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Excerpts from Dr. Quinn's book

Select passages from the 2nd edition of
"The Depression Sourcebook".

Please click on the topics of interest you:

Buy "The Depression Sourcebook" 2nd edition at
Order Brian Quinn PhD's latest book " Wiley Concise Guides to Mental Health: Bipolar Disorder"

On Alternative Treatments

Only a modest number of government and academic institutions have done well-designed research on natural compounds and alternative procedures for the treatment of mood disorders. Most of the research has been done on only a few compounds and most research has not been done in this country. No one has had the money to advertise the results of what little research there is to doctors or the public. As a result, until recently, natural compounds have gotten little medical or public attention.

This is unfortunate, since some of them are promising. Why are these compounds now coming to our attention? It’s certainly not because they are new. The possible antidepressant properties of St. John’s Wort, 5-HTP and SAM, for instance, have been known for decades. The main reason that we are hearing so much more about these compounds is that a change in US law in 1994 made it possible for nutritional supplement companies to market these compounds as long as they do not claim that the compounds treat illness. Suddenly, there was money to be made. As a result, the nutritional supplement companies have spent a lot of money in the last few years bringing these products to the public’s attention. They have used the existing research to lend legitimacy to the substances. As you look over the material on alternative approaches described below and ponder what might be helpful for you, consider what George Lundberg, MD, a former editor-in-chief of the Journal of the American Medical Association, has written: “There is no alternative medicine [or conventional medicine for that matter. There is only scientifically proven, evidence-based medicine supported by solid data, or unproved medicines for which scientific evidence is lacking. . . “ I will begin by describing compounds for which some scientific evidence exists. For suggestions on a comprehensive alternative treatment plan for mild to moderate unipolar depression, see chapter 11, “Putting it All Together.”

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Alternative treatments discussed in The Depression Sourcebook, 2nd edition :

  • St John's Wort
  • Amino acids
  • 5-HTP
  • SAM
  • Inositol
  • Trans-cranial magnetic stimulation
  • Essential fatty acids

Can Psychotherapy Alleviate Depression? How Does it Compare to Medication?

Since the early 1980s, researchers have been studying the effectiveness of cognitive and interpersonal therapy in the treatment of major depressive episodes. Researchers have also done studies comparing the effectiveness of these therapies to each other and to antidepressant medication. What do the results tell us about how well psychotherapy works, especially when compared to medication?

Unfortunately, the answer is not straightforward and often depends on how the outcome data are analyzed. For instance, the National Institute of Mental Health (NIMH) sponsored a study comparing the effectiveness of cognitive therapy, interpersonal therapy, an antidepressant medication called imipramine and a sugar pill (placebo) combined with reassuring contacts with a doctor in the treatment of major depressive episodes. Initial analysis indicated that the cognitive therapy, interpersonal therapy and the medication were about equally effective.

Then Donald Klein, a psychiatrist and psychopharmacology researcher, reanalyzed the data and found the following: Medication provided faster relief and greater overall benefit than both psychotherapies and placebo for patients who were severely depressed. IPT was somewhat better than placebo for this group. CBT was no better than placebo.

For mildly depressed patients, Klein’s analysis indicated that the psychotherapies and the medication were equally effective. This might lead the reader to think they should opt for psychotherapy if they suffer from mild depression. But placebo treatment turned out to be as effective as the psychotherapies in mild depression. This suggests that someone who is mildly depressed should not even bother seeking help! But then Klein did another analysis of the data. He excluded from the analysis those patients who had so-called atypical symptoms of depression (about 30% of the patients had atypical symptoms). Why? Most patients with atypical symptoms do not respond well to imipramine -- the medication used in the NIMH study (although they often have an excellent response to an entirely different class of medication called MAO inhibitors). The patients with the atypical depression drastically lowered the apparent response rate to medication. When these patients were excluded from the analysis, a clear ordering of treatment response was found. Medication was superior to both placebo and the psychotherapies even in those patients with mild depression! So what should the prospective patient do? Consider this...

A type of therapy for depression called “behavioral activation” (BA) has recently been developed as a result of efforts to determine whether the cognitive or the behavioral component of CBT was the most helpful. One study showed that BA was equal in effectiveness to antidepressant medication and that both BA and medication were better than CBT, which did not provide much more help than a sugar pill placebo. In the latest study, BA was equal to antidepressant medication even in severe depression. Both BA and medication were much more effective than CBT in this study.

Therapists practicing BA help patients shift away from dwelling on depressing thoughts to activities that are meaningful to them and that will enrich their lives. BA therapists typically put little direct effort into trying to change patients' negative thinking. Getting patients to change their behavior changes negative thinking indirectly.


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Are Cognitive Behavior Therapy and Interpersonal Therapy Superior to Less-focused, Supportive Therapy?

Many people tend to take for granted that the modern psychotherapies designed specifically for depression are an improvement over old-fashioned supportive therapy. The argument is based on the appealing notion that focusing on problems associated specifically with the illness of depression (automatic thoughts or interpersonal problems) is more efficient and effective than providing support, education and reassurance. In fact, it is not at all clear that this is true. Psychotherapy research has generally shown that therapies based on very different theories tend to produce roughly the same clinical results. There must be common elements in all forms of psychotherapy that account for this -- elements that have nothing to do with theory or specific technique. Let’s look at these . . .

Patients Sometimes Say to Me: I Want to Learn How to Deal With My Problems on My Own.
Isn't Medication Just a Crutch?

Nothing is further from the truth. This belief is based on the assumption that you could pull yourself out of the pits emotionally if only you had the guts, the right tools or if you could figure out what is “really” bothering you. You probably have more guts than the average person! If you did not you would not have been able to expend the extra effort to drag yourself through life. People with depression who keep functioning in their usual roles as worker, parent or partner (although not functioning as well or as efficiently as they would like) are like people who keep going all day even though they have anywhere from a cold to pneumonia and a fever of 103 degrees. The “right tools” can help you manage your depression but they will not fix it. And if you are severally depressed, trying to fix your depression with psychological tools may leave you feeling frustrated and upset with yourself. You will get angry at yourself for not being able to do something you thought you should be able to do. The end result is you may get more depressed. Once you understand the nature of depression, it will seem odd that you would blame yourself for being weak and unable to snap out of it.

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The Depression Sourcebook table of contents:

Chapter 1
An Overview of Depression and Other Mood Disorders
Chapter 2
Mild Mood Disorders That Masquerade as Psychological Problems
Chapter 3
Major Depression, Bipolar I Disorder, and Bipolar II Disorder
Chapter 4
Mood Disorders in Children and Adolescents
Chapter 5
Other Psychiatric Disorders Often Found Together with Mood Disorders
Chapter 6
Mood Disorders and Marital Problems
Chapter 7
Psychotherapy for Depression
Chapter 8
Medication for Depression
Chapter 9
Treatment of Bipolar Disorders
Chapter 10
Natural Compounds and Alternative Procedures for the Treatment of Mood Disorders
Chapter 11
Self-Help and Summary Guidelines for the Prospective Patient
Chapter 12
Diagnosis and Treatment of Mood Disorders in the Twenty-First Century

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