By Dr David Laing Dawson
I recently had a request from a woman suffering from depression who is seeing both a psychiatrist and a psychologist. The psychologist is focusing on the woman’s relationship with her mother when she was a young girl and I was asked what I thought of cognitive behavioural therapy. This is my reply:
We are complicated creatures and I don’t have a simple answer to your question.
Depression, serious depression, something we used to call “clinical depression”, meaning beyond simple sadness or grief, and usually involving physiological dampening (energy, appetite, sleep, slowed speech and thinking) and even cognitive changes (I described those in a recent blog) is an illness.
The first and most important treatment is medication. We have many of these now to choose from and the choice can be guided a little by science and mostly by clinical experience. If the depression is accompanied by high anxiety (we used to call this agitated depression) then the SSRI meds work well: Cipralex, Zoloft etc. If the depression is more of a flat, can’t get up kind of depression, then the medications with some stimulant quality may work better: effexor, wellbutrin (buproprion). Sometimes a combination works best.
It has long been known that depression can follow a serious viral or bacterial illness, and now it appears this may be because of the bacteria and the antibiotics used changing the gut flora and eliminating all the good serotonin producing bacteria. And it is much more likely this or current events in life trigger a depression than something from distant childhood.
In a state of depression though, our brains dredge up all the things that we have felt guilty about, or angry or aggrieved. These are not necessarily causative, but merely associative, something like thinking about all the previous good times in a current good time, and thinking about all the previous bad times in a current bad time.
But certainly a professional counselor – supportive, non-judgmental and wise – is an important part of treatment and recovery. The actual conceptual foundation for that therapy is not important, providing it does no harm.
Now one of the ways therapy can do harm is to “create memories”. There is no such thing as a “repressed or blocked” memory of significant events. That is not how memory works. We may choose to never think about, dwell upon, or address or talk about something significant but we don’t “forget” it. We may retain accurate memories of a few words, an emotion, the outline of an event, but all the rest is re-created, and re-invented as we talk about it. It is very easy for a therapist knowingly or unknowingly to create false memories in a patient. Surprisingly easy. And very easy to shape a memory into something far more significant than it really is.
Now basic CBT is okay and merely a complex version of “thinking positively” or as the AA people call it, getting rid of the “stinking thinking”. And it is based on the notion that our ways of thinking and the words we use affect the ways we feel. A crisis can be an overwhelming problem and hopeless, or an opportunity.
So give yourself time. If you like your therapist and she or he is not rigid in their philosophies and techniques, stay with it. But mostly talk about people and events in your life in this decade.
Work to find the right medication. Keep balance in your life, adequate good sleep, good diet (there may be a role here for probiotics), exercise, music, routine; maintain all your important and good relationships. You will get well.