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Old 01-07-2004, 08:22 PM   #1
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carrielynn HB User
Study on CBT vs. anti-depressants

Hey Everyone,

There was an article in the Wall Street Journal yesterday (1/6/04) about a recent study that compared how cognitive behavior (cbt) therapy and antidepressants each affected the brain. The study is published in the Archives of General Psychiatry -- Jan issue.

Anyway, according to the WSJ article, the study "found that antidepressants reduce activity in the brain's emotion centers, called the limbic system. Cognitive-behavior therapy quiets overactivity in a different region of the brain -- the cortex, which is the seat of higher thought."

It then says that cbt "gives patients an 'over-ride' capacity so that when sad feelings bubble up from the brain's emotion centers patients can resist being sucked back into the pit of depression."

The article goes on to compare relapse rates of antidepressants and CBT, saying that there's a relapse rate of 80% in the year after stopping drugs, but a relapse rate of 25% in a year after ending CBT.

Apparently it was a surprise to the researchers that cbt and anti-depressants operate on different regions of the brain... they originally thought that if you do well with either treatment your brain will change in the same way, no matter how you were treated.

CarrieLynn

 
Old 01-08-2004, 07:43 AM   #2
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thickman HB User
Re: Study on CBT vs. anti-depressants

Interesting.

Sounds like the best thing to do is a combination of both.

 
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Old 01-08-2004, 08:14 AM   #3
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carrielynn HB User
Re: Study on CBT vs. anti-depressants

Quote:
Originally Posted by thickman
Interesting.

Sounds like the best thing to do is a combination of both.
I think anti-depressants can get you out of the "hole" in order to function better, but I also think it's necessary to utilize therapy like CBT to figure out what got you into the anxiety and depression. Anti-depressants buy you some time in order to do that. According to the article (and the 80% relapse figure cited backs this up), "... pills exert their effect only as long as a patient takes them."

All that being said, I want to add that when I saw a psychiatrist last spring, he put me on Zoloft and told me I would be on it for over a year and probably "maintenance dosage" the rest of my life. When I argued with him about this "sentence" he was imposing on me, he cited statistics ... I think he used higher numbers about the relapse rates than the WSJ article used. But I was able to get off the Zoloft in 6 months and I'm feeling better than I have in years. I attribute this to therapies like CBT and biofeedback and neurofeedback. I just want to make sure everyone reading these articles knows that you don't have to be a statistic. Or you can be part of the statistic that does well. I truly believe you can make that choice. I also know from personal experience that it's extremely hard work to get better... (just as it's hard work to lose 100 pounds).

CarrieLynn

 
Old 01-08-2004, 08:18 AM   #4
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Re: Study on CBT vs. anti-depressants

Hmmm... RIght now I am on Celexa and have been stuck on it for over 3 years now... My system has grown dependant...

I have tried to "wean off" in the past... Funny thing is, after several weeks of weaning/lower dosages my system gets very depressed... As soon as I pop my correct dosage, I stabalize...

I dunno, mind you, I have some BP Tendancies according to some doctors, so who the hell knows...

As for CBT and stuff, I have so much difficultly with "compliance" when it comes to doing things... I am only compliant with taking meds ONCE A DAY IN THE MORNING... if i try any other medication (say pain or antibiotics) where I need to take them 3 times I day, I fail miserably.

 
Old 01-08-2004, 09:41 AM   #5
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~Kris~ HB User
Re: Study on CBT vs. anti-depressants

CarrieLynn,
Were you doing CBT on your own, or with a psychiatrist?
I have an appointment with a psychiatrist in April, and I'm hoping I don't talk 15 minutes and then leave there with meds. This is my first time going to a psychiatrist and I'm not wild about trying meds right now. I've had major problems with AD's. Should I see a psychologist rather than a psychiatrist? I'm waiting 3 friggin' months and I just want to make sure I'm doing the right thing.
I'm not saying I'll never take meds again, however I want to try a few more options b/f going there.

