Attacking Major Depression​—Professional Treatments

“Awake!” is not endorsing or promoting any of the popular modes of treatment. We are simply reporting some of the recognized professional approaches. These attack a severe mental disorder that is far more intense than the “blues” that occasionally affect all of us.

THE patient’s depression was crippling. He couldn’t work and was in and out of psychiatric hospitals. Realizing that all other treatments had failed, neurosurgeon Keith Langford performed an operation, opening the man’s head and placing on his brain a battery-operated “pacemaker.” Reportedly, without damaging the brain or altering the thinking process, this “pacemaker” emits a rhythmic electrical pulse that alleviates depression.

It worked! The man regained his positive attitude and returned to work. “You saved my life,” he told the doctor. “Now I can live a normal life.”

This man had more than the normal blues. He was among the eight million Americans who yearly seek professional help for major depression​—a disorder that creates intense feelings of guilt, helplessness and hopelessness. Usually, there are disturbances in appetite and sleep, constant fatigue, crying spells and inability to derive any pleasure from life.

Very few cases require radical treatment with a “pacemaker.” Usually, however, with major depression some form of help from trained professionals is suggested. Studies indicate that in some lands as many as one out of every four women and 10 percent of the men will suffer such an episode at some point.

What treatments are available? There are a variety. Some are poles apart in their approach; yet others overlap. Why is this?

Some researchers feel that severe depressions are caused by a physical defect in the body (even if precipitated by some stressful event)​—a biochemical imbalance in the brain—​and therefore medication is considered vital in correcting this imbalance. Others argue that the disorder results from faulty thinking and that the mind creates the imbalance and can thereby rectify it. These believe that the mind needs correction by “talk therapy,” psychotherapy. There is some truth in each approach, yet neither has the full answer.

Mind and Body Involved

This issue is difficult to resolve because of the close interworking of the mind and the body. Each has decided effects on the other.

Mental disorders are very complex and every patient is different. Therefore a doctor who is acquainted with the patient usually can make recommendations as to which approach is best for the patient. If the patient is not satisfied, perhaps the doctor can assist him in seeking other specialists. The following material may be helpful in aiding both patient and doctor to realize that several treatments are available. No one form of treatment cures all cases of major depression. It is recognized, too, that within each field of treatment there is often a wide range of practitioners. For instance, in psychotherapy 130 different approaches are reported. Moreover, those using the nutritional approach may vary from prominent researchers who have behind them decades of study to some who have become “weekend experts” after attending a two-day seminar.

Talk Out Depression

When major depression is diagnosed, one recommendation is psychotherapy​—or “talk therapy.” Since a depressed person usually has greatly disturbed ideas, many have been aided by their talking to a therapist. Such professionals may include psychiatrists, psychologists, social workers and others with specialized training. However, some have found help by talking with a lovingly concerned minister.a

Armand DiMele, director of the Center for Psychotherapy, observes: “The depressed person is protecting himself by shutting down his mind and body and not allowing any stimulation. For example, when someone suffers a loss such as a death, he may go into a depression rather than face the loss.” The job of the counselor is to help the sufferer to face the feelings and anxiety that come from such a loss. DiMele continues: “If the therapist sitting with him can really nurture him through and tell him what to anticipate in body sensations, then the person gradually realizes he can cope with the emotion, and the depression lifts.”

Submerged feelings, such as anger, resentment and guilt, have often bred depression. For instance, a psychologist employed by the New York State Mental Health Department treated a 58-year-old woman suffering from severe depression. She felt that God had abandoned her and that everyone was talking against her. As this expert of 20 years’ experience began to talk with her in a kindly way each week, he noticed that in discussions about her family she never mentioned her mother, with whom she was now living. He probed. In time she revealed that she felt that her mother, by her neglect, was responsible for her beloved father’s recent death. Gradually the counselor helped her to overcome this resentment, and her depression melted away.

Since guilt is often a major symptom of depression, psychologists will endeavor to eliminate it along with the patient’s feelings of worthlessness. One woman became severely depressed when her child turned rebellious. “I was never really a proper mother, was I?” she cried to the psychiatrist. “That’s why she’s gone wrong.” The doctor helped her to see all the good she had done for the child. The guilt then vanished​—and so did her depression.

