Depression, drugs & CBT question

Sorry if this is really obvious, just some things re my SO’s depression I was thinking about.

My SO has been struggling with depression for several years now and on anti-depressants for about 3 years (should really check what kind, I forget). I’m noticing in him the same I think I see in my really good friend: the medication seems to treat the feelings, but not necessarily the other symptoms.

Both seem to feel less depressed: less anxiety, less negative thoughts. But neither of them manage to “function” in every day life. They don’t really go out (unless I drag them), they don’t manage everyday tasks.

What I know it boils down to for my SO is: he doesn’t feel depressed, but he still functions as depressed.

Is this because only CBT addresses this aspect? That just feeling better doesn’t actually bring them back up to their “former level”, where they managed to successfully live their lives? Is this fairly common? Any advice?

You don’t actually mention that either is undergoing CBT; assuming that one is, I would say no, that’s not actually how it works. CBT is intended to actually counteract those “sinkholes” of negative thoughts, and in someone faithfully working on it and in whom it is effective, I personally would not expect it to only make you feel a little better but not increase motivation, etc.

Whatever they’re doing in both medication and therapy may need to be adjusted.

IANAD/N/P; I’m speaking only from my experience with a couple decades of on-and-off major depression (which included meds, talk therapy, and self-directed CBT), plus my time in graduate school for psychology.

Ah sorry: neither is undergoing CBT.

My SO previously did, but it was frankly disappointing. That’s sort of why I’m wondering if we should give it another shot.

Its not an intended outcome of treatment but not an unknown one.

One problem is how long they’ve had depression, and how entrenched the lifestyle they have developed to cope with it is. Even if their symptoms improve, it can still require a fair bit of work to recover whats lost, ie doing activities and working at them till they are enjoyable again, getting back into more healthy routines etc.

One problem is people sometimes are waiting for motivation to return, but motivation generally improves as they do things and succeed at them, not before. This kind of issue is where CBT should be helpful.


The lack of depressed feelings but the presence of other symptoms of depression may mean that your boyfriend and friend are suffering from anhedonia - a form of depression where a person doesn’t feel bad, but they never feel good either. Anhedonia includes other symptoms of classic depression, including loss of interest in everyday or previously enjoyed activities, lack of energy, problems with sleeping (too much/too little).

It’s impossible to say “this medication is sure to work!”. Both of them need to see medical professionals and discuss both what medications they’re currently taking and how they’re responding.

Also, gracer, you have to set boundaries for yourself. Do not get sucked into this. Help where you can, when it’s appropriate, and when it doesn’t conflict with taking care of yourself. It’s very, very easy for those who try to care for depressed people to become depressed themselves.

The most apparent approach is seeing about getting those meds re-adjusted. There are so many different kinds of antidepressants that there should be something out there for just about anyone.

I myself am taking Amitriptyline, an older drug but a miracle worker for me. I lucked out and my GP picked the best thing for me on the first try, but geeze I know so many people who have sampled a whole host of options before finding the right drugs or drug combinations for them. It’s tricky because you usually have to spend at least a month before you are sure if a particular drug is working, so it can be a frustrating process to get medicated correctly, I’ve seen a lot friends go through this.

Now secondly, if he isn’t actually depressed but only “acts like he is”, could it be that this is just a part of his personality? You are the one who knows him, and if you think he’s a bright gregarious guy waiting to burst out by all means help him find medinal help. But if just maybe he’s the kinda person who everyone assumes is depressed but really isn’t (like me in high school). He may just be ok after all.

Depression is one word for a whole lot of things, most of which we don’t really understand.

For some, depression descents like a chemical cloud of out nowhere, suddenly throwing an otherwise stable person out of whack. In these cases, it may very well be a matter of messing with the chemicals until things are back in balance.

For me, depression was the result of a lifetime of unlearned coping skills which eventually hardened into a warped worldview. This isn’t to say the depression was my “fault” or a “weakness,” but the reality was that I had a screwed up way of dealing with the world that created a negative feedback loop. It’d be impossible to say whether it was the brain chemistry that caused the behavior or the behavior that caused the brain chemistry…and that argument would be besides the point. In the end, balancing the brain chemistry would be a losing battle until I learned new coping skills and developed a more helpful worldview. In the end, I was able to overcome decades of depression without medication through my own homegrown CBT, and after seven years of being depression-free, I think I can safely say I beat it at the source.