 
Old 01-08-2004, 11:45 AM   #6
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carrielynn HB User
Re: Study on CBT vs. anti-depressants

Quote:
Originally Posted by ~Kris~
CarrieLynn,
Were you doing CBT on your own, or with a psychiatrist?
I have an appointment with a psychiatrist in April, and I'm hoping I don't talk 15 minutes and then leave there with meds. This is my first time going to a psychiatrist and I'm not wild about trying meds right now. I've had major problems with AD's. Should I see a psychologist rather than a psychiatrist? I'm waiting 3 friggin' months and I just want to make sure I'm doing the right thing.
I'm not saying I'll never take meds again, however I want to try a few more options b/f going there.
I am not a professional, so keep that in mind.

That being said, here's my opinion. I don't think a psychiatrist is going to help you with CBT. Most psychs these days are only trying to evaluate you to figure about the best medication to put you on. I remember calling for an appointment with a psychiatrist and telling the receptionist that I didn't want to take medication. She replied, "That's all we do here." So by virtue of me walking in the front door, I was setting myself up for taking medication. I don't have any idea what the psych will do when you see him/her, but I suspect your experience will be similar.

If you're going to try to do CBT, I would see a psychologist, someone who is not going to suggest you go the medication route right away and who is willing to work with you on your thoughts and feelings. I have been in psycho-therapy off and on for about 10 years. In the beginning I only went when things were bothering me. Then I decided to get serious and start going once a month to give myself some accountability and to stay on track. One of the therapists I saw suggested I buy the "Feeling Good Handbook" by David Burns. It has worksheets and helps you understand "stinking thinking" that gets you off track.

Anyway, I believe CBT is useful because it shows how negative thoughts can affect who you are.

However, I started making the a lot of progress when I saw a biofeedback therapist. We did muscle biofeedback for several weeks so I could see how my anxiety was making my muscles tense. We then started doing neurofeedback, which does brainwave training. I see this therapist once a week. It's basically like weightlifting for the brain... the computer feedback works beyond your conscious thoughts and takes your brain to different states -- shows your brain different ways of operating. I have started having more insights since doing this and I can actually understand better what the CBT therapist was trying to tell me all those years. It really is true that your thoughts create who you are, but if you have a hard time recognizing your thoughts, or recognizing what feeling good feels like, it's difficult to change things. The neurofeedback is showing me how to do that. It's so difficult for me to explain here... it's experiential. Now that I'm experiencing it, I understand, but it's on a deeper level than I can adequately talk about at this time. All I can say is my "being" has changed.

The neurofeedback therapist has told me that saying negative things about yourself actually changes your nervous system. For example, if you think "I am a bad person" your nervous system works to make that happen. She said, "I am" is a CREATIVE statement. You create yourself by these statements.

And, as the WSJ article shows, CBT does change your brain... so if you can change your thoughts, you can change your brain. Again, this is not an easy thing to do and it doesn't happen overnight. I still struggle with it. I was a very motivated "student" and I found it very difficult. I don't think I could do it without something like neurofeedback. If I didn't have neurofeedback, I think another therapy like meditation or yoga which can calm the nervous system would be good to do. I have a friend whose husband suffered from severe depression and he started meditating every day. She said it took a long time, but he got better and better and he's fine today. He never went on medication.

The Association for Applied Psychophysiology and Biofeedback (AAPB) has a website with a directory of bio and neurofeedback therapists. (Under the Find a practitioner link). There's also a book that explains neurofeedback called "A Symphony in the Brain." by Jim Robbins. If you go this route, make SURE you find a qualified and experienced therapist... ask a lot of questions about their background and make sure he/she understands what's going on with you. This -- and CBT -- are not overnight cures and you have to be committed to it.

good luck!

CarrieLynn

 
Old 01-08-2004, 01:33 PM   #7
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~Kris~ HB User
Re: Study on CBT vs. anti-depressants

Thanks for the info.
Can I just call and make an appointment with a psychologist or do I have to be referred?
I've read "Been There Done That Do This" and although I haven't gotten real serious with it, I do think it's helping. I'm more aware of my negative thoughts and I try to think differently in certain situations.

 
Old 01-08-2004, 01:55 PM   #8
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carrielynn HB User
Re: Study on CBT vs. anti-depressants

Quote:
Originally Posted by ~Kris~
Thanks for the info.
Can I just call and make an appointment with a psychologist or do I have to be referred?
I've read "Been There Done That Do This" and although I haven't gotten real serious with it, I do think it's helping. I'm more aware of my negative thoughts and I try to think differently in certain situations.
I don't know if things have changed, but I think I just called the psychologist up and made an appointment.... didn't need a referral. My brother-in-law had seen this particular woman and recommended her.

