For most of us, our mood varies. Sometimes we are happy, sometimes we are sad. If we are consistently sad we can find ourselves demoralised. Eventually we feel disengaged from life, and can no longer be bothered doing things. We become withdrawn and lethargic. We have become depressed.
Being depressed is not pleasant, and if you ask most depressed people, they do not want to be depressed and want to feel better. The question is, how best to achieve that?
There are two relatively quick strategies’ that are heavily promoted these days. Antidepressants and cognitive behavioural therapy (CBT).
Antidepressants are a form of medication prescribed by your GP. Despite the name, they do not treat the depression; rather, they treat the symptoms. As a quick fix in treating depression, they are as quick as you are going to get. If you will react well to the drug, you can expect the full benefit after 8 weeks or so. I say ‘if’ advisedly. Antidepressants are powerful drugs, but their effectiveness is, on average, barely higher than the placebo effect. Some people do respond well to the medication. However some people, whatever they are prescribed, fail to respond to medication.
Antidepressants also run a long list of unhelpful side effects, including increasing your risk of suicide dramatically.
CBT is a little slower in getting results. Expect treatment for depression to take a little longer, say 16 to 20 weeks. CBT for depression usually combines two strategies. The first is to gently increase your activity levels. Depressed people often stop doing fun and rewarding things. Reintroducing such activities is one of the quickest ways of lifting people’s mood. The second is to monitor and change the automatic negative thinking about self, future or the world that often accompanies depression.
There is some evidence that antidepressants combined with CBT gets the best results. In theory the antidepressant treats the symptoms, and the CBT treats the underlying cause.
In my experience as a Manchester therapist who treats depressed clients regularly with CBT and other strategies, sometimes CBT is not enough. There are a small but significant proportion of people whose depression does not respond to the quick approaches. We need to reflect a little to understand why.
Depression, for many people, is not so much an isolated event, but something they have experienced, on and off, all their lives. Some people are so chronically depressed they simply cannot recall a time in life when they were happy. ‘Treatment failure’ with CBT and antidepressants can often add to their despair, and confirms their belief that ‘nothing seems to work’. Depression, for these people, is a way of life.
Sometimes such people need to engage with several therapists over many years to gain the insight to transform their worlds into something more positive. Therapy for such people needs to be patient, creative and long term.
Unfortunately the needs chronically depressed people are not served by the ‘fix me quick’ culture engendered by CBT and antidepressants. It does them a disservice to suggest their lifetime of suffering is somehow equivalent to someone who has enjoyed a lifetime of good mental health and only started having problems recently. Both people, of course, deserve to be treated appropriately. It is a shame in the NHS to see a reduction in the number of therapists working long term with clients. Not everybody needs long term work, but for those that do, it should be made available for them.
Dr Phil Tyson is a Men's Psychotherapist based in Manchester in the UK. He offers:
- Cognitive behavioural therapy (cbt) for men in Manchester
- Counselling for men in Manchester
- Psychotherapy for men in Manchester
- Telephone and Skype counselling for men wherever you live
- Supervision and consultative support for therapists in Manchester
- Mediation for employment disputes in Manchester and the UK