I wonder whether the majority of people realise that in reality we are still completely in the dark as to how to treat depression effectively? Forget about treating depression for a moment and take a step backwards - do we even know what REALLY causes depression?? There’s been little progress despite the anti-depressant industry being worth billions of dollars... In addition, there's been no real widely adopted advances since the 1950s when SSRIs first came onto the scene!

Are you feeling stuck, repeating the same cycles or not comfortable taking brain altering drugs just to get through the day? There may be a much milder AND more effective alternative. This article introduces a new approach based on our core beliefs.

My interest in this topic was triggered by recent findings that made the news headlines Tuesday (26 Feb 08) evening. A recent trial found that SSRIs are only marginally more effective at treating depression than placebo tablets!!!! This is obviously very alarming news, considering there are countless people relying on these drugs, not to even mention those on the brink of seeking help and seeing antidepressants as a way to bear their painful existence… What happens now?

Well, what happens is we find another way! I think it’s time the wider public realises that we don’t know enough about how the brain/mind works to start tinkering with it’s mechanisms… Just have a look at how SSRIs really work! I never realised until now that it actually decreases the number of serotonin receptors in the brain. This means it actually changes the brain, rather than just temporarily blocking the re-uptake of serotonin in the presynaptic cell. Wikipedia can give you more information about how that works… I’m going to take my time to explain my own methods instead! If it’s all too technical for you, just have a read through the side effects - teeth clenching anyone?

Other than the different antidepressant variants, another popular and current method of treating depression is of course psychotherapy. Due to the high cost, long treatment times and general slow and impermanent nature of results it is not really a viable option for all depressed patients. The efficacy of the therapy is amongst others a factor of the skill of the therapist, the approach taken and level of depression of the patient.

A point to consider is, do any of these psychiatrists and neuroscientists suffer from depression themselves? Probably in most cases, they don’t. As depression is clearly an illness that manifests at the level of the mind, is it really the sort of thing someone can comprehend fully without experiencing it first hand for themselves?

In addition, does it actually matter whether depression is ‘caused’ by a chemical imbalance, lack of adequate social or life skills (resilience), flexibility of mind or attitude?

Lets consider for a moment how the brain of a depressed person compares to that of a happy individual. (In reality there are many neurotransmitters that affect a person’s mood, but for the purposes of making my point, lets use serotonin as an example.) It is believed that depressed individuals have relatively lower levels of serotonin signaling (through chemical synapses) in the brain. If we consider this from a chemical (brain) perspective, this can be due to:
(1) lower availability of serotonin in the brain (through lower levels of production)
(2) higher number of serotonin receptors - more receptors could mean with even the same amount of serotonin a cell would require more serotonin to cause the same signal strength
(3) more serotonin is re-absorbed back into the presynaptic cell rather than being passed on to the post-synaptic cell. This is where SSRIs come in - they bind with the receptors on the presynaptic cell instead so as to block the re-uptake of serotonin and have more available to bind with the post-synaptic cell and therefore cause a stronger signal.

What’s really critical to understand here is the link between the chemical imbalance described above and the state of mind that would necessarily accompany it. Basically, we cannot on a chemical level have weak serotonin signaling and at the same time have a positive, happy mind. The brain and mind are interconnected. This brings me to my point - whether or not the cause of depression is in the brain (chemical imbalance) or in the mind (negative outlook) is actually irrelevant - we cannot have one without the other. That could therefore imply that we could cure depression from both sides - the mind (psychotherapy) and the brain (antidepressants). One approach should automatically fix the other as the two go hand in hand. Based on options available to depressed individuals today, the duality of the problem (or rather solution) is confirmed.

Given where we are today in terms of safe and effective antidepressants, and the high cost associated with psychotherapy, our society is badly in need of an effective solution. Some reports claim that as many as 1 out of 6 adults are suffering from depression! And how many of the remaining 5 out of 6 of us are actually happy, successful individuals living their dream life??? I think we are down to only a fraction of society actually attaining the levels of blissfulness we are all seeking.

With that said I think it’s time for us to move away from the “victim” based framework. Here’s an example of the sort of thinking we are entertaining:
Individual is not loved enough as a child => Individual needs therapy or drugs to deal with these feelings and become a well adjusted member of society.

The truth is, very few (if any) of us would qualify for not being victims. Statistics claim that about 70% of families are dysfunctional (by definition!) and that the majority of today’s kids associate more with the Simpsons family than any other on TV!

We need to move on and consider what it is that forms the basis of who we are as individuals. Who we are fundamentally is what really determines whether or not we are predisposed to depressive stints.

What causes me to be the person that I am?

I see myself as a product of my life experiences up till now and feel that my basic character was formed quite early on as I learned about life and as such built up my personal set of beliefs about myself, the world and my place in it. Over time my view of the world has expanded and my character has evolved together with my view. At some point along the way I’ve realised that my beliefs are different to the beliefs of others. At yet a further point I’ve realised that I can consciously choose the beliefs I would like to have. Now I’m on a journey to build up a healthy set of beliefs that would serve me well, rather than keep me stuck at the level I am now.

The first step is discovering which mindset (view) is the most beneficial. I think we could benefit tremendously from studying commonalities in fundamental beliefs in happy, successful, inspired people versus those of the unhappy and depressed amongst us.

If we go through this process and we discover that there is an indeed a common set of shared beliefs amongst our happy counterparts and a shared set amongst the unhappy ones, wouldn’t the best next step be to tackle these beliefs one by one? Imagine if you could get a list called “This is what happy people believe”. Wouldn’t that be a great start to getting your own list fixed?

I intend this to be the first of a series of articles dedicated to what I would collectively title ‘Core belief selection therapy’. Over the next few weeks I will be exploring the most empowering beliefs versus the most depressing ones. In addition I would tackle possible methods for actually acquiring new beliefs and letting go of those that do not serve us. Unfortunately it‘s not a process that happens overnight for most people. Fortunately though, it just might be the light at the end of the tunnel for many of us!

Update on 24 March 2008:
Very Highly recommended reading - discusses the role of the conscioua and subconscious (and where beliefs enter the equation) in shaping behaviour:
http://www.brucelipton.com/article/mind-over-genes-the-new-biology