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For any given antidepressant, 30%-50% of individuals do not show a response (Baghai, Moller, & Rupprecht, 2006; Ruhe, Huyser, Swinkels, & Schene, 2006). When an effect is observed, there remain significant chances of relapse. The chance of relapse is between 3 and 6 times greater when any symptoms of dysfunction remain (Tranter, O'Donovan, Chandarana, & Kennedy, 2002). This is particularly important given that antidepressants tend to lose their efficacy during the course of treatment, and symptoms tend to reappear before a new antidepressant can be prescribed (Byrne & Rothschild, 1999).

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A recent study from McCullough and colleagues found that CBT (Cognitive Behavioral Therapy) for depression coupled with antidepressants was effective in reducing symptoms in 73% of the studies participants, while the use of CBT or an antidepressant alone resulted in an effect of only 48% (Keller et al., 2000).

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Kickle said:
It's really not that far away from racism, in my mind.

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So, CBT was shaped around creating a more 'realistic' view of the world. Pushing individuals thoughts towards that of a healthily functioning individuals. This however is not the case. CBT is not creating more accurate views of reality, in fact, it is doing the opposite. It is creating an overly positive view of the world, which the depressed individual does not naturally observe.

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This seems more than a little dangerous.
1) An individual is being told that their thoughts are incorrect, and inaccurate of reality. That what they're seeing is false. This could easily cause a rift between what an individual believes to be true, and what they are told is true. The authority figure of a therapist in this situation creates a dangerous dynamic.

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Again, my findings in this domain do not coincide with your statements.
Firstly, a therapist (unless he's a complete moron ) doesn't tell his patient that they are wrong in what they do and feel, this is completely destructive to the therapy and nonsensical.
Also, the same therapist that's not a complete moron will never abuse the authority figure that some people might project onto him, as this has been proven to be a very unsuccessful tactic. One of CBT's main ideas is to insulate and teach people how to be self reliant and in control of themselves.
Also, a CBT therapist is encouraging people to explore the truthfulness and functionality of their thoughts, think about how much they benefit from a certain kind of thinking, and put their preconceptions to a reality check. Then if it turns out that they were off from what reality seems to indicate, help them find ways of integrating more reality in their lives, and in the case in which their negative thoughts are in accordance with reality, help them find ways to cope with that reality, and change the perspective to one that doesn't choke the pleasure of experiencing life. This doesn't mean that the therapist in lying to their patient, making reality seem different than it is, in a way that's appealing to that person.

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2) When therapy is terminated, the world does not change with the thoughts. An individual is still going to see the world the way their brain is wired to. Remembering the positive and negative events that occur, giving both equal weight...

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The likelihood of relapse, without continued therapy seems high. The more time that goes by, the greater the chance. Hence an effectiveness of 48% in the above quoted study.

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If this is the case, why the fuck are we even playing this game?
Why is CBT trying to make people fit the norms? Why are antidepressants trying to make levels of neurotransmitters fit the norms? It's clear to me, that the individual is not built to be the norm. There is no need for them to be the norm, except for whatever reason, we who are in the norm, believe that anyone who is not the same as us, is broken.

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I don't think that CBT is stopping people on the streets to tell them they're wrong in the way they think.
A person doesn't feel happy with themselves anymore, and comes asking for help, this is how it works. That person has the obvious intention of changing into something that serves them better, it is that person that decides to change.

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cyb3rtr0n said:
A broken arm is a broken arm, but all broken intellects are not the same.

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Are you suggesting that ALL broken arms are the same? Need I explain how off this statement is?

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MushroomTrip said:

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cyb3rtr0n said:
A broken arm is a broken arm, but all broken intellects are not the same.

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Are you suggesting that ALL broken arms are the same? Need I explain how off this statement is?

