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Muhammed Ali

Cognitive Therapy Vs Medication For Depression

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This is a good paper for those who are interested in the subject. The implications of the findings are serious.
 
CT = Cognitive therapy
ADM = Antidepressant medication

The evidence shows that that CT is as efficacious as ADM, and that its effects are more enduring. Thus, even if CT and ADM work through the same mechanisms in the same temporal order to reduce depressive symptoms, any enduring effects of CT must be produced by mechanisms that are not mobilized in the same way by ADM. The model that is proposed in this article suggests that CT helps patients learn to recruit prefrontal regulatory brain mechanisms – a skill that these patients could continue to use long after treatment ends. 

 

In a more recent CT -ADM placebo-controlled comparison, 240 severely depressed patients 

 

Please note that these patients were severely depressed and not just moderately depressed.
 
As shown in FIG. 2, 76% of the ADM responders relapsed following medication withdrawal, compared with only 31% of the patients who had been treated with CT.38

These findings, which are consistent with the pattern observed in previous studies, indicate that CT has an enduring effect that is not found with ADM. This suggests that, whereas the acute responses to CT and ADM might be due to changes in similar mechanisms (consistent with the similar rates of change of different symptom clusters resulting from the two types of treatment), CT can be assumed to also produce changes that ADM does not.

 

Would Allah inflict upon humanity commonly occurring mental/spiritual illness that mandate the use of modernly available drugs?

 

Allah promised severe trials and also provided other means of ease.

Edited by Muhammed Ali

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Would Allah inflict upon humanity commonly occurring mental/spiritual illness that mandate the use of modernly available drugs?

 

Allah promised severe trials and also provided other means of ease.

 

 

I do understand this logic.  But isn't mental illness far more serious and pronounced in today's modern world than any other previous time in history?  Not that spirituality focused solutions have become outdated or less relevant, but maybe handling mental illness has just become a more sophisticated affair today, just as for most physical and organic ailments, and requires modern tools to handle the modern manifestations of these long standing ancient afflictions. 

 

It depends on whether you see antidepressants treating mental illness the same way as seeing antibiotics treating bacterial infections or steroids treating inflammatory conditions for example. 

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Salams,

 

This doesnt surprise me at all. It seems to me that the only time ADM is actually helpful is in cases of depression that have clear biological causes like post natal depression (although CT is still helpful in tackling any negative thinking that is triggered by chemical imbalance). For longer term depressions which are linked to perceptions in any way at all CT is going to be the better solution because it requires the patient to actively rewire their brains to think differently. AD's essentially just mask the problem for a while.

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In most cases of acute or severe depression, patients cannot mentally access CBT process without the use of medications.  Depression is a chemical imbalance regardless of the etiology of the condition.  So these treatments (meds and CBT) are usually used in concert once the patient is well enough. The patient has to be at a certain level of cognitive accessibility or they will reject or ignore the CBT process. So the treatment begins with pharmaceuticals, progresses to CBT and as the patient advances through CBT, the medications are weaned. 

 

A healthy person who has not suffered from clinical depression does not understand the depth and the impact of the condition on the functioning level of those who are afflicted. It is probably the use of the word "depression" that is used concurrently to mean sadness, disappointment or discouragement.  There is almost no connection between the two meanings.  One is a crippling disease that crushes a person's ability to function in the most basic of ways and who are living a life of extreme torment and the other is a common manifestation of the ups and downs of life.  Often those who have clinical depression are harshly judged by those who have the gift of a balanced perspective and are mentally healthy. 


Salams,

 

This doesnt surprise me at all. It seems to me that the only time ADM is actually helpful is in cases of depression that have clear biological causes like post natal depression (although CT is still helpful in tackling any negative thinking that is triggered by chemical imbalance). For longer term depressions which are linked to perceptions in any way at all CT is going to be the better solution because it requires the patient to actively rewire their brains to think differently. AD's essentially just mask the problem for a while.

 

If the meds are used as part of a therapeutic program of treatment, they are not used to mask but to lessen the symptoms to an extent that they can access treatment.

