Dr. Zorba: Study finds mindfulness therapy just as good as drugs for depression

[neversickanymore]

Dr. Zorba Paster: Study finds mindfulness therapy just as good as drugs for depression
Dr. ZORBA PASTER | family physician, Dean Health
5/28/2015

Depression is a recurrent disorder affecting millions of people. By some estimates, 5 percent of the population suffers from it at one time or another.
For some it’s a one-and-done episode, but for others it happens over and over again. And while drugs have monumentally changed many people’s lives for the good, they have side effects.

The first-generation group of drugs, called tricyclics, cause dry mouth and sleepiness. The next generation, the SSRIs (selective serotonin re-uptake inhibitors), can cause ejaculatory dysfunction in men including difficulty getting an erection or keeping it long enough to “finish.” A similar type of orgasmic dysfunction can occur in women.

Psychotherapy is an excellent non-drug treatment that works for many. The old-fashioned Freudian psychoanalysis has not been shown to have any effect at all, while the relatively new kid on the block, cognitive behavioral therapy, has been found to be quite useful. A good psychotherapist can do wonders.

And, according to new research published in the journal The Lancet, mindfulness therapy might also be quite useful.

Here’s the scoop: Nearly 500 patients with long-term depression who were on medications for years were divided into two groups. One group continued on their meds just as before, and the other group dropped their meds and started MBCT — Mindfulness-Based Cognitive Therapy — a structured training for the mind and body in which people are encouraged to change the way they think and feel about their life and their experiences, and also how they look at their ups and downs.

This therapy teaches people how to “constructively” face their feelings and how to calm their mind when it’s agitated. This is not a one-and-done session — it’s not something that’s learned immediately.

With the research group, there were eight two-hour sessions, and everyone was given homework. Participants also were offered four follow-up sessions over the next year.

Both groups were followed for two years. The results showed that mindfulness therapy was just as effective as medications. This non-drug approach took more time and more training, but it was just as effective as medication. Good news.

Now, I don’t recommend that anyone who is reading my muses stop their medication. If you’re on drugs and want to toss them, it’s important to do it the right way — under supervision. Some shouldn’t stop them at all, while others have to do it on a gradual reduction basis so they don’t have a rebound.

My spin: Too many people view depression as a character flaw, something you can just get over — stiff upper lip and all, or “just get on top of it and you’ll be OK.” This outmoded view is still far too common in our society.



contiuned http://host.madison.com/print_only/...20d-58ff-94fc-1f0283497cfb.html#ixzz3bSS5xJBN

 

[Felonious Monk]

Good piece. I would generally agree. I've been on a fair number of SSRIs and other anti-depressants and I would say, for myself anyway, that psychedelics, therapy, cannabis and meditation, now just cannabis and meditation, are more effective than medication. Medication might have helped in crisis, but when I was willing to work at it, any of my own methods were just as effective. With medication it also gave a perverse incentive not to do the work on myself, plus it's the "in" that let's the Dr. write a dozen other prescriptions as well..

 

[Burnt Offerings]

I guess it really depends on whether or not you believe that there's a neurological basis for depression.

But even if there's a neurological basis, I suppose there's still the possibility that you can have a substantial effect on the physiological processes of the brain simply through conscious effort, ie meditation and things like that.

Depression is a really vexing problem, though. My mother has "clinical depression" that is around even when things are going well in her life...she's tried pretty much everything to combat it and nothing has really worked. I think she finds some solace in religion, though.

 

[slimvictor]

no need to choose meditation or drugs.
why not just use both?

 

[Crankinit]

I guess it really depends on whether or not you believe that there's a neurological basis for depression.

Not really, the ability of meditation to influence brain structure has been demonstrated fairly extensively.

no need to choose meditation or drugs.
why not just use both?

I guess it comes down to a case by case basis. What works for one person might not necessarily work for another - best thing to do is to explore all available treatment options and see what helps. I think ideally you want to keep any kind of drug intake on as short term a basis as is possible (especially when the drugs in question have a massive list of side effects and cause physical dependence), but ie. putting someone on pills for a few months (which, from every account I've heard, is about the longest period over which they have a net positive effect) while they undergo therapy and learn meditation/mindfulness techniques could work very well, and I think it's something we'll see more of in the future.

