The Best Treatment to Overcome Depression

I recently wrote the first part of my article exploring the best treatment to overcome depression. The previous focused mostly on the medical facts surrounding antidepressant medication. This article will discuss the option of therapy and modern therapy’s association with Stoic philosophy.

Antidepressant Medication Overview

If you or someone you know are evaluating treatment options for symptoms of depression, some important facts to consider:- Depression is NOT caused by abnormal levels of serotonin or any other known chemical in your brain- Science does not understand the exact mechanism of antidepressants or how they actually work- The drug companies’ own trials demonstrate they are only slightly more effective than a placebo, and only in short term trials. At least 80% of the effectiveness of antidepressants is due to the placebo effect

Does the premise of antidepressants even make sense?

If depression is not caused by abnormal levels of chemicals in your brain, why would it make sense to treat depression by altering these chemicals? At face value, the premise sounds great. You feel sad, take these pills and they will make you happy. That is what the drug companies would have you believe. Unfortunately, there is no medication or substance that can give you another personality. Even if it were possible, your brain has a fantastic ability to adjust to a substance if it is regularly exposed to it. Your nervous system will always work hard to return to normal function to maintain the status quo. Ask anyone that has battled addiction, when they started using whatever substance it felt great at first. But over time, their body became accustomed to it and no longer provided the same feeling. For the same reason, taking the same dose of an antidepressant every day for 10 years with the assumption it is still providing a benefit does not make scientific sense. Unfortunately, the ability of your brain to adapt and build up a tolerance will cause someone who abruptly quits taking their antidepressant to feel terrible. These are symptoms of withdrawal and are often misinterpreted as evidence that the medicine IS working. Another thing to consider is there is no way to make precise medication for mental health. If in fact the antidepressant does work at numbing the deep pain of sorrow, it would also limit the ability to feel strong positive emotion as well. This is a known side effect called emotional blunting.

What IS depression?

Most people would recognize that there is an association with depression and negative thought patterns. Patients suffering from symptoms of depression are known to distort experiences in a gloomy and self-deprecating way. These patients likewise frequently ruminate on past experiences and exhibit a strong negative bias to events and have an overall pessimistic outlook on life. These feelings often lead to guilt and self loathing. What most people don’t recognize is these unpleasant feelings and thought patterns are not just associated with depression, they actually CAUSE symptoms of depression. Depression is not a simple disease and it usually has many factors. As with all issues related to mental health, everyone’s situation is different and there is never a single fix that will work for everyone. There is typically some combination of learned behavior and coping mechanisms.  Sometimes people are born with mental wiring associated with genetics that increases the risk of depression. Undoubtedly, traumatic or unfortunate events can all contribute to depression. But at the core, working to improve thought patterns and beliefs is what will treat depression by focusing on the cause. At best, medication can only decrease the severity of the symptoms by covering them up.

Effective Treatment

The current recommendation for treatment of depression is either antidepressants or a specific form of therapy called Cognitive Behavioral Therapy (CBT). Patients with severe depression who are treated with medication do show signs of symptom improvement earlier than CBT but this quickly fades and ultimately patients treated with CBT see more improvement and lower risk of relapse. The blueprint for the most effective therapy is based on the teachings of the Stoic philosophers of ancient Greece and Rome.Theirs was a time before the concept of psychiatry and psychology had been conceived. These earlier philosophers were referred to as  “physicians of the soul”. The creator of Cognitive Behavioral Therapy, Aaron Beck fully acknowledged he drew his inspiration from foundations of Stoic philosophy. 

Why it works

The whole premise of modern therapy is to slowly work to adjust your thought process. The goal is to change irrational negativity and learn to improve the thinking process to foster more open and less distressing emotions. This is not just thinking happy thoughts or living in denial. This is done by actively improving your mental habits, developing constructive routines and skills. 

“The happiness of your life depends on the quality of your thoughts”

Marcus Aurelius

A popular assumption is for therapy to require regular benefits with a licensed therapist over long periods of time for it to be beneficial. However, CBT is successful because it uses your own reasoning to explore your thoughts and emotions. You can explore and benefit from these principles by learning and practicing yourself. You can in effect function as your own personal therapist, which is in itself empowering. One of the basic lessons of CBT is accurately reflect by Epictetus

“Men are disturbed not by things, but by the views which they take of them”

It is not necessarily our current situation that makes us unhappy, but what we think about it. 

Epictetus’s statement is similar to what is referred to in modern therapy as cognitive distancing. Working with this belief builds the foundation that with practice, it is possible to overcome neurosis with logic and reason by restructuring how you think. The founder of CBT Dr. Beck has stated “control of most intense feelings may be achieved by changing one’s ideas”.

Core features of both Stoicism and CBT

• Be mentally present in the here and now 
• Do not dwell on events from the past
• Do not worry about what you can not control
• Do not make assumptions about what you do not know
• Questions your thoughts and feelings as they arise as they are often false

Where to go from here

Practitioners of CBT teach a triangle consisting of Thoughts, Emotions and Actions. These 3 components are deeply interconnected. Thoughts impact our emotions which then affect how we act which further affects our thoughts in a continuous way. The beauty of CBT and Stoic philosophy is the techniques are helpful for EVERYONE. You don’t have to have clinical depression, you don’t have to have terrible anxiety to improve your thought process. No matter the state of your mental health right now, it can be better by working on these techniques. And you can get started today, by yourself without seeing a therapist. Start by reading a book about Stoicism. I recommend letters from a Stoic by Seneca. This is one of the best books ever written. Read a book about CBT. Don’t just read it, learn it, live it. Monitor your thought process and continually improve. Stoic philosophy is about helping you be the best version of yourself. This is a never ending process. Continue to follow these posts and I will share with you the weekly goal I am personally working on and take this journey together with me.

“We suffer more often in imagination than in reality”

Seneca