Edited by Maryaam

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Thanks for the post.The effect of CT is still underestimated but alhamdulillah it's taken more and more serious as a therapy form against depression.The power of thoughts and the ability to change them is of great value.

"The type of psychotherapy with the most research behind it is cognitive behavioral therapy (CBT), which consists of an array of techniques aimed at transforming self-defeating thoughts, beliefs, and behaviors. For example, in this type of counseling patients learn to identify their dysfunctional thoughts—such as exaggerations and black-and-white thinking—and stop or minimize this type of damaging thinking, which contributes to making depression worse."

http://www.takepart.com/article/2013/05/24/best-therapy-for-depression-counseling-or-antidepressant

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I am not going to deny the use of drugs in some situations, but I am posting this because drugs seem to be the default recommendation from many people. To them that recommendation seems to be the wise thing to do. E.g. over the years, how many times have you seen people on this forum recommending drugs for even moderate problems? How many of us know of people who are taking drugs? I know of people whose lives have been ruined by them. Most people don't even know that drug companies actually promote the use of their drugs via immoral means. Drugs are overly prescribed and are over-rated by the common person. There needs to be some education so that people learn about these things.

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"In most cases, patients cannot mentally access CBT process without the use of medications."

I doubt this.It depends on the causes and nature of "the depression".A lot of people suffer from depression due to cervical spine problems.That's why i think most important is to examine patienst physically and mentally.The body can hint to defects of the mind and the soul symptomizes in the body.It is not as simple as The statistical manuals may suggest.

Edited by mina313

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"In most cases, patients cannot mentally access CBT process without the use of medications."

I doubt this.It depends on the causes and nature of "the depression".A lot of people suffer from depression due to cervical spine problems.That's why i think most important is to examine patienst physically and mentally.The body can hint to defects of the mind and the soul symptomizes in the body.It is not as simple as The statistical manuals may suggest.

 

You may doubt it, but it is correct.  The first step in treating mental illness is with a thorough medical workup to rule out other issues that may be causing the symptoms.  And I mean thorough.

 

It is due to a lack of understanding as to how debilitating acute the symptoms of severe  depression become.  A person who is not able to raise themselves from a bed or wash or eat will not be able to access a treatment that depends on a certain level of cognition.

 

My concern is that people who desperately need treatment are shamed into not seeking it due to others who feel they are experts in an area that is extremely complex.  There is a stigma against mental illness especially in Asian communities. Many suffer needlessly when there is help from people who spend their lives studying and practising in this area.  

Edited by Maryaam

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I am not going to deny the use of drugs in some situations, but I am posting this because drugs seem to be the default recommendation from many people. To them that recommendation seems to be the wise thing to do. E.g. over the years, how many times have you seen people on this forum recommending drugs for even moderate problems? How many of us know of people who are taking drugs? I know of people whose lives have been ruined by them. Most people don't even know that drug companies actually promote the use of their drugs via immoral means. Drugs are overly prescribed and are over-rated by the common person. There needs to be some education so that people learn about these things.

 

It's the modern world.  We like quick fixes because life is quick.  Everything is with the click of a button and the flip of a switch.  We like things simple, compact, and immediate. 

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I am not going to deny the use of drugs in some situations, but I am posting this because drugs seem to be the default recommendation from many people. To them that recommendation seems to be the wise thing to do. E.g. over the years, how many times have you seen people on this forum recommending drugs for even moderate problems? How many of us know of people who are taking drugs? I know of people whose lives have been ruined by them. Most people don't even know that drug companies actually promote the use of their drugs via immoral means. Drugs are overly prescribed and are over-rated by the common person. There needs to be some education so that people learn about these things.

 

You are right in that meds are overprescribed by doctors who know little about the disease they are treating.  Antibiotics, stimulants for children who are mistakenly diagnosed with ADHD, tranquillizers  and sleeping medications are also over prescribed.  We have so many drugs floating around it is a wonder our waters are not completely toxic with them.  But people with a serious illness need to be treated with the best methodology and by specialists in the field.

