Following is the third segment of my interview with Dr. Ken Duckworth, the medical director of the National Alliance for the Mentally Ill (NAMI), that I was afforded through a blogger call hosted by Revolution Health. After this segment, I have just one more part (Part 4), which I will publish next Friday. Then we can move on to some other expert or fellow mental-health blogger that I will interview for this series, “How Do You Move Beyond Blue?”

I’m indebted to all the Beyond Blue readers who begged me to transcribe the rest of the interview, because Dr. Duckworth is certainly one of the most knowledgeable voices available today in the field of psychiatry. And, as I said in my first segment, he speaks in a language that even I can understand!
For Part 1, click here.
For Part 2, click here.
Here, then, is Part 3:
How can you find a therapist who is able to address your issues from a spiritual perspective?[Note Beyond Blue readers: I’m posting more on this topic next week, as I think it’s an important issue]
If you are looking for a Christian therapist, you have to go to a state where that is the culture, an active piece of the puzzle. Within Massachusetts, where I work, I get asked for referrals every single day for everything, because I’m supposedly an expert resource, and I spent my whole life doing this line of work. I don’t know of one Christian therapist in the state of Massachusetts.

Really? Wow.
I personally don’t know of one. Maybe there are some, but I’ve never come across one who self identifies. There are programs in Texas that I’m aware of. There are programs in many of the red states that have an active focus in this area. And that’s another interesting question … Does it have to be the core of your treatment, or just an integrated component to your treatment? And that, again, is another individualized question. It might be different for different people.
Yeah, one of the doctors I went to before I found my current Johns Hopkins doctor was a kind of New-Age guru. The plan was to wean me off my meds and pump up my meditation and service work to the poor. Ah, that didn’t work so well.
Meditation is good. Helping the poor is good. It’s all good. But what I would say, is that the danger of using that as a SUBSTITUTE for thoughtful, professional intervention does have risk. Again, not because I’m a psychiatrist and I need the work. But because people kill themselves with these conditions! And their lives can become ruined. And so you have to be really thoughtful about that. So you have to look at the symptom package that a person is presenting, and then try to integrate these other pieces.

Usually what I would do is have a person get the best treatment they can and be well for six months to a year—almost symptom free—integrating these other pieces into the puzzle, and then asking the question … do you think you’re ready? And slowly decrease these other interventions. Not quickly. SLOWLY. I’m talking about the way an airplane, when it’s in Las Vegas starts its decent to land in Kansas City. That’s how I visualize medications.
A lot of doctors do it much more quickly than I do. And I don’t know why that is because it seems to me if there are many, many neurochemicals involved in the intervention of these medicines, it’s prudent to be gentle in terms of your lowering the meds. I know this is a fairly common sense approach, but I have seen people stop medications quickly in the hopes that an alternative intervention would be helpful. And I just think you have to be very careful about that.
Six months to a year is usually the rough rule of thumb of when you can start to back off of some of your interventions. But many psychiatrists don’t measure symptoms in a formal way. They are going by their and their patient’s hunch, which isn’t necessarily a bad thing. If a person is sleeping well, and can laugh, and can concentrate enough to hold a job, and has an interest in sex, for instance, they probably aren’t going to meet the criteria for major depression. That’s the time to consider the conversation … “Gee, how long to you have to be on this? What side effects are you experiencing? Does the benefit outweigh the risk?”
What we don’t have in our field are a lot of long-term studies. That’s unfortunate but it’s true. We just don’t have them. And I think it’s difficult to know how long a person needs to be on a treatment. This is one of the great dilemmas in our field. So you’re on Zoloft to get better. Should you stay on Zoloft for the rest of your life?
How important is traditional talk therapy versus medication in treating bipolar disorders or depression?
Ahh. The term versus is the key problem with that statement. Basically, you don’t have to pick one or the other, unless you live in a rural area without access to talk therapy. Most of the studies show, and this is decades in the making, that the combination of talk therapy and medication is really best for most conditions most of the time. And this is everywhere from panic disorders to depression to bipolar illness.
In bipolar illness there is less of the literature showing that individual psychotherapy per se is helpful. But there has been a recent demonstration that with medication plus some of the more creative interventions–like social interventions (family psychoeducation) or cognitive behavioral therapy—people do better. In that study, they were on Depakote, and they did better with the psychosocial stuff than they did with an addition of an antidepressant. That STEP-BD study came out a few months ago, and I reviewed it on the NAMI website. On the NAMI website, we try to be pretty up-to-date on the big studies. And I do my best to summarize the greatest hits.
I guess what I would say is that there is a role for therapy. However, there are cases where therapy is not enough. What I find is that some people who respond to the medication can then use the psychotherapy better. They have more of a life force, and more access to their energy so that they can begin to self-examine their own thinking, and understand patterns of how the depression interferes with their relationships. But you can’t do that if you can’t get out of bed.
Again, there’s really no one size-fits-all. The question of who needs what kind of intervention is really an art. One of the problems we have is that many of the interventions are not available in different parts of the country. It’s difficult to get talk therapy in different parts of the country.
But I would say that if a person is having difficulty sleeping, has difficulty with appetite, if their body has slowed down, if they are having suicidal thinking, cognitive-behavioral therapy, or talk therapy are relatively unlikely to be able to intervene under those conditions. The sleep, the appetite, the lack of energy, the concentration—these are essentially biochemical byproducts of having a depression. And we wouldn’t expect talk therapy to make a massive intervention in a biochemical process.