However, the treatment of most cases is unsuccessful, according to Dr. Ronald Fieve. He reports in his book Moodswing​—The Third Revolution in Psychiatry that not infrequently, after weeks, months and years of working with a moderate or severe depressive, helping him to analyze his behavior, “very little happened.”

There is also a danger here for persons who are endeavoring to live by high moral standards. Some therapists go too far, justifying attitudes that the Bible disapproves. This is done to alleviate the patient’s guilt. True, a person should neither be overwhelmed with guilt nor feel “condemned by God” if improper feelings enter his mind. Yet, rather than reasoning that such erroneous thoughts are not wrong, as some therapists would say, those who highly value the Bible’s counsel prefer to correct such ideas or dismiss them. So they have to weigh seriously (or have help to weigh) counsel offered by a therapist. Potential problems may be avoided if the patient, or a companion, explains to the therapist the importance of the patient’s religious beliefs.​—Gal. 5:16, 19-21; Jas. 1:14, 15.

Authorities in the field differ as to intensive psychotherapy’s effectiveness. One of the reasons for this is that many doctors feel that the chemical imbalance present in severe moodswings cannot always be corrected by psychotherapy. They advocate the use of . . .

Antidepressant Medication

“I used to think that people could overcome any mood by just setting their mind to it, but now I don’t believe it,” confessed one housewife who previously slumped into a major depression. “At times I would drop to the floor and just sob for no real reason.” She finally contacted a doctor who had an answer that helped her.

After listening to her symptoms of major depression, the doctor said: “First off, let me explain that you have a physical illness. I have some medication that I feel will help.” He prescribed a tricyclic antidepressant. He believed this would offset a suspected chemical imbalance in her brain and relieve the depression. “Nothing improved for a while,” but then, she said, “in six months I was like a new person, completely off the drug.”

There are over 20 antidepressants and also lithium available. These are not “pep pills” (amphetamines) or tranquilizers, which immediately either stimulate or calm the nervous system and can be addictive. Rather than hinder certain impulses that produce anxiety, as do tranquilizers, these antidepressants (tricyclics and monoamine oxidase inhibitors, MAO for short) apparently modify the levels of certain neurotransmitters in the “pleasure center” of the brain and this is believed to make it easier for pleasurable impulses to be transmitted from one nerve cell to the next. So these drugs possibly treat a chemical imbalance within the brain.b

According to Dr. Ronald Fieve, director of Fieve Lithium Clinic in New York city, “lithium treats the manic phase of bipolar manic-depression and serves well as a preventative for this disorder and sometimes helps recurrent major depression.” He reported that in a 20-year period, over 6,000 patients given lithium in a dozen countries were carefully studied. Of those suffering from manic depression, 70 to 80 percent were successfully treated.

Of course, there can be unpleasant side effects with all these drugs. Frequently, several drugs are tested until the “right one” is found. The MAO inhibitors can cause a lethal reaction if combined with certain foods, such as aged cheeses, beer, wines and chicken livers. So all drugs must be used under the careful supervision of a well-informed doctor.

“[Drug therapy] is not, however, a magic solution to all of a patient’s problems,” writes Dr. Nathan Kline of New York city, in his book From Sad to Glad. This pioneer in the use of antidepressants continues: “What it does do is correct a particular kind of functional breakdown, so that the patient can address problems with capacities restored.”

Nutritional Approach

That a deficiency in what you eat can cause mental disorders, including major depression, was established over 65 years ago. A killer disease, pellagra, was then raging in many countries and sweeping away 10,000 Americans each year. The first manifestations of the disease were usually mental disorders​—predominantly depression.

In trying to get to the root of the problem, Dr. Joseph Goldberger put some healthy persons on the same diet that he found was being provided for some mental patients​—meals consisting mainly of cornmeal, grits, cornstarch and other corn products, and a tiny amount of vegetables. He waited. Seven of the 11 participants developed the depression and came down with pellagra! The doctor then added to their diet brewer’s yeast, lean meat and milk. All quickly recovered. A nutritional deficiency had been responsible for their depression.

Corn, the bulk of the diet of the poorer people in that area, lacks almost totally a vital amino acid​—tryptophan. This led to a shortage of some of the B vitamin complex.