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You may doubt it, but it is correct.  

 

It is due to a lack of understanding as to how debilitating acute the symptoms of severe  depression become.  A person who is not able to raise themselves from a bed or wash or eat will not be able to access a treatment that depends on a certain level of cognition.

 

My concern is that people who desperately need treatment are shamed into not seeking it due to others who feel they are experts in an area that is extremely complex.  There is a stigma against mental illness especially in Asian communities. Many suffer needlessly when there is help from people who spend their lives studying and practising in this area.

It depends on the depression what works.

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Allah promised severe trials and also provided other means of ease.

This is used and associated too lightly and too commonly to the causes of oppression. All the tests, are generally caused by other people, apart from natural causation's. For example, kids with torn limbs, cannot grow up as normal functioning humans, while the possibility was there. We know, from a collective, a few would be conditioned to accept and live as if they had  a 100limbs, but majority would suffer mental break down as time progresses.

 

 

I am not going to deny the use of drugs in some situations

Yes. I would expound regarding situations, such as sexual abuse, rape, physical pain, isolation for years etc. But herbal or also ancient medicinal practice should be advised. Each mind, functions separately to the physician.

 

 

Edited by monad

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You may doubt it, but it is correct.  

 

It is due to a lack of understanding as to how debilitating acute the symptoms of severe  depression become.  A person who is not able to raise themselves from a bed or wash or eat will not be able to access a treatment that depends on a certain level of cognition.

 

My concern is that people who desperately need treatment are shamed into not seeking it due to others who feel they are experts in an area that is extremely complex.  There is a stigma against mental illness especially in Asian communities. Many suffer needlessly when there is help from people who spend their lives studying and practising in this area.  

 

People having discussions need to make sure that they are not having disagreements over something, even though they are not speaking about the same things. We may actually agree on many matters.

 

I am sure you know that this is not an area where the leading figures agree. For example: 

 

In a groundbreaking move that has already prompted a fierce backlash from psychiatrists, the British Psychological Society's division of clinical psychology (DCP) will on Monday issue a statement declaring that, given the lack of evidence, it is time for a "paradigm shift" in how the issues of mental health are understood. The statement effectively casts doubt on psychiatry's predominantly biomedical model of mental distress – the idea that people are suffering from illnesses that are treatable by doctors using drugs. The DCP said its decision to speak out "reflects fundamental concerns about the development, personal impact and core assumptions of the (diagnosis) systems", used by psychiatry.

 

 

http://www.theguardian.com/society/2013/may/12/psychiatrists-under-fire-mental-health

Edited by Muhammed Ali

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People having discussions need to make sure that they are not having disagreements over something, even though they are not speaking about the same things.

 

I am sure you know that this is not an area where the leading figures agree. For example: 

 

 

http://www.theguardian.com/society/2013/may/12/psychiatrists-under-fire-mental-health

 

 

Please explain your comment - hopefully I am reading it incorrectly.

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You are right in that meds are overprescribed by doctors who know little about the disease they are treating.  Antibiotics, stimulants for children who are mistakenly diagnosed with ADHD, tranquillizers  and sleeping medications are also over prescribed.  We have so many drugs floating around it is a wonder our waters are not completely toxic with them.  But people with a serious illness need to be treated with the best methodology and by specialists in the field.

 

I am not going to deny the need for drugs in some cases. However I will have to ask about who the specialists are. Certain things may be the standard teaching in certain fields, but this doesn't make it right and it doesn't mean that there isn't significant academic opposition to it.

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I am sure you know that this is not an area where the leading figures agree. For example: 

 

 

http://www.theguardian.com/society/2013/may/12/psychiatrists-under-fire-mental-health

 

I know that there is a lot of disagreement on treatments - but my statement is correct.  Most on CBT have gotten to that point with meds.

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I am not going to deny the need for drugs in some cases. However I will have to ask about who the specialists are. Certain things may be the standard teaching in certain fields, but this doesn't make it right and it doesn't mean that there isn't significant academic opposition to it.