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MushroomTrip said:

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So, CBT was shaped around creating a more 'realistic' view of the world. Pushing individuals thoughts towards that of a healthily functioning individuals. This however is not the case. CBT is not creating more accurate views of reality, in fact, it is doing the opposite. It is creating an overly positive view of the world, which the depressed individual does not naturally observe.

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I'm sorry, but this really contradicts the idea and purpose of CBT, can you perhaps present some examples which show that CBT is creating a positive view of the world, which is out of touch with reality?

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MushroomTrip said:

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This seems more than a little dangerous.
1) An individual is being told that their thoughts are incorrect, and inaccurate of reality. That what they're seeing is false. This could easily cause a rift between what an individual believes to be true, and what they are told is true. The authority figure of a therapist in this situation creates a dangerous dynamic.

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Again, my findings in this domain do not coincide with your statements.
Firstly, a therapist (unless he's a complete moron ) doesn't tell his patient that they are wrong in what they do and feel, this is completely destructive to the therapy and nonsensical.

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Agreed.
It isn't the therapist personally telling the individual this.
It's an underlying principle of CBT.
Consider Beck's 'Cognitive Triad' which involves the belief that depressed individuals possess an overly negative view of:
  1. The self,
  2. The world/environment, and
  3. The future.

And then consider, that future research has discovered that rather than depressed individuals possessing an overly negative view of these things, the normal population contains overly positive views of these things, making depressed individuals appear overly negative.

It's the belief that CBT for depression was founded upon. There is no possible way for the therapy not to incorporate such a belief. The therapist doesn't need to say it, the therapy says it for them.

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Also, the same therapist that's not a complete moron will never abuse the authority figure that some people might project onto him, as this has been proven to be a very unsuccessful tactic.

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The authority is implicit. The therapist needn't claim any authority. You're going to a therapist because you believe he/she has the expertise to help you. That has an effect, and if any of the authority studies out there can be trusted, simply being placed in a role of authority, regardless of skill set, changes everything.

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One of CBT's main ideas is to insulate and teach people how to be self reliant and in control of themselves.

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Agreed.

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Also, a CBT therapist is encouraging people to explore the truthfulness and functionality of their thoughts, think about how much they benefit from a certain kind of thinking, and put their preconceptions to a reality check. Then if it turns out that they were off from what reality seems to indicate, help them find ways of integrating more reality in their lives, and in the case in which their negative thoughts are in accordance with reality, help them find ways to cope with that reality, and change the perspective to one that doesn't choke the pleasure of experiencing life. This doesn't mean that the therapist in lying to their patient, making reality seem different than it is, in a way that's appealing to that person.

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I'm going to give it the benefit of the doubt, and concede on all points here. Only because it doesn't matter in the long run. Sure, a therapy should reflect individual differences in reality perception. And sure, there are tools for a therapist to get an idea of how accurately an individual is perceiving their surroundings. Keeping thought logs is an example.

But as you said, if their negative thoughts are in accordance with reality, the therapist tries to change their perspective.

I am suggesting to you, that you can not change what is built into an individual, nor should you try. In attempting to do so, you're encouraging a belief that what the individual sees, is not good enough. That it is not sufficient to provide happiness. That they should instead, focus on the positive events, and find better ways to cope with (tune out, ignore) the negative. I say tune out/ignore because that is what is implied by the techniques I have observed

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MushroomTrip said:

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2) When therapy is terminated, the world does not change with the thoughts. An individual is still going to see the world the way their brain is wired to. Remembering the positive and negative events that occur, giving both equal weight...

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But that's not true, since a depressed person, by definition, will only weigh the negative more than the positive and dwell on failures and misfortunes.

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daytripper23 said:
Maybe you could clear something up for me: Have Neuroscientists recognized unique chemicals or mechanisms in the brain that apply respectively to anxiety and depression? If they do, have they further geared their drugs  in clearly distinct respect to one and the other?

