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Counselling vs. Drugs (Depression)

colmena

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Hello,

I would very much like to know your opinions regarding treatment of depression.


---
If you would like to cater for me:

I have been given a form to fill, and have been told to consider whether I would rather be prescribed drugs (non-specific, as yet), or begin counselling.

I believe I may have Dysthymia, and cannot see how counselling would be beneficial, but I realise there may have been some things that I could have overlooked.
 

Tallulah

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That's a tough one, Colmena--I think that proper treatment of dysthymia (which I have) involves a combination of the right drug and at least some therapy.

Basically, the drug lifts the feelings of hopelessness so that you're able to do the work in therapy. I think if you're basically functional, maybe I'd go with the therapy and see if you can get by without the drugs. The other option would be to get on meds and then get a good book to help you.

Effexor has been good for me, drug-wise. Dysthymia is harder to medicate, and you might have to try several before you find the right one.

If you have any specific questions, I'd be happy to answer them the best I can.
 

Oso Mocoso

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I believe I may have Dysthymia, and cannot see how counselling would be beneficial, but I realise there may have been some things that I could have overlooked.

Yeah, I suffer from seasonal depression. I am pretty much the same way. Fortunately, I have a doctor who agrees with me. My depression crops up pretty predictably around December, and gets pretty nasty until around March when it gradually starts to subside. Here in mid-May, I'm fine. If I move south, it goes asymptomatic. There's not much counseling could do to help me. There isn't really "an issue" to discuss.

I'm not taking meds. I do plan to move before next winter, though.
 

matmos

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I am a firm believer that depression is *normal* - even the most extreme kinds. It is a natural reaction to the environment - physical or otherwise - in the same way that pain instructs you to avoid something.

As Tallulah said the absence of light in Winter causes a problem. The ailment is a reaction to the environment. Whereas, in evolutionary terms we are still equatorial monkeys.

I would suggest cogitive behavioural therapy as a way of *recognising* where the problem lies. It may lie in your past or present environment.

Drugs have a habit of not dealing with the problem, only the symptoms. I don't know enough to comment further, but you sound like you have highly developed Ti and this is not doing you any favours in this case.

Additionally the problem is that it *normalizes* and appears like the in-laws at Christmas - expected, but unwanted.

I would try therapy before medication; if it does not work try the meds.

Some of the work by R D Laing makes interesting reading.

Ronald David Laing - Wikipedia, the free encyclopedia
 

Ivy

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Are you being forced to choose between them? As far as I know, the combination of medication and therapy is the most effective treatment.
 

Totenkindly

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Are you being forced to choose between them? As far as I know, the combination of medication and therapy is the most effective treatment.

Yes, and the actual problem as diagnosed helps determine the level of each to use.

Pharmacological solutions seem to be driving the diagnosis to some degree in our culture nowadays. So it's something to be aware of.

- Healthy people do suffer distress. Not every bad feeling needs a diagnosis or "needs fixed." But pervasive bad feelings resulting in destructive behavior, inability to function in life, or a stopping of personal growth should be dealt with.

- Often mental conditions can result from bad/weak coping skills or improper assumptions about the nature of one's life and reality. Providing better coping skills for a particular person's situation or a new outlook can help strengthen them enough that they'll continue on the path to mental health.

- There are still some things that can have a partially (or more) biological root. it's the responsibility of the psych to figure out what is what. Sometimes dosages are given before a firm diagnosis, as part of the troubleshooting and in order to prevent self-harm or a continual slump. That seems realistic to me.

drugs (i think) are usually best used to take the edge off the condition so that the person can move forward in therapy. So far I haven't personally met a therapist who behaves otherwise either, although there are horror stories (some left over from the late 80's and 90's where stories were predominate) and there seems to be CW that therapists are somehow bad or "drug pushers."

Anyway, I am digressing... Let us know what you find out, Col, and how you're doing, okay?
 

Ivy

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I agree, Jennifer-- the drugs are helpful to relieve some of the symptoms but long-term improvement is going to depend on dealing with the underlying issues (unless the issues are entirely biochemical in nature). Self-help can work to a degree, but a therapist can accelerate the progress and help you escape from negative thinking cycles.
 

Hirsch63

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Col, I've been through a bit of this...every therapist I've seen here in the US seems to strongly recommend the combination of drugs+therapy. And looking back over the last ten years I'd have to say it probably works best. I thought that the therapy was silly. I could not see how it could help me at all...then the drugs allow you to be more "open-minded" and less cynical and the therapy can take effect.

