Great Video on Understanding the Experience of Depression

When I saw this video, I wanted to hate it…but actually it was pretty good.


Video via Kaine DeBoer on Facebook.

In particular what I liked was that the experience was described very well, at least from my own personal experiences with feeling depressed. It also fits with how people usually experience their symptoms, which is as something happening to them, not something they are doing. This video also transitioned nicely from symptoms to proposed strategies for resolution, and one of those strategies in particular was really good in my experience – that of embracing the parts of me that I didn’t like and considered “other.”

There are many types of “parts therapy” like this, but the one I found most effective for my own depression is called Core Transformation. (Note: I work for the creator of this method and facilitate sessions of it as well.) I myself practiced this method hundreds of times before I achieved a full and complete resolution of any depression symptoms…which is pretty remarkable, because I had depression symptoms for years, and like this video indicates, often depression recurs or even gets worse for many people. That was just one of the things I did, but it was by far the most helpful.

embracing the black dog of depression

I also like that they mentioned that exercise has been shown as good for depression as anti-depressant drugs. (see “Exercise for mental illness: A systematic review of inpatient studies” and “Exercise for depression” for a couple of recent examples.) Of course that’s just saying that both aren’t all that good…but at least exercise has positive side-effects, unlike anti-depressants which often have negative side-effects and are notoriously difficult to come off of (if ever).

However, there are also a few things I didn’t like about the video.

One thing I didn’t like is that they didn’t mention how anti-depressant drugs don’t appear to be any more effective than placebo for all but the most severe cases of depression according to several meta-analyses:

Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration.”

Antidepressant Drug Effects and Depression Severity: A Patient-Level Meta-analysis.”

Conclusions
The magnitude of benefit of antidepressant medication compared with placebo increases with severity of depression symptoms and may be minimal or nonexistent, on average, in patients with mild or moderate symptoms. For patients with very severe depression, the benefit of medications over placebo is substantial.

Almost all people prescribed anti-depressant drugs have mild or moderate symptoms, which means they probably shouldn’t be taking these medications at all!

In this meta-analysis, anti-depressants seem to perform slightly better than placebo and equally as well as psychotherapy, and a combined psychotherapy and anti-depressant approach seems to work best: “A Systematic Review of Comparative Efficacy of Treatments and Controls for Depression.”

The authors of this study conclude that perhaps the most important thing may be to get people involved in their own treatment. That certainly seems better to me than simply passively ingesting a pill and hoping one’s life changes as a result. In fact, I tend to think that the opposite of depression is not a cheery optimistic mood, but a sense of personal empowerment, and that personal power shows up as taking an active interest in dealing with life’s difficulties and challenges.

Publication bias may also unfairly present SSRIs as more effective than they actually are in treating depression. See “Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy“. Indeed, there’s a lot of money riding on the idea that these drugs can make you feel better, and money can lead drug companies to shelve studies that don’t show their drugs as working.

The increasing consensus seems to be that SSRIs are no more effective than placebo for mild to moderate depression, but might have a significant effect for severe depression.

In terms of therapy, Cognitive Behavioral Therapy is the #1 most recommended approach to treating depression and has a lot of evidence to support it being more effective than other approaches. However, publication bias has almost certainly overstated CBT’s effectiveness for depression. (See “Efficacy of cognitive-behavioural therapy and other psychological treatments for adult depression: meta-analytic study of publication bias.“)

My personal experience with CBT for depression is that it was quite helpful in identifying my patterns of thought which were causing me to depress myself, but not especially effective in eliminating those patterns of thought. Having learned numerous much more effective techniques of personal change from Steve and Connirae Andreas, I see standard CBT protocols as still in the dark ages – using conscious, willful effort to try to change unconscious processes…a method that will never be as effective as just changing the unconscious processing.

In any case, depression is a big topic that I have a lot of thoughts about, and I think only a bio-psycho-social approach will really do the trick.

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  • olimay

    “…the opposite of depression is not a cheery optimistic mood, but a sense of personal empowerment…”

    Great explanation. If you don’t mind I’ll be using this way of communicating things from now on. It works even if people are bugging you about not seeming happy or cheery: “I can’t say I’m exactly cheerful right now with all these challenges, but I feel pretty empowered to deal with them.” (I’d prefer a less awkward phrasing, but I wanted to use “cheerful” and “empowered”.)

    • http://scientificgoals.com/ Duff McDuffee

      Feel free! In fact, it was my experience that I needed to learn to express anger before I fully recovered from depression, quite possibly because I “learned helplessness” from being bullied in my youth.