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What I have seen is an almost interchangeable use of these words. I would guess that based on the way these anti depressant/anxiety medications are labeled and prescribed, they have not recognized these differences to unique chemical or mechanistic roots. Instead, this dynamic seems to be reduced to a general "negativity", and treated holistically, despite whatever other minute criteria they can manage to the dot.

In all practicality, I can see how anxiety and depression easily and often relate, and even express the same "negative" stream of consciousness. But I think its crucial to draw the difference between the two.

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Suppose that the way anxiety meets depression is crucial to how an individual expresses himself through action: You could say that both of these "negativisms" are personal reflections, but they are chiefly distinct in that anxiety occurs before an event, and depression after

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If there is any truth in that, without this, or any similar minded contrast, (for the sake of some inner dialect) it would seem that this blunt model of utility puts to stake the entire creative process.

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Not sure how relevant that was. I couldn't make much sense of the Neuroscience and behavioristic lingo, but what I did understand was your closing statement. If we are talking about a normative utility, that would be my take.

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iamconfused said:
The most effective way to "fix" depression would be to create a physical/social environment that met the depressed person's needs more closely. But that would be questioning a time-honored status quo, that people (generally) become depressed because there is something wrong with them, not because there is something wrong with their environment. I'm going to use a plant analogy to make this clearer. Most people are like hardy perennials, they'll thrive almost anywhere. However, there are some people who are like delicate flowers, and will only thrive in only the most pristine conditions, and slightest taint in the atmosphere will make them droop and whither away. Typically, we condemn those delicate flowers for their weakness, when in reality their weaknesses, their susceptibilities, could be used to isolate the impurities in our society. Without those impurities, the hardy perennials would become more robust and beautiful flowers would start blooming everywhere.

I believe that there are mental minorities, those delicate flowers, who are subconsciously persecuted by society at large, like "ugly" people or people of different color.

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daytripper23 said:
Maybe you could clear something up for me: Have Neuroscientists recognized unique chemicals or mechanisms in the brain that apply respectively to anxiety and depression? If they do, have they further geared their drugs  in clearly distinct respect to one and the other?

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zouden said:

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daytripper23 said:
Maybe you could clear something up for me: Have Neuroscientists recognized unique chemicals or mechanisms in the brain that apply respectively to anxiety and depression? If they do, have they further geared their drugs  in clearly distinct respect to one and the other?

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The classical model says that depression is treated with fluoxetine and anxiety is treated with diazepam. These are very different chemicals. Diazepam (valium) works on the GABA system, and it's efficacy is unprecedented. It is truly a fantastic anti-anxiety medication and one of the greatest drugs ever developed.

Fluoxetine (prozac) is the total opposite. Sure, it works well as an SSRI, but the simple fact is that it doesn't work as an antidepressant in most people. The success rate is roughly 1/6. Terrible. Most other SSRIs aren't much better. 

Essentially, the classical model of depression is flawed. It is almost certainly not caused by a serotonin deficiency. If anything, it's a noradrenaline deficiency. The paper I've been working on for the past year explains all of this but it's not published yet (still going through the review process...). The evidence is pretty convincing though. I believe that in the next decade we'll see a new class of antidepressants that will completely supersede the old ones. Thank goodness!

But depression is probably more than just a neurotransmitter deficiency. I think the truth is that the term 'depression' covers maybe 3 or 4 distinct diseases that we haven't properly identified yet. They have the same symptoms but different causes. This would explain why CBT works on some people, and SSRIs work on some people, yet others require electro-shock therapy and still others are unaffected by any known treatment.

Depression won't be solved until we can accurately diagnose these different diseases, and have effective treatments for each one. We need to be able to examine a person and say "you have type I depression - try CBT" or "you have type III depression - take this drug" or "you don't even have depression, cheer up emo kid". Until then, we're fumbling around in the dark and it's no wonder we have such poor success rates.

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zouden said:
Depression won't be solved until we can accurately diagnose these different diseases, and have effective treatments for each one.

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