I would talk to friends and relatives who you trust and see if anyone has recommendations. Also, there are lots of different types of helping professionals, so if you don't like the person you see, change as soon as possible and see someone else. Make it clear to them you want to exhaust all routes before you try medications. There are many wonderful, caring, competent professionals out there, but like everything in life there are also some "weirdos", according to some of my friends' experiences, so don't automatically trust everyone.

I haven't read "Been There Done That Do This" so I can't comment on it. I think anything that helps is good, though. I do think it's necessary to make a commitment to feel better and to practice exercises that are recommended on a daily basis, if possible. It's just like losing weight or eating healthy or exercising... you have to do it every day. If you slip up, or miss a day, don't worry about it or flog yourself, just get back on the horse and keep going.

CarrieLynn

 
Old 01-08-2004, 05:49 PM   #9
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cahcinderella HB User
Re: Study on CBT vs. anti-depressants

Hi, everyone. I just want to add my cbt experience to this discussion. I am on 20mg of Lexapro and see a psychologist and psychiatrist. I finally got sick of all of this and ordered Lucinda Bassett's, The Midwest Center Attacking Anxiety And Depression. It is a 16 week cbt program. Let me just say, I am on week 3 and haven't felt this good in a long time. I went from wanting to die and not wanting to wake up in the morning to waking up and actually wanting to face the day. I recommend this program to everyone as long as you're ready to give it a chance. I still am on meds and see my therapist but this is what has really, really helped me. good luck to all of you. ~cindy~

 
Old 01-14-2004, 06:05 PM   #10
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Re: Study on CBT vs. anti-depressants

Quote:
Originally Posted by carrielynn
I don't know if things have changed, but I think I just called the psychologist up and made an appointment.... didn't need a referral. My brother-in-law had seen this particular woman and recommended her.

I would talk to friends and relatives who you trust and see if anyone has recommendations. Also, there are lots of different types of helping professionals, so if you don't like the person you see, change as soon as possible and see someone else. Make it clear to them you want to exhaust all routes before you try medications. There are many wonderful, caring, competent professionals out there, but like everything in life there are also some "weirdos", according to some of my friends' experiences, so don't automatically trust everyone.

I haven't read "Been There Done That Do This" so I can't comment on it. I think anything that helps is good, though. I do think it's necessary to make a commitment to feel better and to practice exercises that are recommended on a daily basis, if possible. It's just like losing weight or eating healthy or exercising... you have to do it every day. If you slip up, or miss a day, don't worry about it or flog yourself, just get back on the horse and keep going.
CarrieLynn

Hi Carrielynn-
Excellent series of posts, thanks! CBT changed my life after being on meds and in therapy for years. It is well worth the effort required in my opinion, but you do have to practice using the tools on a daily basis to get the most out of it. I found Been there Done That? Do this! and Feeling Good to be by far the best resources on CBT. I still refer back to both of them to this day. Take care and keep min touch
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Old 01-14-2004, 06:11 PM   #11
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Re: Study on CBT vs. anti-depressants

Quote:
Originally Posted by ~Kris~
Thanks for the info.
Can I just call and make an appointment with a psychologist or do I have to be referred?
I've read "Been There Done That Do This" and although I haven't gotten real serious with it, I do think it's helping. I'm more aware of my negative thoughts and I try to think differently in certain situations.
Hi Kris,
I'm happy to hear you are having some success with CBT Remember the more serious-effort you put into CBT the more rewards you will reap. Having said that, we all have to go at our own pace so perhaps you are not ready to jump in head first yet; don't fret though as you will get there when you are ready
Once you get good at practicing the tools in the "Been there.." book and feel ready for more I would recommend getting a copy of Feeling Good by David Burns. They are my two favorite books on CBT and great resources. Take care and keep us posted on your progress?
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Old 01-15-2004, 06:20 PM   #12
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tweedledee HB User
Re: Study on CBT vs. anti-depressants

Quote:
Originally Posted by ~Kris~
CarrieLynn,
Were you doing CBT on your own, or with a psychiatrist?
I have an appointment with a psychiatrist in April, and I'm hoping I don't talk 15 minutes and then leave there with meds. This is my first time going to a psychiatrist and I'm not wild about trying meds right now. I've had major problems with AD's. Should I see a psychologist rather than a psychiatrist? I'm waiting 3 friggin' months and I just want to make sure I'm doing the right thing.
I'm not saying I'll never take meds again, however I want to try a few more options b/f going there.
i would recomend a psychologist. all the psychiatrists i've seen wanted to prescribe drugs and none were interested in talk therapy. one even told me that wasn't his job. i think they're biased towards prescribing drugs. a psychologist can't prescribe anything and is biased towards talk therapy.

