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Brief therapy is an established and proven treatment for depression. People who are helped out of depression this way are less likely to relapse. But, tragically, this remains a contentious issue, mainly because of ignorance.

Talk therapy alleviates depression. This has been well known for over 20 years. Research continues to show it and treatment guidelines are clear and specific. Yet most people don’t seek help and of those who do, only a small proportion are offered adequate treatment that will enable them to become and remain depression-free.

Depression guidelines

Not any therapy will do. Depression treatment guidelines from NICE (National Institute for Clinical Excellence) the WHO (World Health Organization) and others say that brief therapy for depression should be collaborative, time-limited and active. It should be aimed at functioning and lifestyle rather than insight and understanding.

With the right approaches, most depressions can be cured or substantially alleviated in under 10 sessions. In practice, particularly with milder forms of depression, improvements start from the first session and few sessions can be sufficient. Effective therapy means the symptoms can overcome, with less likelihood of relapse.

Drugs are good for alleviating symptoms but they don’t address the causes of depression. Talk therapy is a vital part of the equation in helping patients to become symptom-free. This is because it addresses the underlying psycho-social causes of depression. While there are many contributory factors and causes of the syndrome, brief therapy for depression addresses the thinking and behavioural patterns that help to maintain it.

This is not to say that medication in undesirable; it is effective for many people but it isn’t the whole solution, nor, many would argue, the best one (see for example Yapko, 1998). The guidelines recommend drugs and/or therapy depending on client preference and the severity of the depression.

A tragedy of ignorance

While there has always been a debate about whether talk therapy could be a really effective treatment for depression, we have known since at least the mid-’90s that it can. Not only is it effective, but the right sort of therapy also has several distinct advantages over medication. For example, there are no side-effects, it is low cost, and the relap[s rate is lower than with pharmacological treatment.

Depression is a curse that blights the lives of millions of people. It is so widespread that the WHO says that it is becoming a leading cause of disability worldwide. Most people struggle in silence and most will never seek treatment. It is a tragedy of ignorance that so many people continue to suffer unnecessarily because depression can be reliably and effectively treated in most cases (Mitchell et al, 2013).

Depression and other conditions

The diagnosis and treatment are often hindered by other conditions and symptoms. Depression and anxiety often occur together, for example. Depressive symptoms are also common with physical disorders like cancer, stroke, and acute coronary syndrome. This is often missed by doctors who are more focused on the physical symptoms they are treating, yet depression has an adverse on illness and recovery.

Because of its prevalence and the costs associated with depression and anxiety, there has been a huge amount of research and we understand the types of therapy that work with depression. Clinical guidelines show helping professionals the way to handle treatment, who should be offered it, how long it should last and what the outcomes are likely to be. The guidelines don’t just cover psychotherapy, they also signpost when medication should be offered, for how long, and even how to judge when it should be stopped.

Specific treatment

Depression is a naturally occurring phenomenon so it is to be expected for a short time following a loss or other major life event. It becomes a problem when it doesn’t lift after a few weeks or when it is recurrent. It arises for other reasons as well and it can take many forms, which is why healthcare practitioners can be slow to spot it.

Treatment really has to be tailored to the individual, and it should be collaborative, involving practitioner, client and even family members working together to resolve it. It should be time-limited and therapists who treat depression usually have had specialist training in dealing with it; they should be able to explain their approach and the sorts of outcome they anticipate.

The right therapy

‘Therapy’ and ‘counselling’ are generic terms so, if you are considering talk therapy, make sure you feel comfortable with the therapist you choose and that they can explain how they go about things. You may have to speak to a few people to find someone you are happy with, just as you would with any provider of a service. You can find guidelines for choosing a therapist here. I have also published a list of Frequently Asked Questions (FAQs) about therapy and coaching.

There is hope

Keep in mind that depression is common and though it can be tough it is not a life sentence. It responds to the right treatment and many people, including myself, have come through it and now live without it. It is a serious condition but when tackled in the right way it responds well to treatment in 70-80% of cases, and even if it can’t be cured completely symptoms can be alleviated so that life can be more normal.

Recommendations

If you suffer from depression or want to help someone who does:

  • Depression is so common as to be “nearly universal” (Burns 1998). Sufferers are not alone, crazy or weird. They are often misinformed and the condition induces thinking patterns that mean they won’t seek help.
  • It is partly caused by thinking style and belief, which is why therapy can be so effective. The trouble is, depression is also so persuasive that sufferers are often convinced that nothing can help them.
  • Depression is often accompanied by anxiety, which compounds the cycle. Even when depression lifts, as it does from time to time, anxiety can mask any improvements.
  • Active forms of therapy aimed at broadening understanding, problem-solving and empowerment should be brief and combined with simple homework assignments to enable the client to address the things that perpetuate depression.
  • Some people suffer for years, but long-term problems don’t necessarily need long-term solutions; therapy should be brief, supportive and outcome-oriented.
  • As well as therapy and drugs, practices that have been shown to help reduce the symptoms of depression include acupuncture, massage, mindfulness, yoga, walking and social interaction.
  • Depression affects not just the sufferer, family members also feel it. So in some cases it is helpful for a partner and other family members to be part of discussions with the therapist.

Related posts by Barry Winbolt

It May Be Just a Sticking Plaster…

Seven Ways to Change Your Thinking

The Talking Cure

References

This post draws on the references below. As I wanted it to be accessible and readable I have not referenced all the points that I have made, but all can be checked against these references.

Burns, D., (1998), The Feeling Good Handbook, Penguin, London.

Kang, H. J., Kim, S. Y., Bae, K. Y., Kim, S. W., Shin, I. S., Yoon, J. S., & Kim, J. M. (2015). Comorbidity of depression with physical disorders: research and clinical implications. Chonnam medical journal, 51(1), 8-18. Available at: https://www.icsi.org (Accessed 25/8/14)

Mitchell J., Trangle M., Degnan B., Gabert T., Haight B., Kessler D., Mack N., Mallen E., Novak H., Rossmiller D., Setterlund L., Somers K., Valentino N., Vincent S. Adult depression in primary care, Institute for Clinical Systems Improvement (ICSI); 2013 Sep. 129 p. Available at: https://www.icsi.org (Accessed 22/2/19)

National Institute for Clinical Excellence (NICE) Depression in adults: The treatment and management of depression in adults,  NICE guidelines [CG90] Published date: October 2009 available at http://www.nice.org.uk/guidance/CG90 (accessed 25/08/14).

Rait, G., Walters, K., Griffin, M., Buszewicz, M., Petersen, I., Nazareth, I.,  Recent trends in the incidence of recorded depression in primary care, British Journal of Psychiatry 2009, 195:520-524. Available at http://bjp.rcpsych.org (accessed 24/8/14)

WHO Fact Sheet No 369 October 2012, What are the most effective diagnostic and therapeutic strategies for the management of depression in specialist care? Available at: http://www.euro.who.int/ (accessed 25/8/14).

Yapko, M., (1998), Breaking the Patterns of Depression, Bantam Doubleday Dell Publishing Group, New York.

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