With standard doses of the most commonly used class of antidepressants (SSRIs) only 30 percent of people with severe depression achieve remission with the first medication prescribed. Switching to a new drug — and it often takes twelve weeks to achieve an adequate response to medication — is effective about 25 percent of the time, according to the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study, an unbiased investigation funded by the National Institute of Mental Health.
So after 24 weeks (close to 6 months), only 55 percent of people with severe depression will experience a remission of symptoms.
That isn’t exactly good news to me.
What about the other 45 percent?
Every day on Project Beyond Blue, my depression community, I hear from someone who has unsuccessfully tried 20, 30, or 40 different medication combinations and is hanging on to life by a very thin thread. I know that desperation myself, which is why, in the last two years, I have spent a lot of time and money exploring different alternative therapies.
Here are 10 non-drug therapies for depression that have provided some relief to members in my community or to friends I know battling this beast. Even if you don’t have treatment-resistant depression, they are good to know about and can be used in addition to taking medication to build extra resiliency.
*Remember that I am just a highly-opinionated (but well-researched) writer, not a doctor, so consult with your physician before changing the course of your treatment.
1. Transcranial Magnetic Stimulation
I can’t count on my fingers the number of people I know who have been saved by transcranial magnetic stimulation (TMS). Former advertising executive Martha Rhodes certainly was. In her riveting memoir, 3000 Pulses Later, she shares her journey back to health with this new technology. TMS involves a non-invasive procedure that stimulates nerve cells in the brain with short magnetic pulses. A large electromagnetic coil is placed against the scalp which generates focused pulses that pass through the skull and stimulate the cerebral cortex of the brain, a region that regulates mood. The procedure was approved by the FDA in 2008.
I first heard about TMS two years ago. I investigated it for myself, but my insurance didn’t cover it, and all 30 sessions can run about $15K. However, due to efforts made by Neuronetic, Inc., a leader in TMS technology, insurance coverage for patients has increased from 100 million to over 200 million people, in both government and commercial insurance plans.
A recent study in the Journal of Clinical Psychiatry demonstrated the long-term effectiveness and durability of NeuroStar TMS Therapy in adult patients for over a period of one year. Just this morning the company announced that it has $34.4 million (including an investment from GE Ventures) to spend in order “to broaden treatment accessibility for existing patient populations in need of a non-drug therapy option.”
2. Dialectical Behavioral Therapy
Dialectical behavioral therapy (DBT) has become another popular topic in my depression community. A kind of cognitive-behavioral therapy developed in the late 1980s by psychologist Marsha Linehan, it once was reserved to treat borderline personality disorder. Today it is used to address all kinds of mood disorders.
“As someone who has suffered from depression and anxiety, I use many techniques that I learned from my DBT support group in my daily life,” one woman in Project Beyond Blue told me. “The behavioral exercises and visualizations I learned in the group help to calm me and have been extremely effective, especially when I’m feeling an anxiety attack or overwhelming sadness coming on. Breathing techniques, distracting and interrupting myself from negative thoughts, and total acceptance of my strong emotions without judgment give me a sense of control and self-love when I’m feeling most out of control and unlovable.”
Many studies have confirmed that yoga helps relieve depression. For example, in a 1993 study, 50 female university students with severe depression practiced Shavasana yoga for 30 minutes daily for 30 days. There was a significant reduction in their depression score mid- and post-treatment.
Teagan Fea has been teaching yoga and facilitating retreats for 15 years in New Zealand, Australia, Peru, and Mexico. She has designed a comprehensive online meditation and yoga program to help free people from depression, especially those who have tried medications.
“When yoga is applied therapeutically,” she explained to me, “the practice can be specifically designed to reduce the symptoms of depression. Moving and holding postures while focusing on the breath discharges stored and depressed energy, allowing it to move through the body and be released. The visualization, breathing, and meditation components of the practice assist in rewiring the brain and strengthening new thinking patterns. Yoga is a powerful tool that can assist with deep transformation.”
4. Mindfulness-Based Cognitive Therapy
As I mentioned in my piece on mindfulness the other day, a new study from the University of Oxford found that mindful-based cognitive therapy (MBCT) is just as effective as antidepressants for preventing a relapse of depression. Studies indicate that both MBCT and mindfulness-based stress reduction (MBSR) programs “have broad-spectrum antidepressant and antianxiety effects and decreases general psychological distress.”
I took the 8-week course last year. As a result, I am more aware of my stress reactions and am proactive about reducing my stress before I break down. I can identify the thinking patterns that lead to depression, like the inner critic and jumping to the future. Especially beneficial is locating tension in a certain region of my body, and trying to relax it.
5. Hanna Somatic Education
“You translate everything, whether physical, mental, or spiritual, into muscular tension,” said F.M. Alexander. Our muscles have memory. They tell our story. We respond to life events with physical tension. With repetition and trauma, this reflexive physical tension can continue into chronic muscular tension.
Hanna Somatic Education, developed by Thomas Hanna, is a system of neuromascular education (mind/body training) that gently addresses chronic pain, restores freedom of movement, and relieves stress. Somatics works specifically with sensory-motor amnesia — teaching the brain how to relearn muscle motions.
Ryan Moschell, a long-time Annapolis massage therapist, is now a somatic educator. Instead of manipulating muscles for his clients as he did as a therapist, he now teaches clients how to do the work themselves, how to move specific muscles to relieve pain and tension. “Learning HSE from a certified Hanna Somatic Educator empowers you to have more control over your own body and lifelong neuromuscular wellness,” he explained to me.