Depression

Popular opinion: depression is caused by a chemical imbalance in the brain.

Uncommon fact: it is not.

Johann Hari is a journalist and author who has written extensively about depression and mental health. In his book "Lost Connections: Uncovering the Real Causes of Depression – and the Unexpected Solutions," he describes depression as not just a chemical imbalance in the brain, but a symptom of deeper issues in a person's life. The “chemical imbalance” theory of depression hypothesised that because people suffering from depression often had low levels of neurotransmitters such as serotonin, norepinephrine, and dopamine, it was the inadequate amounts of these “brain chemicals” that caused one to experience symptoms of depression. However, the evidence supporting this is not conclusive. For one, it is difficult to tell if the decline of these chemicals caused the depression or if they declined as a result of depression. Or in other words, what came first? The chicken or the egg?

We also know that there are many other factors that induce depression. Factors such as loneliness (or social poverty), life experiences such as financial hardship and grief, and environmental factors such as reduced sunlight and captivity. Overall, Hari's approach to depression emphasises the importance of addressing the whole person and their life circumstances, rather than simply treating the symptoms of depression with medication designed to “correct” chemical imbalances. The medical explanation just seemed to simplistic, didn’t it?

While medications such as antidepressants can be helpful for some people, in fact many of my clients report great improvements in mood and functioning once they commence antidepressant medication, there is growing evidence to suggest that psychotherapy may be just as effective in treating depression.

In a recent study published in the journal Lancet Psychiatry, researchers found that cognitive-behavioral therapy (CBT) was just as effective as antidepressant medication in reducing symptoms of depression. CBT is a type of psychotherapy that helps people identify negative thought patterns and replace them with more positive ones. The study, which involved over 500 patients with moderate to severe depression, found that both CBT and antidepressants were equally effective in reducing symptoms of depression after 6 weeks of treatment. However, after 6 months, patients who received CBT were less likely to relapse than those who received medication.

This is not the only study to suggest that psychotherapy can be an effective treatment for depression. A meta-analysis of 11 randomized controlled trials found that CBT was significantly more effective than control conditions (such as no treatment or waiting list) in reducing symptoms of depression.

Of course, psychotherapy is not a one-size-fits-all treatment for depression. Some people may find that medication works better for them, while others may benefit more from a combination of medication and therapy. The current gold standard of treatment is a combination of both. It should also be said that CBT is not the only form of psychotherapy that has benefits for depression. It is simply the type of psychotherapy that has been subjected to the most investigation. However, more and more research demonstrates the efficacy of behavioural activation therapy, mindfulness-based therapies, psychodynamic therapies, interpersonal therapy and acceptance and commitment therapy. I believe treatment should be tailored to the individual so in my practice it is not uncommon for me to incorporate techniques and concepts from different approaches all the while tweaking and adjusting interventions to suit my client’s needs. It's so important to work with a mental health professional to determine the best course of treatment for you.

But the evidence is clear: psychotherapy can be a powerful tool in the fight against depression.

Click here to make an appointment with Penelope.