 

[Burnt Offerings]

Not really, the ability of meditation to influence brain structure has been demonstrated fairly extensively.

Didn't the next sentence of what I posted pretty much acknowledge that?

 

[Felonious Monk]

I guess it really depends on whether or not you believe that there's a neurological basis for depression.

But even if there's a neurological basis, I suppose there's still the possibility that you can have a substantial effect on the physiological processes of the brain simply through conscious effort, ie meditation and things like that.

Depression is a really vexing problem, though. My mother has "clinical depression" that is around even when things are going well in her life...she's tried pretty much everything to combat it and nothing has really worked. I think she finds some solace in religion, though.

I totally agree, I've experienced depression when things are objectively great as well, it can be as much of a spiritual problem than a purely neurological or social one, though I'm sure it has every component possible, in varying ratios in different people.

At different times people need different things as well. There's a time in my life that the only thing that saved me was a pharmaceutical intervention, but I now have tools so I have more awareness and control before it gets that bad. Sometimes it's also "manning up" and changing things in your life even if it's difficult/unpleasant.

A spiritual hobby, like religion, is also very helpful. I have art/drugs/culture myself, but I could exchange it for religion or AA if I wanted to, they fulfill the same need.

no need to choose meditation or drugs.
why not just use both?

I totally agree, for many people both are probably the best answer. Except there's a 3rd part that's more important than either of the first two, and that's talk therapy. Medication is at most 30% of the puzzle, but it's by far the easiest, so it's often the only one.

 

[SixBuckets]

How effective is "just as effective", though?

I know that if a depressive goes to their psychiatrist and says that the new antidepressants aren't working, they'll get a range of responses which may include "Let's change you to a different medication" or "antidepressants don't work for everyone" or "give it time, they take a while to stop working".

However, every time I've told a psychologist or other meditation proponent that mindfulness does nothing for me, the response has been "You're doing it wrong".

 

[noone1]

The problem is psychiatry in a lot of ways is more of an art than a science in terms of diagnosis. Definitely a lot of people need to be on medication but who is hard to diagnose just based on a doctors say so. A lot of medications have huge placebo effect like 20%. Might as well try meditation, spirituality, exercise, good eating first if you can (or all plus medication)

 

[Crankinit]

How effective is "just as effective", though?

I know that if a depressive goes to their psychiatrist and says that the new antidepressants aren't working, they'll get a range of responses which may include "Let's change you to a different medication" or "antidepressants don't work for everyone" or "give it time, they take a while to stop working".

However, every time I've told a psychologist or other meditation proponent that mindfulness does nothing for me, the response has been "You're doing it wrong".

Well there's the obvious issue of there being no single defined "depression," it's just a cluster of symptoms piled together under a single label because they frequently occur together. Compared to, say, a bacterial infection, where the cause, effects, treatment and side effects are generally known, psychiatric diagnosis is rather imprecise. Perhaps your symptoms don't respond to meditative practices simply because the cause isn't something influenced by meditation. You've discussed chronic pain extensively in the AUDD section, if the depression is caused by living with chronic pain, then I don't see why it should be assumed that basic mindfulness would lift it if the key issue, the pain, is still there.

The second issue is that meditation isn't a prescription like a pill, you can't just say "go meditate for 30 days and see if it helps." It's a skill which takes months to develop to a basic level and years to master (if one could ever be said to "master" it), assuming you dedicate yourself to at least 30 minutes or so of daily practice. It's also a deeply personal and highly variable practice, one which manifests in a myriad of forms of traditions which differ tremendously from each other in technique, effect and intensity. Meditation was never intended to be a prescription, a rote activity to cure whatever ails you. Most meditative systems were developed in some combination of either monastic settings or within yogic or martial arts lineages for the purpose of spiritual self exploration or as a form of developing self mastery and mind-body connection. It was never intended as an activity which the population at large would participate in.

Yes, practicing it in a sincere and dedicated fashion for an extended period of time under the guidance of an experienced teacher will yield various physical and psychological benefits, that much has been demonstrated, but it is a skill and a lifestyle change (thinking of it as the mental - although there are of course physical components to most meditation systems - equivalent of working out at the gym wouldn't be too bad an analogy in terms of the learning curve and the dedication required), not a medicine, and certainly not a psychological panacea. In certain circumstances it can even cause negative experiences or symptoms of varying intensity, either from improper practice or as a part of the process which the practice is intended to induce, but those who push it as though it is just another treatment rarely mention this.

