The Treatments for Depression

I have been in the business of treating depression for nearly two decades now and, during this time I have seen many additions to the treatment armoury that psychiatrists use. Since the latter half of the last century enormous leaps of progress have been made in the arena of medication - producing more effective medicines with less and less side effects. Antidepressants attack the problem at the level of brain chemistry, that's why they are particularly effective for people with a more "biological" depression that may (though not necessarily) occur in people with an inherited predisposition.

Towards the end of the last century certain therapies grew a rapidly expanding bedrock of evidence to support their success in the treatment of depression. We became more and more informed about the specific forms of therapy that worked in depression and even got an idea about the length of time they were needed to produce results. Cognitive behaviour therapy, or CBT as it is more commonly known, is the most prominent of the various therapies with success in treating depression. CBT tackles the problem, as the name suggests, at a cognitive level, and it examines the way in which ingrained patterns of processing the world around us can influence our mood and our vulnerability to develop or perpetuate depressive episodes. Versions of this started to be rolled out online, with the advent of Internet therapy and spin offs like dialectic behaviour therapy (DBT) and cognitive analytical therapy (CAT) also grew in popularity.

Each of these treatment initiatives essentially addresses the problem via the realm of thought. The medication influences the brain chemistry that in turn influences the way we think, and the therapy more directly approaches and challenges the way we think.

What I came to realise, however, over the years was that one of the key factors that contribute to depression - indeed to every form of mental illness - is, to put it simply, too much thought. Whether it's negative thought cycles in depression, flights of grandiose thinking in mania or whirlwinds of psychotic ideas in schizophrenia, the root here is that the sufferer has become trapped in a world of his own thoughts. I reckoned sometime ago, therefore - and I know I wasn't alone in this - that solutions that approach the problem from a perspective of going beyond thought, and helping people experience themselves and the world around them, as much as possible, in a deeper mindful way, might have even greater success.

A few trials that looked into therapies centring around meditation techniques started around the turn of the century and now we are in the very exciting moment of watching the results come in. Recent trials have found that mindfulness or meditation based exercises are having huge success in reducing relapse rates for depression. One study found that relapse rates reduced from 66% to 37% and a second found a reduction from 78% to 36%.

The results were so compelling that the UK National Institute for Health and Clinical Excellence (NICE) now officially recommends such interventions as an effective treatment for depression and healthcare professionals in the UK are encouraged to utilise them.

The consciousness around this is expanding so rapidly that even schools in the UK are beginning to provide regular mediation sessions for their pupils as part of a holistic preparation for life. All in all, it feels like we have come a long way; from medication through CBT, DBT, Internet therapy and CAT (all of which continue to have a place), the hyperactive world of psychiatry has finally landed upon stillness (which is where meditation gradually takes you) as an effective cure and I must say that from my vantage this has all been a great joy to watch.

Time to get back to that meditation group I think...


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Dr Russell Razzaque earned his medical degree from the University of London, he is a member of the Royal College of Psychiatrists and practices in the British National Health Service. In 2009, after years of development, he launched Sileotherapy ' a stillness based online self help program teaching people to go beyond thought and realise their true potential:

http://www.meditation-therapy.net