There are many effective types of psychological depression treatment. However there is little understanding in the lay community about the causes and treatments for depression. Many individuals have fallen under the impression that the best treatment for depression is pharmacological. However, the medications that are available for depressed individuals are less than ideal. They have a number of side effects, and recent meta-analyses show that they may not be as effective as previously thought. In fact, in most cases they are no more effective than placebo.
The entire idea for modern antidepressant medications comes from the presumption that there are certain biological chemicals (neurotransmitters known as biogenic amines) that are missing in depressed people. This is what your psychiatrist means when he tells you that your depression is a brain disease caused by a lack of serotonin or norepinephrine. The problem with this idea is that it is incorrect, as has been disproven for quite some time. The medications based on this presumption seemed to work, though, and so they kept making them in spite of not knowing why they work. To this day many of the psychiatric medications that you will find are not based on any modern theory of neurochemistry.
For example, when you start taking a new antidepressant your psychiatrist will tell you not to expect any results for at least 4 to 6 weeks. However, immediately after you start taking that medication, literally within just a few hours, it will have already done what it was designed to do. It will have already increased your level of the target neurochemical. Now some of these drugs target serotonin, some target norepinephrine, some even target dopamine, but the fact is that within a few hours of taking that medication you will already have elevated levels of that target neurotransmitter. Nobody is exactly sure what's happening in the ensuing weeks after you begin taking medication that starts to alleviate the symptoms of your depression. But we suspect this is caused by another process in your body's adjustment to the medication.
All this is really fairly irrelevant, because we now know that the medications don't really work that well after all. Most of the reason why anyone thought they worked very well was because the pharmaceutical companies paid a very a lot of money to produce a very a lot of studies in order to find studies that have positive results. Any scientist can tell you that if you perform enough studies, sooner or later you'll get one with positive results. The odds are simply in your favor, the more studies you perform. The problem has been that only the studies with positive results were getting published. Now that the unpublished study results are starting to become available, we now understand that this has been the case all along.
So the bottom line is that there should really be very little trust for modern psychiatry in spite of its claims to evidence-based practice. Granted, there are certain medications that do seem to be effective. For example, medications for bipolar disorder. However, in my opinion, these medications are not any more effective than appropriate psychotherapeutic interventions and by appropriate I mean therapeutic interventions which specifically target the symptoms and causes of those symptoms of whichever psychiatric or psychological disorder you're talking about.
So in the case of depression treatment, we can say that we should not be trying to treat the depression. As I have mentioned in the previous article, we should instead be trying to treat the patient, to understand why it is that they are malfunctioning, why it is that they are not properly adapted to the present situation, and what meanings their maladaptation holds for them.
I actually believe in the idea that there are chemical differences in a depressed brain vs. a nondepressed brain, but I don't think that there is any specific nondepressed chemical profile. I think it is specific to the individual and I think that the chemicals that the brain is using are based on the needs of that individual and their specific internal and external environments. So in order to truly enact change at the chemical level. We must find the correct psychotherapy, which will enable the individual to naturally adapt to their circumstances. That is in fact the entire purpose of psychotherapy, whether it be treatment for depression, bipolar disorder, schizophrenia, or any other diagnosable disorder.
In future articles I will discuss specific types and subtypes of depression, possible ways to classify them, as well as the diagnostic criteria for depression and the types of available treatments for depression.
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