When you’ve got a leaky kitchen sink, you call a plumber. When your car’s brakes start making an awful screeching noise, you take it to a mechanic. For almost any job requiring a specialized skill, there’s a professional trained to help. You could try to handle the leaky pipe or car repair on your own, and you may even be successful, but a professional has the right tools and knowledge to get the job done quickly and more efficiently. Yet, when it comes to depression, so many people are unwilling to seek professional help.
While there are many, many lifestyle changes, ranging from diet, exercise, meditation, sleep, stress reduction, and more, you can (and should IMHO) try first on your own to ease depression, psychiatrist and psychologists can be a valuable part of the solution when these other things don’t provide relief.
Depression is different in every person with unique causes, symptoms, and manifestations in that person’s brain and life.
For some, breaking a sweat or writing in a gratitude journal regularly may help. For someone else, medication may jump-start their brain into feeling better. For others, talking with a therapist may bring relief. And still, for some, a combination of all of these might work while for an unfortunate few, nothing seems to help.
The Statistics About What Helps Relieve Depression
Let’s look at the statistics. If we give one hundred depressed people medication, about thirty people will get fully better within a couple of months. Another twenty will get better, but still feel slightly depressed. And if we give the remaining fifty people a different antidepressant, about fifteen will see improvement and a few more will with a third medication.
Research shows that with therapy alone, the numbers are similar to the first rounds of antidepressants with roughly half of the people showing substantial improvement. If psychotherapy and medication are combined, the chance of recovery almost doubles.
One of the frustrating things about depression treatments, therapy or medication, is that neither are immediate and take a while to work. One large study showed that half of the participants recovering from depression took over six weeks while many people took longer but still got better.
How Psychotherapy Works
While having the support of friends and family has invaluable benefits when dealing with depression, talking with a therapist has its own advantages. Psychotherapy works for different reasons and on different parts of the brain than medication.
To simplify greatly, depression is a dysfunction in the communication between your brain’s frontal lobe and limbic system. In The Upward Spiral: Using Neuroscience to Reverse the Course of Depression, One Small Change at a Time, Alex Korb explains that psychotherapy normalizes limbic system activity.
He tells of one German study in which researchers took fMRI scans of depressed people’s brains before and after a year of Freudian psychotherapy. In the earlier scans, the depressed group showed increased prefrontal cortex activity meaning they had higher levels of self-focus and emotional processing. After a year of talk therapy, the depressed brain patterns changed with the limbic activity going back to normal and other parts of the brain associated with depression calmed down. Similar results have not been observed with medication.
Another Finnish study showed that psychotherapy increased the number of serotonin receptors in the brain’s prefrontal cortex and other areas which means people’s brains could grab more of the neurochemical. Contrary to popular belief, depression isn’t a direct result of low serotonin levels, but there’s a definite connection there, which is not fully understood, and upping serotonin levels helps many people. Studies have not shown an increase in serotonin receptors with medication.
Cognitive Behavioral Therapy
Korb tells of another study in which depressed people participated in cognitive behavioral therapy (CBT). CBT is a form of talk therapy which attempts to change a person’s thoughts and feelings to alter maladaptive behaviors taking advantage of neuroplasticity to make permanent physical changes in the brain. Adopting new thought and behavioral patterns recruit different neural networks, making new connections and communication pathways in the brain over time.
Brain scans before treatment showed the participants having overactive limbic systems that interpreted all incoming information the same, not differentiating between emotional and neutral content. Basically, their limbic systems tended to freak out at everything. After just talking with a therapist and following the CBT recommendations for six months, scans showed that their brains had begun to discriminate incoming stimuli and respond appropriately.
Behavioral Activation Therapy
One of the hallmarks of depression is not being able to derive enjoyment out of the activities or events that a person used to find pleasurable. Korb tells of studies showing that behavioral activation therapy (BAT) successfully reverses this. BAT is similar to CBT but focuses solely on a person’s behavior, getting them to do the things that are likely to be enjoyable, meaningful, or useful, and stop doing things which might contribute to depression. For instance, part of BAT might be as simple as getting up every morning, making the bed, and showering. By doing these tasks, a person is accomplishing small goals which cause their brain to reward them with positive neurochemicals which can start it on an upward cycle.
Research has confirmed that BAT increases the brain’s neurochemical response to reward. You can do your own form of BAT by doing simply what you used to enjoy and/or enforcing good habits – even if you don’t feel like it – and your brain will benefit.
Talking Successfully Treats Depression
The evidence shows undeniably that talk therapy does work to change your brain and help lift depression. Psychotherapy and medication alter the brain in different ways to help ease depressive patterns and if one doesn’t work, maybe the other will. People experience the most benefit from combining the two.
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