 
Old 01-16-2004, 11:15 AM   #13
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Endymion HB User
Re: Study on CBT vs. anti-depressants

Just want to add my thoughts to this discussion.

I've been on various ADs for several years. Up till about a year ago, I got prescriptions from my GP, with no therapy. Last spring I was feeling suicidal, and finally was referred to a psychiatrist, who's prescribing paxil and wellbutrin. I'm also seeing a therapist, who suggested I pick a self-help book. I'm working my way through Feeling Good right now, and I have to say it's been very, very helpful. (The therapist hasn't done much for me, to be honest.) I work at CBT daily, keeping a log of dysfunctional thoughts and doing the exercises. I am starting, finally, to notice improvement. I'm getting through some situations (that would have triggered a depressive episode in the past) without really giving them a second thought. What a relief!

As I see it, the medication just helps to quiet the emotions, allowing me to "talk myself out of" my depression. With the barrage of emotions under control, I can think rationally about what's really bothering me. But I know from experience that if I just stop the meds, the depression will come back with a vengeance.

Ultimately, I hope the CBT helps me beat depression so I can wean off, or at least cut way back on, the ADs. So, I see CBT and ADs as going hand-in-hand. One wouldn't help me much without the other.

 
Old 01-19-2004, 12:19 PM   #14
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billy7772 HB User
Re: Study on CBT vs. anti-depressants

Quote:
Originally Posted by Endymion
Just want to add my thoughts to this discussion.

I've been on various ADs for several years. Up till about a year ago, I got prescriptions from my GP, with no therapy. Last spring I was feeling suicidal, and finally was referred to a psychiatrist, who's prescribing paxil and wellbutrin. I'm also seeing a therapist, who suggested I pick a self-help book. I'm working my way through Feeling Good right now, and I have to say it's been very, very helpful. (The therapist hasn't done much for me, to be honest.) I work at CBT daily, keeping a log of dysfunctional thoughts and doing the exercises. I am starting, finally, to notice improvement. I'm getting through some situations (that would have triggered a depressive episode in the past) without really giving them a second thought. What a relief!

As I see it, the medication just helps to quiet the emotions, allowing me to "talk myself out of" my depression. With the barrage of emotions under control, I can think rationally about what's really bothering me. But I know from experience that if I just stop the meds, the depression will come back with a vengeance.

Ultimately, I hope the CBT helps me beat depression so I can wean off, or at least cut way back on, the ADs. So, I see CBT and ADs as going hand-in-hand. One wouldn't help me much without the other.

Hi Endymion,

Great note! Your experience sounds somewhat similar to mine as being on AD's while I learned CBT was helpful and as I got better and better at using the tools I was able to slowly reduce and get off of all medication and have not looked back. I still practice the CBT tools and they continue to naturally become a bigger and bigger part of me and thus automatic in the same way that the inaccurate thoughts were automatic before. Keep at it and you will get there too I'm also happy to hear you are using one of my two favorite books; isn't it awesome

Take care!
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Old 01-19-2004, 05:43 PM   #15
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Re: Study on CBT vs. anti-depressants

Quote:
Originally Posted by carrielynn
I am not a professional, so keep that in mind....

That being said, here's my opinion.....I believe CBT is useful because it shows how negative thoughts can affect who you are.....this -- and CBT -- are not overnight cures and you have to be committed to it.

good luck!

CarrieLynn

Hi CarrieLynn,

Just wanted to say thanks for your posts. Very informative and insiteful stuff!! I'm going to really have a crack at CBT and possibly the biofeedback you mentioned. Particularly because I have had chronic neck pain now for 8 months. I'm certain it's emotional tension causing/perpetuating many of my health problems.

Cheers again.....sd3

 
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