explore non-medical opportunities for depression treatment, these two therapies are your best opportunities. Keep in mind that these are special therapies that have been “manualized” to one degree or another. They have been specifically studied for how well they can help depression, unlike many other more generic types of therapy. Not just any therapist out there knows how to do them right. You will need to find someone who has had specific training in one or the other approach in order to know you are in good hands.

The best way to find a therapist is to ask someone you trust for a referral. If you can’t do that, there are searchable registries available that you can consult to help you locate a local provider. Mental Help Net offers one such registry here, but another good registry is available at psychologytoday.com. A list of trained cognitive therapy providers is available here.

There are some other very powerful non-therapy things you can do to help lift yourself out of a depression. Working out vigorously for extended periods of at least 30 minutes multiple times per week can have an anti-depressant effect (assuming you are healthy enough to do so safely). Finding ways to distract yourself from depressive rumination can be effective as well. One of the best non-therapy-non-medical ways to improve your mood is to make it a point to get out and spend time with other people who are not depressed. Socialization helps to take your mind off your problems and provides people with the human contact and support they need to function well. Left to their own devices, depressed people tend to isolate themselves and deprive themselves of company

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