 

[herbavore]

For me mindfulness practice has been a very powerful healing tool. It has changed the way that I think and that continues to change and improve the way I perceive my life and relationships. I will admit to having a very strong anti-drug bias but I am not so arrogant as to assume I know what is best for everyone else in the world so please do not take my criticisms of over-medicating to be an outright denial of the benefits that some people may receive). We can all agree that drugs (and the diagnoses that support their use) are vastly over-used, in America at least. Working in an elementary school and seeing increasing numbers of children under 12 "medicated" for what are essentially behavioral issues is alarming to say the least. Telling people that they have faulty brain chemistry that requires a lifetime of medication (the analogy to diabetes is often used) creates a medical epidemic when I think what we have is a case of our culture having reached a crisis point: it no longer supports the authentic humanity of any of us while demanding that we continue to prop it up, blinded to our own complicity. The result is disconnection to the self and to each other.

Diagnosing children as young as 3 with bipolar disorder and depression should be a crime. Medicating children that do not fit into traditional school systems with amphetamines (and giving them a diagnosis for what is essentially just a brain variation) is also criminal in my mind. I am all for the research into the brain that is shedding light on what makes a person like me distracted, impulsive and antsy by nature but if all that research does is give me a "disorder" label, no thanks. My brain does not work in the same way that many others do but then again, theirs don't work like mine. In addition to having a harder time accessing motivation (being spacey), being unfocused and distracted etc, my brain also gives me enthusiasm (I have never been bored), creativity and hyper-focus when I am engaged. Yes, I could choose to medicate myself with amphetamines which artificially increase my productivity (and how!!) but at what cost? Depression on the comedown, all the health ramifications like messing with metabolism, hormones etc, not to mention my new victim status in my own mind ("I have a disorder" and therefore am at a disadvantage to "normal" people). I know we are talking about depression and I have just strayed off into ADD/ADHD but I think it relates in that mindfulness has helped immensely in this area as well. Being ADHD/ADD-defined means that you are rarely living in the present; your mind is jumping around so fast you are not sure what moment you are living in! Bringing your awareness back to your breath, your body and the present moment is an indispensable skill for a person like me.

Clinical depression runs in my family and I have seen (though not experienced) people I love very much suffer greatly. One thing I will say that I have observed is that my relatives who are chronically depressed live lives that do not nourish them--in other words they are deeply unhappy with even their own accomplishments and nothing ever seems to be enough.T hey have spent years trying medications but scoff at things like self-awareness retreats, spiritual practices, bodywork, etc. OK, we are all different and I will be the first to admit that the world of bodywork and self-awareness retreats can be trite and ridiculous in the wrong hands but it can also be very rewarding and life changing in the right hands. I would much rather give years of my life to exploring those avenues than to exploring different pharmaceuticals. The "side effects" for my relatives have been wanting to sleep every hour of the day, extreme weight gain, flattening of emotions or heightened rage and loss of libido for most of their adult lives. When one barely positive effect out of many negative effects is seen as treatment you have to question the treatment.

Legally prescribed drug use should be like any other drug use: informed and carefully considered. In America, most doctors that prescribe these medications do not even know how to safely wean their patients off of them. When the very "experts" that you should be able to trust are blindly saying, "try this/try that/try this again with that" it becomes very hard to be informed. For people with persistent and chronic depression it would seem that the most proactive thing to do then is to find a psychiatrist that works from a holistic point of view. That doctor will most certainly prescribe drugs minimally and carefully while also prescribing adjunct therapies that enhance a person's innate power to heal.

 

[Jabberwocky]

While he was in my area I had a great relationship with a therapists, but he was a special kind of trauma therapists - I mean how many psychotherapists end up suggesting you go to central America to learn how to administer iboga under a Bwiti shaman/priest (MUGANDA!) with them?

