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Treating depression: A good mix is the best medicine

Depression can sneak up, gradually stealing a person´s will until it’s hard just to get out of bed. By the time they realize what’s going on, their friends and families may have been concerned for weeks.

Nearly 4% of the world´s population suffers from depression, adding up to hundreds of millions of people. This condition can be complicated to treat, because the withdrawal and isolation connected to it reinforces its symptoms.

Perhaps the most popular and well-known treatments for major depressive disorder (MDD) are SSRIs. These are often effective, and have been joined by SNRIs, atypical antidepressants, and others.

While medication alone is shown to be effective for MDD and related conditions, numerous studies show that combining meds and psychotherapy work even better.

Alternative treatments in the mind-body space are also shown to improve outcomes for those with depression. Here are some natural and therapy-based approaches that can help boost the benefits of medication:

CBT Therapy

Cognitive behavioral therapy (CBT) is one of the most used and effective psychotherapies for depression. It focuses on automatic negative thoughts that tend to keep people discouraged.

For example, if someone frequently thinks, “I’ll never amount to anything,” they may give into that assumption. In CBT, patients bring these thoughts into the light of day and begin to challenge them.

Because of that, their patterns of thoughts change overtime, and they learn how to take the techniques into their daily life. CBT also includes behavioral changes, where patients take small steps to challenge negative assumptions. These activation strategies help combat depression.

Mindfulness-Based Cognitive Therapy

Mindfulness-based cognitive therapy (MBCT) is a structured, 8-week program that combines mindfulness and CBT. It’s shown to prevent depression relapse as well as treat active cases, sometimes working as well as antidepressants.

There are virtual and in-person MBCT groups, as well as asynchronous programs. The traditional program includes weekly classes, along with homework meditation assignments to reinforce the practices.

Patients can also practice other mindfulness techniques on their own, through activities like yoga, Tai chi and more formal meditation. Numerous smartphone apps also offer guided sessions.

Adding Exercise

Exercise is another known activity that helps naturally relieve depression symptoms. One study comparing medication, exercise, and a placebo showed that exercise may stand up well to antidepressants. Follow-up work on this group also showed that ongoing activity decreased relapse over time.

Like with other behavioral interventions, adding new activities can be very difficult during a bout of depression. Starting with small steps can help get the ball rolling. For example, beginning with a previously enjoyable hobby or activity may work well, even if a patient has their doubts.

Increasing Social Interaction

Social isolation is one of the warning signs of depression, so it makes sense that reversing this behavior may help alleviate the problem.

Spending more time alone and less time with friends is associated with depressive symptoms. Interestingly, socializing in groups of three or more, rather than ruminating with an individual friend, may be most beneficial.

Again, the issue of socializing brings up the chicken and the egg problem. Even if a patient is not ready to socialize, they may start simply by visiting a store, mall, or coffee shop until they feel more motivated to interact.

Also, being around others, even at a distance, may break them out of an isolation trend.

Finding the Right Mix

The addition of SSRIs and other depression medications was a game-changer in mental health. We know now that other psychological and behavioral changes work as well, and that combining these may add up to the best outcomes.

With this in mind, starting with one or two goals can help jumpstart the process of breaking out of depression. For some, certain activation strategies may help them feel better faster, and prevent relapse. At the very least, they probably can’t hurt.

Resources

American Psychological Association. (2011). The exercise effect.

Beck Institute. (2018). Introduction to CBT.

Cuijpers, P., Sijbrandij, M., Koole, S. L., Andersson, G., Beekman, A. T., & Reynolds, C. F., 3rd (2014). Adding psychotherapy to antidepressant medication in depression and anxiety disorders: a meta-analysis. World psychiatry.

Sipe, W. E., & Eisendrath, S. J. (2012). Mindfulness-based cognitive therapy: theory and practice. Canadian journal of psychiatry.

World Health Organization. (2021). Depression.

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