This guest article from YourTango was written by Dr. Deb Schwarz Hirschhorn.
What a difference a few years makes.
“New Cures for Depression” shouted the 1986 essay in New Woman magazine; “Dramatic Progress against Depression,” blared a New York Times Magazine piece in 1990. Its subtitle was revealing: “The success of new drugs is prompting debate on their overuse—and the value of talk therapy.” That story smugly said that the new wave of antidepressants, including the then two-year old Prozac, which took the country by storm, had “proved to be as effective as the older ones and often safer.” What’s more, the article went on to say that these amazing new drugs worked when old-fashioned talk therapy didn’t. Psychotherapy was relegated to the dustbin of history.
Fast-forward just a couple of years. Suddenly, the manufacturer of Prozac, Eli Lilly, was being sued by families of people who either committed suicide or tried to do so while taking the drug. In the next 15 years, lawsuits for other antidepressants piled up against other manufacturers for the same reason: Forest Pharmaceuticals, maker of Celexa; Lilly (again), maker of Cymbalta; Pfizer, maker of Zoloft; and GlaxoSmith Kline, maker of Paxil.
At the same time, the U.S. Food and Drug Administration started coming down hard on pharmaceutical companies for promoting “off-label” uses of their products, that is, uses that had not been approved by the FDA. To accomplish their goals, big pharmaceutical companies would pay doctors to prescribe various drugs already in use for symptoms not related to the drugs’ stated purpose.
Not only did the drug industry promote off-label uses, but many of the research papers that touted the benefits of the medication were fraudulent. Doctors on the drug makers’ payroll would submit fictitious results to such prestigious journals as the New England Journal of Medicine and the Journal of the American Medical Association. Journals subsequently added to their editorial policies a requirement that all submissions include the funding sources for the research.
And now, the latest blow to the pharmaceutical industry: research shows that not only are dummy pills, called placebos, just as effective in routing out depression as antidepressants, but in some cases they are even more effective! What’s more, the latest technology shows that both the dummy pills (used in scientific research as “controls”) and talk therapy change the brain’s wiring. That means we can take psychotherapy out of the dustbin and restore it to the place of honor—and hope—where it belongs.
When it comes to depression, we need that hope. According to a 2009 study in the Journal of Marital and Family Therapy (JMFT), close to 16% of people will be diagnosed with Major Depression during their lives; in fact, the World Health Organization states that, of all health problems, depression is the second from the top. Of interest, more women than men suffer from depression in marriage.
If depression is that serious, how could psychotherapy work where drugs have given us a bouncy ride (like side effects and how they can just stop working if they had any effect in the first place)? How does talk therapy have the robustness to counteract what pharmaceutical companies have billed as a chemical imbalance in the brain? Most importantly, how could counseling tackle the kind of depression that comes out of strained personal relationships?
The good news is that brain chemistry “imbalances” in depressed people have never been found. That is, there is nothing about the brain of a depressed person that doesn’t work right. When there is less serotonin (a neurotransmitter that signals good feelings) in their brains, it is a reflection of their depression, not a cause of it. More good news is that talk therapy is actually the best solution to the kind of depression that comes out of strained personal relationships. According to JMFT research, both couples counseling and individual therapy can improve depression, but only relationship therapy improves relationships.
Research using functional magnetic resonance imaging (fMRI) demonstrates that drugs, placebos, and talk therapy all can change brain chemistry. But how could drugs have the same effect on the brain as placebos? Scientists hypothesize that these dummy pills work because of the attention and care that the researchers give to the people participating in the experiment. And wouldn’t you know: Psychotherapy research comes down to the same thing. When talk therapy works, it does so because of the quality of the therapeutic relationship. So of course the pharmaceutical will work because it is distributed by researchers who talk to—and listen to—the research volunteers. What we’re saying here is that the way we’re treated changes brain chemistry.
Studies in the animal kingdom shed more light on this. In 1986, Discover Magazine reported research by Jacqueline Crawley with Siberian hamsters, animals that are unusual because, like most humans, they mate for keeps. When a female is taken away from her mate, the male not only acts depressed, but serotonin levels in the brain go down—a sure sign of depression. But look at this: to raise those serotonin levels back to normal, all the researchers had to do was re-introduce that mate!
In other words, how you feel about your relationship really is in your head, but that doesn’t mean it started there. Sometimes correcting external factors is all that is needed to correct what’s not right in the brain.
There’s another external factor that has a powerful effect besides the care and attention mentioned above. Another JMFT article noted that more women than men initiate separation and that when they do, if they started out depressed, their depression lifts. One conclusion you should not draw is that a separation from the s.o.b. was the right move. It doesn’t prove that at all.
The authors speculate that the person who initiates separation has more control over events at that moment and that is why the depression lifts. One of the hallmarks of depression is the hopelessness that comes from being out of control of the situation. The real solution is for the therapist to work with the controlling partner to relinquish control, be a listener, and behave respectfully—in addition to being caring and attentive. Then, just as in the case with the Siberian hamsters whose depression lifted simply by changing external circumstances, a partner’s depression can lift, too.
There’s a huge bonus to therapy. Partners in a relationship can be taught how to make each other happy rather than fight over why the other person was making them unhappy. In other words, partners can learn how to inject serotonin into each other’s brains with just a well-placed smile and a thoughtful gesture. That’s so much more powerful than drugs, isn’t it?
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