Mind Matters - June 2006
Written by Ron Sterling, M.D. and Published in Northwest Prime Time Magazine

Psychotherapy vs. Medication
by Ron Sterling, M.D. -- June 2006

    Dear Dr. Ron:

      Can you tell me a little bit about how psychotherapy or counseling could have an effect on what I have been told is primarily a biological problem? Even on Prozac®, I am still not feeling that great. I consider my depression to be mild, and more of a nagging, ongoing thorn in my side, rather than a more severe form. Signed: On Prozac, But Very Puzzled

    Dear Puzzled:

      Thank you for writing! The treatment of depression is a very complex subject, but I think it is possible to give you some basic facts in a short article. As I have said before, the problem with the word "depression" is that it can stand for anything from a bad hair day to a very serious or life-threatening disorder. So, professionals like me don't use the word depression without adding to it the word "mild," "moderate," or "severe."

      Depressions that last longer than two weeks and include symptoms such as early morning awakening with difficulty returning to sleep, severe loss of motivation, energy, or interest in life (suicidal feelings or plans, constant sadness), and loss of appetite with weight loss are the moderate to severe type and do not generally get better without help from medication. Milder forms of depression may include symptoms such as increased hostility, irritability, over-eating, over-sleeping, and difficulty concentrating. "Clinical depression" is a term that is reserved for the moderate to severe forms of depression.

      Please keep in mind that no matter how healthy our brain may be, we are each vulnerable to a more biologically-based depression under the right circumstances of physical or emotional stress (see earlier articles on depression at MindMatters.ws). How vulnerable we are to depression depends on our physical ailments and our family history of depression. More ailments and more family members with clinical depression signify a higher vulnerability.

      The short answer is that there is no single, best treatment for mild to moderate depression. In my opinion, medication is often not a complete solution. In fact, in the mild to moderate range of depression, medication can be a complicating factor by producing mostly side-effects.

      Depression is complex for many reasons. It is very individual. Many difficult experiences and dysfunctional belief systems can give rise to depression. That is why, for the purpose of finding long-lasting solutions to depression, professionals should not rush to judgment and think only of one-sided solutions. Utilizing compassionate and thorough data gathering and assessment is important for discovering the roots to a nagging depression and to formulate a plan of treatment.

      Many professionals feel that it is not necessarily what happens to depressed persons that causes them to be depressed, but rather, what they tell themselves about what happens. Some examples of common thinking patterns that can lead to depression include over-generalized thinking, perfectionistic thinking, and the tendency to catastrophize.

      Social skills that should be looked at are related to dissatisfaction with friends, coworkers, family, or job. Depression can result from a feeling of disconnectedness brought about by misperceptions of ourselves and others. Depressed individuals often have negative self-perceptions. There may be a tendency to be less assertive and less positive for various reasons relating to self-concept or old programming about how one should behave.

      In my opinion, psychotherapy, notably cognitive–behavioral or interpersonal psychotherapy, should be considered the treatment of first choice for mild to moderate depression because it has been shown to lead to a superior long-term outcome. If antidepressants are used, psychotherapy should be included because of what has been shown to be a higher risk for relapse with treatment by medication alone. In addition, it has clearly been shown that exercise increases certain neuroprotective hormones in the brain which decrease vulnerability to depression.

      If we therapists can learn to be patient in dealing with the emotional difficulties of depressed individuals and help them find specific treatment strategies, a very significant percentage will respond positively. I hope this helps. -- Best wishes, Dr. Ron.

        Author Bio:

        Ron Sterling, M.D. is a 64 year-old General and Geriatric Psychiatrist with a private practice in Seattle. He invites you to e-mail him at with any questions about mental wellness or emotional, relationship, or aging concerns. He is the only person who reads e-mail sent to Dr. Ron. Please be assured that your questions and identities are completely confidential and protected. For more information about Dr. Ron and for resources related to senior mental health, please go to SeniorMentalHealth.org. The content offered through Mind Matters is for information only and is not intended for medical, psychiatric, or psychological diagnosis or treatment. Never disregard professional advice or delay seeking it because of something you have read in this column. Read our Disclaimer. If you wish to understand more about Dr. Sterling's potential biases in health care advocacy, please check his Conflicts of Interest Disclosure Statement

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