In any case, the point here is that not everyone is going to be able to be beat depression by medication alone. It may work like a charm for some people, but if you have underdeveloped coping skills and unhelpful mental constructs and habits, you are probably going to need more than just a new set of chemicals.

IANAP, but I suspect that depression is both physical and psychological for the vast majority of people who suffer from it. Medication can straighten out a chemical imbalance in the brain, but habits and beliefs and behaviors are equally a part of depression and need to be treated as well. Even if your SO’s depression were purely chemical in origin (which IME is extremely rare), it takes deliberate work to break the bad habits that come with it. As others have mentioned, a med change may be called for, but you’ll need a professional to evaluate that one. I’d strongly suggest that he give therapy a try and see what happens.

One of my previous counselors said that he sees many patients who have have a round or two of CBT, but the CBT hadn’t done much for them. Unlike something like physical therapy, which is more readily observable, counseling is not an exact science. It took me a long time to find a counselor who had the experience to know how to help my particular issues. (And then she moved away, and I’ve had to go to a different one. :frowning: )

As others have pointed out, depression is caused by a wide range of factors, and not everyone is helped by the same treatment. For me, a lot depended on motivation. Before I had kids* I wasn’t as motivated to really find a way through the depression. Now that I have kids, it’s that much more important to get better.

This is one problem with other people enabling depressed people. While it can help the depressed person function better, it can also be a crutch. Each circumstance is different, and I’m not qualified to say either way what is going on, but you may want to talk to a professional yourself to get some feedback on what is appropriate for you to be doing.

*I would never, ever recommend deliberately having kids as a method of treatment. If it goes wrong, it can have very dire consequences.

The thing with CBT is, it’s work. A fuckton of work. And if you’re too depressed to really work at it, it won’t help you a whole lot. For me personally, the medication got me to a point where I could actually put some effort into CBT, instead of nodding at my therapist’s office, feeling better for two days, and then slipping back.

Medications affect everyone differently, but it’s very rare (no cites, but I’d say really damn rare) that a pill a day will bring someone out of depression and make them a bouncy happy person. There are patterns to break and neurotransmitters to balance out, and there’s not really a quick fix. CBT can help, but just going to a therapist won’t do it. It’s a lot of work, and it’s a lifestyle change. It’s like going on Atkins to lose the first 15 pounds, but then realizing that for the rest of the weight, it’s time to change your whole outlook on food and nutrition and exercise, and that’s incredibly difficult to do and stick with.

Thanks for the advice everyone! Also thanks for the concern for me. I grew up with my dad being depressed and me being the only person who could influence him at all (I still am). I know how important it is to not try take it all on. For my SO and I it has been nearly eleven years now, and I would guess maybe 6 of those battling depression. At least it’s nowhere near as bad as with my dad :slight_smile: and I feel like we’re getting better at battling all the time.

Tokyo like you say, I think it would be a tough case of finding someone it works with if we tried CBT again.
I think that one of the problems was that the therapist did not understand where the depression came from at all. He had no idea and wasn’t remotely close to my SO in intelligence. It made it very frustrating, I think. I don’t really know how to go about finding a therapist who might suit. There should be a special kind for ridiculously intelligent philosophers (serisouly, there should, all our ridiculously intelligent philosopher friends have a depression that seems similar to me, none of them fare well with CBT).

I’m hesitant to change medication, it sounds so scary. The change in him when the meds kicked in was enormous. He became all non-negative suddenly :slight_smile: And his sense of humour became really stupid (actual fact).

As for it being part of his personality CyclopticXander, well possibly (I’ve so often wondered how you’d even know the difference, y’know) but two things make me think not:

  1. He didn’t used to be like this. Though of course people change.
  2. It makes him unhappy.

But, seriously thanks guys, you’re helping me think this through! Any more experiences/advice is very much appreciated!

