Best depression treatment – is your guess is as good as mine?

by Martin

in A Depression Blog, Depression Medications

I recently had my second visit to the psychiatrist (let’s call her the Psych, for short) to discuss what might be the best depression treament for me.

My reflections after the appointment caused me to think that the more I become immersed in the world of mental health, the more of a mystery it seems to be.

And, frankly, it’s becoming clear to me that it is pretty much a mystery to everybody else too.

I mean this as no criticism of the Psych, but it seemed that she didn’t really have an answer to any of the questions I asked to try to get to the bottom of what might be the best depression treatment in my case. For example, this is the gist of some of our exchanges:

Me – “So, other than medication, are there any therapies that might help me?”

The Psych – “It’s hard to say until you try them”.

Me – “What about CBT? I’ve never felt entirely convinced by CBT, but I’ve been reading a good book about it. Do you think that could help?

The Psych – “It can help some people. It’s hard to say if it will help you.”

Me – “What about psychoanalysis? A friend of mine had psychoanalysis every day for 9 years. It seemed to help him.”

The Psych – “It’s hard to say if psychoanalysis would be any more effective for your depression than any other treatment.”

Now, you might be forgiven for asking what exactly I am paying this woman for if she doesn’t actually seem to know what’s best for me. Indeed I forgive my wife for thinking just that.

But, oddly enough, I find the Psych’s answers strangely reassuring.

From what I know (and I think this is all anybody knows), in any given case the cause of depression may be genetic, it may be related to the levels of various brain chemicals, it may be the result of stress caused by life circumstances or it may be caused by any combination of all or some of those factors.

So, whilst the physician can gain some understanding of what is going on for a particular patient through careful questioning of the patient about his or her family history, background circumstances etc., as the title of one study says, ‘there is no blood test’.

What’s more, the answers the doctor has to rely upon are mediated through that patient’s own subjective perception of things. If you’ve ever been depressed, think about how reliable your view of the world is. If you haven’t then believe me, the capacity to promote clarity of thought is not one of the depression’s best known features.

So, it seems to me that it is next to impossible for your doctor, your psychiatrist, your psychologist or anybody else to really know what is at the root of your depression, especially as there may be one or more causes each having differing levels of impact.

I’m therefore much happier to hear the Psych say that she’s not sure whether a particular treatment will work or that we have to try a particular medication to see what effect it has, rather than to hear her expressing certainties about a condition where no certainties seem to exist.

Perhaps this just appeals to me because, as a lawyer, I know that it can be professional suicide to try to predict the outcome of a process (such as litigation) that is full of unknowns and uncertainties or is just subject to the vagaries of human nature.

So, at the fees the Psych is charging and with no insurance cover, my second visit could well be my last. But it won’t be because she hasn’t given me the magic bullet to make me better.

Song of the post

I’ll dig back into my late seventies youth to bring you Graham Parker’s song of uncertainty in the face of tough questioning: “Hey Lord, don’t ask me questions, there ain’t no answers in me”, from his ground-breaking ‘Howlin Wind’ album.

US readers

Howlin Wind

UK Readers
Howlin’ Wind

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About the Author

Father, husband, writer and website publisher, discontented in his day-job, he writes here about depression - his own and in general. You can follow Too Depressed on Twitter. Please share the content on this site with all your friends, followers and contacts using the buttons above.

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Last revised on February 22, 2012

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