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Beyond Blue

Thanks to Beyond Blue reader, Ellen, who wrote this on the combox to my post “If Your Depression Is Triggered By Stress, Should It Be Treated With Medication?”:

Surely if a depression is caused by stress, the first step should be to look at the stresses in a person’s life? That’s just common sense. To say that medication is just as likely needed as not just seems ridiculous to me and pandering to a drug industry in whose interest it is to medicalise all human problems. I have a real problem with that.

I agree with you to some extent, Ellen. I do think the starting point is to look at the stresses in a person’s life, and you’re right sometimes medication is doled out prematurely. 

I think you all know where I stand with regard to medication and depression. I believe medication is a tool that allows us to do the hard work of psychotherapy, meditation, and cognitive-behavioral therapy. I believe for such illnesses as bipolar disorder and schizophrenia, it is irresponsible not to take meds. However, I certainly don’t believe you take a pill and are fixed. If any of you have had that success, could you please tell me what you are taking?

In my view, tons of hard work goes into recovery, which is why I appreciated Elisha Goldstein’s post called “Depression: Medicate, Meditate, or Both?” To get to it, click here. The only part that I disagree with (and he would probably concur with me) is that for some mood disorders–and especially for bipolar disorder and schizophrenia–medication does have to be part of the long-term plan. I have excerpted a few paragraphs below:

The Psychiatric field has found medications that increase the flow of certain neurotransmitters in the brain that can help relieve these feelings of depression. However, because of the relapse rate, the American Psychiatric Administration had to come up with three phases of treatment with medications, acute, continuation, and maintenance. Acute medication treatment was aimed at relieving symptoms during a depressive episode. Continuation treatment was for prescribing medication for 6 months after the episode had passed and maintenance was to prescribe for up to 3 years. So what’s the problem here? What happens after 3 years? What about the people whom medication doesn’t agree with or unable to take? 

Medication can be a wonderful support; however, it’s important to also cultivate the skills to work with the potential relapse of depression moving forward. This is a more effective long term strategy.

Based on Jon Kabat-Zinn’s Mindfulness-Based Stress Reduction (MBSR) program, Zindel Segal, Mark Williams, and John Teasdale developed Mindfulness-Based Cognitive Therapy (MBCT) for depressive relapse. Teachers of this program support participants in cultivating mindfulness meditation skills to foster the ability to be more nonjudgmentally present to thoughts, feelings, and sensations in daily life. In doing this, people learn a new way of relating to their distress; rather than avoiding it they learn to approach it and live in the midst of it. This has profound consequences for what follows. When we spend our time hating and cursing our distress it’s as if we are sending negative energy into a blob of negative energy. What happens? The negativity we’re sending is food for that blob and it only grows. We don’t realize that the way we are relating to our depression, adds to it. It’s difficult to grasp this concept if we’re in the depression and that is why this approach is best when the episode is lifting or has lifted. Here is where medication can be supportive.

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