Be aware that finding the right drug for you may take several goes. Effexor, though it works for Tallulah was horrific for me...good ol'prozac does the trick so far...lexapro was just lame. This is common as far as I understand it. Once begun it is a long term process that requires a commitment (but hopefully not an actual commitment). this is the toughest part and you have to be your own best advocate and be in as much communication with your therapist as needed to adjust your dosages to achieve a maximal benefit. You must be invested in the process as much, if not much more than you health care providers.

The bottom line is: this can work. It is not as easy as just taking a pill but they can help.
 
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Totenkindly

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Yes, it's important to remember that drugs don't have consistent effects between people, even the same dose of a drug.

Personally, I did very well with Wellbutrin, but I've heard from others who did poorly. And I hated Effexor (can't say why, it just didn't "feel right") and the withdrawal symptoms took me a month to kick. Uggh.

Usually what I see is shrinks making the best guess they have, trying you out on something for two months to see the effect, then switch or modify things if it's not quite right. Some people go through a number of drugs before they find an effective one, which isn't fun... but it's just the way it is.
 

anii

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From what I understand of the field (masters in counseling, LMHC), a combination of both medication management and talk therapy is more effective than either one alone.

Even if you just have dysthymia, cognitive-behavioral therapy can address distorted thoughts, schemas and resulting behaviors that may be causing you emotional distress.
 

ThatsWhatHeSaid

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I'm kind of afraid of drugs and not really into them. I think all disorders, short of maybe schizophrenia, can be dealt with through counseling. My objections to drugs are: 1) don't trust them 2) side effects 3) dependency 4) avoiding the real issues instead of confronting 5) I like to own my progress, and I'm afraid taking drugs sorta compromises that ownership. My aversion to drugs bears some relationship to my aversion to alcohol as a means of self-help/coping. In moderation, alcohol can make you feel a shit ton better and drown out your problems, but you haven't, like Ivy said, addressed the underlying issues and you may have created some new ones in the process. Taking drugs in conjunction with therapy isn't as bad, but I'd personally give therapy a shot, first. I guess one could think of it as natural drugs.
 

redacted

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drugs alone are never going to fix a problem. therapy alone definitely can.

i don't understand this social stigma towards therapy: what's the worst that could happen by going? it's pretty much harmless. and having a place where there's nothing to talk about besides yourself for an hour long session once or twice a week is soooooo good for you. you don't have to worry about offending the therapist, or boring them, or asking them how they're doing. it's just all about you.

also, they'll point out when you're using defense mechanisms, something most people aren't aware of too often. and if they're good, they'll know how hard to push you so that you'll face new things without opening up the floodgates.

in theory, the pros massively outweigh the cons.

the only cons i can think of are
1. bad therapist
2. money

but it also costs a lot of money to stay on drugs for the rest of your life, which you will if you don't work through your problems. it's definitely possible to work through them without therapy, but it's guaranteed to be much much slower. years slower.

but i'm not actually against drugs either. i just think you should start in therapy first. talk to THEM about the pros and cons of drugs. reassess whether or not you need them after a month or two.
 

disregard

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Daily exercise in nature. I will never turn my back on it, because it keeps me afloat.

Neither formal counseling nor drugs. It's always been better for me to talk to friends than to talk to a therapist.
 

alicia91

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I really think it depends on whether you have a lot of 'issues' that need to be sorted out - long term problems for example with a certain relationship, work, etc. or if it's mostly a chemical imbalance. If it's the latter, you might find a session or two with a psychologist useful more in terms of how to cope with having such a diagnosis, but I'd wait until after you got on medication. The longer you go without restoring your brains proper chemical balance the harder it is to treat. Often times when someone had depression/anxiety they have a lot of issues that bother them, after a few months on meds they realize that those issues no longer bother them and they had been a fixation, or blow out of proportion due to the chemical imbalance.

Personally I've spent thousands on therapy for my anxiety, and have not found it particularly helpful. Example - I had a lot of anxiety about a job I had, and I would be freaking out about it all the time to my therapist but as soon as I got on drugs I could clearly see what a crappy place to work it was (no it wasn't ME), I had the strength to quit and find another one. The therapist spendt endless time going over my relationships with my boss, coworkers, even teaching me deep breather techniques to do in the car on the way to work. :rolli: The only success I've had with a psychologist was when I was having some issues with my son and we both went in and got some useful advice. If it's chemical (which is most likely is)...I'd try the drugs first. Then if you have lingering issues go to counselling.

Good luck, please get treatment soon - it's no way to live.
 

colmena

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Thank you all for your input. You've certainly put forward a few things I hadn't considered, and have been very helpful.

I've been prescribed Prozac, and have another appointment in two weeks to see if it's started to have any effect.

There is a six week waiting list for counselling, and I don't want to hold it up further for people with acute depression or bi-polar.