 

There are discussions about treatments in every field of medicine.  

 

No one would deny a diabetic insulin as it is not shameful to take insulin, but there are lots of lay experts in mental illness as mental illness is not seen as acceptable (due to cultural attitudes mostly) and it is seen as a shameful disease.  Then when those afflicted go untreated and suffer from suicidal or even homocidal ideation - they are judged even harsher.  What an arrogant lot we are... and all due to ignorance.

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I know that there is a lot of disagreement on treatments - but my statement is correct.  Most on CBT have gotten to that point with meds.

 

I am not going to deny that some cases will need medication, but my contention is that most cases of depression wont.

Edited by Muhammed Ali

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I am not going to deny that some cases will need mediation, but my contention is that most cases of depression wont.

 

I am confused as to why would you say that.  I have seen individuals who are so debilitated that they are  unable to talk or move without physical prompts.  They have very little receptive communication let alone expressive communication abilities in tact.  CBT requires both.  It is an interactive therapy.

Edited by Maryaam

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I think all these depression and add/adhd medications are all destructive. They are beyond harmful and destroy your self. People take it because "doctors" prescribe these "medications" that come from mostly 3rd party makers who God knows what effects they possess. Its all a scam to destroy your mental state. People think without medications their life will not get better. But one day without it, they feel like hell, even thinking about suicide. It takes the mind into a deeper and darker hole. Wake up people, no matter how many "tests" show that it has some effects, million dollar companies who are spread wide across this dependency will not jeopardize their BUSINESS. Just like the hundreds of "donation research organizations" who take 90+ % of the donations and use it for anything but research or helping those who have the diseases. I am sure some of you on here have a decapitating mental state, and are only arguing for such medicines because you DEPEND on such garbage to have a "normal" day in life, or know people. Yet at the same time, every single day, you wonder why. I suggest everyone who takes such medicines to go off of them for just a week, see what happens. Your brain has been destroyed so much, that you are way worse then your initial "problem". No such "medicine", is legitimate.

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There are discussions about treatments in every field of medicine.  

 

No one would deny a diabetic insulin as it is not shameful to take insulin, but there are lots of lay experts in mental illness as mental illness is not seen as acceptable (due to cultural attitudes mostly) and it is seen as a shameful disease.  Then when those afflicted go untreated and suffer from suicidal or even homocidal ideation - they are judged even harsher.  What an arrogant lot we are... and all due to ignorance.

 

Those who do not seek help because of cultural stigmas, would not even seek therapy. Here the disagreement isn't on the need to seek help or the need to accept human susceptibility to mental problems. It may be on the nature of treatments. I would agree with you on the arrogance (and even hypocrisy) of belittling those with mental problems.

 

There are discussions about treatments in every field of medicine.  

 

 

Yes there are. But these particular disagreements are sometimes quite severe and polarised. 

I am confused as to why would you say that.  I have seen individuals who are so debilitated that they are  unable to talk or move without physical prompts.  They have very little receptive communication let alone expressive communication abilities in tact.  CBT requires both.  It is an interactive therapy.

 

I am not talking about those people.

 

You quoted me before the edit. I meant medication instead of mediation.

Edited by Muhammed Ali

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I am not talking about those people.

 

That is severe clinical depression.  A diagnosis of severe depression is made due to the fact that the person afflicted is unable to meet their most basic functional needs.  I think it goes back to understanding the definition of clinical depression.  It is hard to separate the meaning of the word we have learned  for general use and the meaning of Clinical Depression in the medical sense.  These people are non functional and usually have suicidal ideation.  Clinical depression is a potentially fatal illness.  They not only want to end the pain in this extreme way - they have their means of carrying it out put in place as well.

 

Yes there are. But these particular disagreements are sometimes quite severe and polarised. 

 

 

Try entering the rounds of oncologists if you want to see severe and polarized.  No field wants to accept status quo - that is stagnation.   We would not be progressing with out constant debate and discussion.

Edited by Maryaam

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