Mindfulness is not some lofty, priest like thing that only ordained monks can do properly. Mindfulness can be so easily misunderstood, and that is just one of an almost infinite array of misrepresentations (both in the communities it's been transplanted to in the West and its homes in the East). It is so easy to begin one's practice. Truly one may begin anywhere. With more experience, one encounters many questions, along with insights (there is even a whole practice called, not very originally, "insight practice", designed to elaborate and strengthen the realizations arising through insight during practice).

I have a good friend who ended up encouraging me, or getting me to encourage myself, to begin my formal practice. The single most important thing he taught me is that there is no one proper way to practice mindfulness. In fact, we will all do it in our own way. The last thing anyone should be concerned about it whether they are "doing it right," but alas...

I should mention that the faddishness many people have noticed in the last decade, compared to the 50-80's especially (at least for the generation directly prior to me) is bothersome. But there is absolutely nothing wrong with encouraging people. Worst case scenario they don't learn anything. Much more often than that they come away with some good Mindfulness Based Stress Reduction techniques that significantly reduce the stress they feel (anxiety, insomnia, depression, whatever tweeks you out MBSR can generally help; not always, but much more often than not).

I have to agree with herby, that finding a nurturing Sangha is simply invaluable. I mean I would never have been able to pursue my formal study without scholarship/financial support from many different groups. The support of such a community goes so much further than money of course, that was the most obvious thing I initially noticed the most though. My how times have changed. This note about sangha does apply to any nourishing, supportive community (for some good people this extends to BL).

Thieving junkboxes make great mindfulness students by the way. Nothing quite like a IVDU nodding out and drooling during a community practice (it's so much nicer than people who fall asleep and then snore).

IN ANY CASE: I choose my practice AND a few dissociative psychedelics

Why is slim always so right?

 

[SixBuckets]

Well there's the obvious issue of there being no single defined "depression," it's just a cluster of symptoms piled together under a single label because they frequently occur together. Compared to, say, a bacterial infection, where the cause, effects, treatment and side effects are generally known, psychiatric diagnosis is rather imprecise. Perhaps your symptoms don't respond to meditative practices simply because the cause isn't something influenced by meditation. You've discussed chronic pain extensively in the AUDD section, if the depression is caused by living with chronic pain, then I don't see why it should be assumed that basic mindfulness would lift it if the key issue, the pain, is still there.

My depression was/is 'caused by' bipolar disorder. There's no agreed cause for bipolar disorder, but it has a strong genetic component, and definitely runs in my family. I know that what I experience as "depression" seems to be very different to what people with unipolar ("regular") depression describe as "depression".

The second issue is that meditation isn't a prescription like a pill, you can't just say "go meditate for 30 days and see if it helps." It's a skill which takes months to develop to a basic level and years to master (if one could ever be said to "master" it), assuming you dedicate yourself to at least 30 minutes or so of daily practice. It's also a deeply personal and highly variable practice, one which manifests in a myriad of forms of traditions which differ tremendously from each other in technique, effect and intensity. Meditation was never intended to be a prescription, a rote activity to cure whatever ails you. Most meditative systems were developed in some combination of either monastic settings or within yogic or martial arts lineages for the purpose of spiritual self exploration or as a form of developing self mastery and mind-body connection. It was never intended as an activity which the population at large would participate in.

I agree entirely with this! I think the whole "try this eight week course of meditation and improve your mental health" thing is actually really appropriative and gross.

I've explored different types of meditation since I was 15. My experiences have ranged from it having exactly zero impact on my mental health and state of mind, to having it significantly increase my anxiety and chronic pain. It's just not for me.

Yes, practicing it in a sincere and dedicated fashion for an extended period of time under the guidance of an experienced teacher will yield various physical and psychological benefits, that much has been demonstrated, but it is a skill and a lifestyle change (thinking of it as the mental - although there are of course physical components to most meditation systems - equivalent of working out at the gym wouldn't be too bad an analogy in terms of the learning curve and the dedication required), not a medicine, and certainly not a psychological panacea. In certain circumstances it can even cause negative experiences or symptoms of varying intensity, either from improper practice or as a part of the process which the practice is intended to induce, but those who push it as though it is just another treatment rarely mention this.

This is my point - trust me, if any research was done on any form of medication that had positive impacts on 100% of participants, we would be hearing about it, because that is completely unheard of in the field of psych research. It just doesn't work for some people (but try telling professional advocates that).