I'm hoping that the drug will give the gusto needed to get to a place where I can better develop. So that's generally some relief of poor self-esteem, listlessness, and apathy regarding my own future.

I will post again if anything notable occurs.
 

wedekit

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Well, my view on the matter is scattered among different posts, so I'll just go ahead and just type it out.

Research on the effectiveness of psychotherapy strongly suggests that longterm therapy is just as effective as longterm therapy + drugs for ALL disorders. I conclude from this that if you are depressed and it is interfering with your life, you should see a doctor about medication but also attend therapy. I see drugs as a band aid to the problem (so that you can function again) and therapy as the cure. The problem with antidepressants is that they take a short period to actually start working, so you will still have some downtime, plus not all medications work the same for all people. I think it comes down to this decision: Do you want to have to rely on medication to keep you non-depressed the rest of your life? Or would you rather try and fix the problem for good?

I have suffered from two bouts of severe depression in my life so far; one was an episode after my recent surgery and another lasted from jr. high to high school. Depression really can be bad; I don't know how to put into words how horrible I felt in those days, but I can say that in some form or fashion I understand. Everything seemed hopeless, and I never want to go back to that again.

I should also mention the distinction between longterm and short term depression. I started taking medication again when I was falling into depression after my surgery. I basically was bed-ridden and in pain for a while, and I just felt like crap. The medication really put me back in the game, and I stopped taking it after a couple of weeks and I was fine. I'm thinking this was only short term depression. Longterm depression is certainly a different story. In my case, the longterm depression (from roughly 6th grade to my junior year of high school) had a cause, and the only way I was able to overcome it for good was to deal with the problems that were causing the depression; which was essentially coming to terms with my sexual orientation. It haunted me since childhood, and then I hit puberty and went through a stage in my life that I can only describe as "dark times".

Don't get me wrong, I think your specific situation will have a lot to do with deciding what the best treatment is for you. Note that I haven't really mentioned that some people have a natural chemical imbalance that gives them a strong predisposition for depression. I wish I had time to go over all the theories of depression from each school of psychology that I learned from my Theories of Personality class, but I'm at work so I don't have my book with me.

Let me end by saying that I hope everything works out for you.
 

colmena

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Research on the effectiveness of psychotherapy strongly suggests that longterm therapy is just as effective as longterm therapy + drugs for ALL disorders. I conclude from this that if you are depressed and it is interfering with your life, you should see a doctor about medication but also attend therapy. I see drugs as a band aid to the problem (so that you can function again) and therapy as the cure. The problem with antidepressants is that they take a short period to actually start working, so you will still have some downtime, plus not all medications work the same for all people. I think it comes down to this decision: Do you want to have to rely on medication to keep you non-depressed the rest of your life? Or would you rather try and fix the problem for good?

I absolutely agree with you. What I'm hoping, is that the drugs will enable me to escape my current environment/situation so that nature, people, work etc. can provide therapy. I don't know how I'd get on living a 'normal' life, perhaps the drugs will get me to a place where I'm willing to give it a go.

I should also mention the distinction between longterm and short term depression. I started taking medication again when I was falling into depression after my surgery. I basically was bed-ridden and in pain for a while, and I just felt like crap. The medication really put me back in the game, and I stopped taking it after a couple of weeks and I was fine. I'm thinking this was only short term depression. Longterm depression is certainly a different story. In my case, the longterm depression (from roughly 6th grade to my junior year of high school) had a cause, and the only way I was able to overcome it for good was to deal with the problems that were causing the depression; which was essentially coming to terms with my sexual orientation. It haunted me since childhood, and then I hit puberty and went through a stage in my life that I can only describe as "dark times".
Youch. Sorry to hear you were afflicted so young. And I can relate to your long-term depression as my best friend in high school was the same. Such a heavy burden made him very isolated, distrustful, and insecure. It's frightening what a disease secrets can be.

Let me end by saying that I hope everything works out for you.
Cheers, Travis. Nice post.

---

A friend and I have decided to write a script together. I thought it might be a good way to flex some creativity and work through subconscious issues. I think the site's called plotbot, perhaps some MBTIc members would like to have a go at one together.
 

bluebell

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There is a six week waiting list for counselling, and I don't want to hold it up further for people with acute depression or bi-polar.

I'm not sure how people are selected to go on waiting lists for counselling where you live, but my reaction to your comment is that while that is very thoughtful of you, I'd be inclined to let the medical profession (or whoever manages the waiting list) decide priorities. It is more than likely that if someone has an acute need for counselling, they'll be moved to the top of the waiting list. From what I've read, counselling is likely to be beneficial in identifying and addressing the underlying cause of the depression, so I suspect it's worthwhile to go to sessions as well as take the meds.

Best of luck with it all.
 
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