Scientists have found that other nutritional deficienciesc cause such symptoms as depression, nervous irritability, fatigue and personality changes. Much research has linked vitamins, especially B-complex, with the conversion of amino acids, such as tryptophan, into neurotransmitters, which carry our thought impulses between nerve cells. A shortage of certain neurotransmitters has been associated with some types of depression.

“Putting the patient in the optimum nutritional balance is the first thing to do,” explains Dr. David Hawkins, founding president of the Academy of Orthomolecular Psychiatry. But even when a nutritional deficiency is discovered, correctional supplements do not always relieve the depression.

For instance, one severely depressed patient had read a book about mega-vitamin therapy and was taking large doses of several vitamins to find relief, but without any noticeable effect. A doctor using the nutritional approach carefully examined the patient’s diet. He found that her one meal a day consisted of a hamburger and French fries, with a little lettuce and tomato. She drank 25 to 30 cups of coffee a day. Adding a variety of vegetables, fruits and nuts to her diet, and restricting her intake of coffee, reportedly brought a complete recovery in a few months.

Even some of those doctors who use the nutritional approach will use drugs and electroshock therapy too. This is because the nutritional approach often is slow, and the patient, especially if suicidal, may need immediate relief.

Doctors advocating the nutritional approach primarily use substances normally present in the body and thereby avoid the dangerous side effects of psychotropic drugs. The American Journal of Psychiatry (May 1980) reported how a naturally occurring amino acid, tyrosine, was administered to a 30-year-old woman who had suffered for several years with major depression and had reacted adversely to antidepressant medication. She “improved markedly after two weeks of tyrosine therapy.” As a test to see whether the improvement really had some psychological basis, she was given a similar looking placebo. Within a week her depression returned! When the amino acid was reinstituted, her depression was “again completely alleviated.”

Research trials have indicated that another amino acid, tryptophan, is just as effective as some antidepressant drugs, with none of the side effects. While not all trials have been successful, Dr. J. H. Growden said in summary: “It seems likely that a group of patients exist whose mood disorders do improve clinically after tryptophan is administered, either alone or in combination with more conventional therapies.”

However, a pioneer in nutritional research, Dr. Allen Cott, warns: “A doctor is always necessary to work out the correct formula. One shouldn’t go around swallowing vitamins by the handful. If a person loads himself down with B6 he depletes his bodily store of magnesium. . . . Only an experienced physician can make sure that correcting one vitamin deficiency does not create another.” So nutritionists usually recommend several supplements, including vitamins, minerals, trace elements, enzymes and amino acids. Also, it is recognized that if a supplement is used in massive doses it acts on the body as a drug.

Psychiatrist H. M. Ross, who uses vitamins and diet in his daily practice and reportedly has treated hundreds of cases of severe depression successfully, states: “Vitamins are not the sole answer to many psychiatric problems.” Echoing this balanced opinion is popular spokesman for those using this approach, Dr. Carlton Fredericks, who admits: “As psychiatrist and psychologist have become obsessed with the concept that mental disease is purely mental, so must the orthomolecular practitioner resist the temptation to place overemphasis on a single biochemical approach to emotional and mental disorders.”

A Careful Self-Search

Though help can often be found through professional treatment, the solution is usually no “one shot cure.” It is crucial that a depressed person do some honest self-searching. One 35-year-old depressed woman found that she had to make several adjustments besides those in her eating habits in order to find lasting relief eventually. She explains: “Antidepressants will not solve all your problems. You must recognize and face your fears and anxieties and change your way of thinking.”

Yes, every form of therapy has its limits. Not one of them can in itself make you a new person. Medication and vitamins may level your moods, but they cannot put your family life in order. “If you require ‘perfect’ performance on the job, ‘just right’ friends, expensive and numerous material possessions,” warns DiMele, “you may be setting yourself up for a lifelong periodic depression.”

So while there is a variety of professional treatments for major depression, never forget that a sound effort on the part of the depressed one must go along with all of them. Only then will one conquer major depression.

[Footnotes]

[Blurb on page 27]

Mental disorders are very complex and every patient is different. Therefore a doctor who is acquainted with the patient usually can make recommendations as to which approach is best

[Box/​Picture on page 23]

There is a close interplay between the mind and the body. Our thoughts can affect our body and can produce a chemical imbalance in the brain, leading to depression. Our body, because of deficiencies, disease or physical defects, can also affect our mind and contribute to depression