One important way I learned to view depression is that it’s not something you have, it’s something you do. It sounds to me like your SO is so used to ‘‘doing’’ depression that he’s continuing to do it even though the negative thought patterns have been corrected. It’s going to take hard work to correct the behavioral habits that exacerbate his depression, and I think this would be an excellent time for intervention from a behavioral therapist. My favorite behavioral activation workbook is here: Overcoming Depression One Step at a Time. The workbook itself is evidence based, meaning this specific book has actually been tested in clinical trials.

I had a recent change in my meds. Prior to the adjustment, I thought I was just “okay”. The apathy and anhedonia were there, as usual, but did not seem any worse. If you do a search on my posts over the last month, you’ll see me talking about my state and being pretty “meh, what can you do?” about it.

I now realize that my whole perception was messed up. I thought I had plenty of energy because I actually did get stuff done, but now I actually really do have plenty of energy (almost too much…I’m a little concerned, yes). The apathy has lightened a little, and the anhedonia is yesterday’s news. Everything tastes wonderful. The Lion King was wonderful. The blue sky is wonderful. Even yoga is wonderful!

Drugs poop out but you can’t tell because you get used to stuff, is what I am trying to say.

You are doing good encouraging activity, but don’t push too hard. Even though I’m feeling kind of groovy now, I’m not in the mood to do everything. Make sure you aren’t confusing personality with illness.

This. For over 30 years depression was a major part of my life. It would get so bad that it didn’t matter what I’d done right–I was never any good as far as I was concerned. Clued into the problem in my late 30s and took steps to get more stable–which has been pretty successful. But I still get anxious in gatherings, despise public recognition for my successes and am tempted to use them as opportunities to remember what I didn’t do right, prefer to be alone, etc. Those are habits I’ve had to learn to break even though I can function in groups, can accept compliments now, actually like getting out…

I would encourage you to try to talk your friends into therapy, either CBT, schema or mindfulness. In the end, it is mindfulness that got me up from my sinkhole and functional. Here’s a link for more information - The Mindful Way through Depression andYou are not Your Brain.

I find CBT to be less helpful because it assumes that once you have challenged the bad thinking, it’ll go away. For me, it doesn’t. Schema therapy helped me to understand why I have depression, but it’s the same deal with CBT - those thinking won’t go away. Meditation and mindfulness, plus lots of exercise, helped me to be more or less functional.

The initial resistant to change is usually high; try to encourage them by telling them how much better life will be if they can control their negative thoughts.

Ah yes, the ‘patient is smarter than the therapist’ problem. :slight_smile: It can take a lot of shopping around to find someone that you work well with. You’re completely allowed to interview the therapist - if you (or your SO, rather) walk in and find out the guy’s not working from the same playbook that you are, you can walk right back out again.

How set is your SO on CBT? Would he consider going to a therapist who doesn’t specifically specialize in it? In my not-so-humble opinion, I suspect philosophical, analytical personalities often do better with therapy that contains some aspect of ‘why the eff do I do that?’ rather than only focusing on modifying current behavior. For me, my problems didn’t clear up until I thoroughly understood the causes behind them and what had prompted their development in the first place. Once I understood that, the behavior/symptoms/problem usually settled back into a healthy place in my head or evaporated entirely.

Thanks for the book tip Olives! And also the idea of continuing to “do” depression, I see that.

monstro, what you’re saying sounds very similar to my SO saying how when the first sunny days come along he suddenly realises how bad it’s been (yes, also some SAD mixed in with the garden-variety depression).
I also know that when he is regularly running, things “get done” much more. The challenge there is to keep him running when the apathy/anhedonia truly hit. I’m thinking certainly a change in meds/therapy is called for. Now just the how to find (the right) one.

Don’t worry monstro, I won’t push too hard. I know fairly well how hard to push after all these years. :slight_smile:

Thanks for sharing your experiences everyone. I think we definitely need to reevaluate (well, really it was his suggestions, hence the thread) and I think we need a professional to help us with it. I think something like CBT might be worth another try and that the meds need another look. Now to find the right therapist…

FlyByNight512, that’s the prob, yup! A-shoppin’ we will go. I dunno how to start though, and we can’t go private. He actually made a very honest effort with the first therapist. It was really quite sad to see how he tried to make it work (though I encouraged, of course). I think he is so ready for change, fed up and ready to work on it, that he does want to commit to something like that. Of course, saying “yes I really want to” and then doing… we’ll get there.