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Working It Out

Dr. Thomas R. Insel

Dr. Thomas R. Insel,
Director of the National
Institute of Mental Health
Photo courtesy of NIH/NIMH

A specific kind of "talk" psychotherapycan help relieve depression

Few people may have heard of a type of psychotherapy called cognitive behavioral therapy (CBT) – but people with depression and their doctors should take notice of this technique. Especially when combined with medications, it can help relieve depression. Research shows that it even helps reduce the likelihood of the most tragic outcome of extreme depression: suicide.

Unlike some other kinds of psychotherapy, CBT is meant to be short-term, usually 10 to 20 sessions, and research shows that it can be effective. The health professionals who provide CBT help patients work through the thoughts and emotions that are troubling them now, rather than trying to work through emotions and circumstances of the distant past.

CBT is based on the idea that changing thought patterns and the behaviors that result from them can help change emotional reactions – including the negative emotional components of depression. People sometimes develop thought patterns that aren't very realistic and that lead to negative feelings about themselves; a fertile breeding ground for depression.

While some people go through the same experiences and don't develop depression, others do. Depression is a brain disorder, and variations in genes that are active in the brain set the stage for how different people react to everyday life events. Some gene variations make it more likely that people will react in ways that lead to depression, which can become severe.

A man talking to a psychotherapist

Photo: Stockbyte

Research Shows the Potential of CBT

Results of a recent clinical trial illustrate the potential power of CBT. Depression is, by far, the leading reason that people end their own lives. Researchers gave one group of adults who had attempted suicide CBT and compared them with another group that instead got the usual treatments that clinicians in the community provide for such patients. In the next 18 months, only 24 percent of those who had undergone CBT attempted suicide again, but 42 percent of the patients in the other group made another suicide attempt.

Research also shows that CBT can be helpful for adolescents—a group that is in an emotionally vulnerable stage of life even under the best of circumstances—who are depressed. A recent study showed that a combination of CBT and the medication fluoxetine (Prozac and other medications like it) was more helpful than treatment with either therapy alone.

NIMH Director Thomas R. Insel, M.D., suggests thinking about treating depression the same way you would think about treating other major illness. For example, with mild high blood pressure, he says, your clinician might start by prescribing lifestyle changes, like diet and exercise. But if your blood pressure was very high when you were diagnosed, you'd probably have to take a medication, and you might have to try different ones to find the one that worked best for you. If your blood pressure got worse, you might have to add another medication.

"Depression follows the same principle," Dr. Insel says. "If you have mild depression, your clinician might want to start with cognitive behavioral therapy. But if you're diagnosed with more severe depression, it's more likely that you'll get a medication, and you'll probably need to try a few before you find the one that's right for you. For some people, a combination of CBT and medication will be the best treatment."

The key, he adds, is to make sure that you get treatment from a licensed health professional, whether it's for CBT or for treatment with medications. He notes that if your clinician offers CBT, you should make sure that he or she has had the training required to provide this helpful kind of therapy.

Read More "Beating Depression" Articles
Beating Depression …Help Is Available / Working It Out / Depression Research

Summer 2007 Issue: Volume 2 Number 3 Page 12