Did CBT work for you?

October 28, 2006 8:22 PM

I have recently been diagnosed with depression. I am taking 40mg of Prozac a day. I have also been advised to persevere with a course of Cognitive behavioural therapy. I am worried that CBT isnt relevant to me. Has anyone else had or currently having success with it?

I have been trying to cure myself of depression scince about June. Despite the fact that I have been taking the drugs for nine weeks I feel I am getting worse not better. I feel increasingly angry. I have lost the ability to cry. I have been cutting myself. My suicidal thoughts are developing structure and intent.

As far as I understand CBT it is based on the premise that negative thought patterns are part of a self fullfilling vicious cycle. Negative thoughts are not necessarily true. Carefully examining them will therefore help reveal this. This will help breakdown the individual's self hatred and improve his or her self esteem and coping ability.

CBT also seems to assume that depression or lack of self belief is commonly founded in the inividual's life experience. (I dont feel that anything has happened to me to explain the way I now feel.)

Intellectually this makes perfect sense. I can totally see how this may be the case for lots of people. But I fear that it is not the case for me. It seems to me that the things I believe about myself are not only negative but absolutely true. Therefore examing them is a waste of time and could potentially make me feel worse.

Are these feelings another symptom of the illness? Did anyone else face this hurdle at the beggining of CBT? How did you overcome it? Did it take long? What hope do you now have for the future?

I would be gratefull for any experience or wisdom that anyone could offer. Im trying to be brave but I dont think that I actually have the strenght to overcome this.

With thanks in anticipation.

posted by anonymous to health (47 comments total)

I wish I had any words of real advice to offer you - but, what I can say is that, as someone who loves someone who is depressed and going through something similar to you, please keep working to overcome this. Whether the people in your life are verbally supportive or not, those who love you need you around.

Best, best wishes to you.
posted by AthenaPolias at 8:35 PM on October 28, 2006

Maybe Prozac is not the best drug to treat your depression, I would recommend talking to your Dr ASAP.
posted by JujuB at 8:36 PM on October 28, 2006

Cognitive behavior combined with meds worked incredibly well for me, with both depression and anxiety. I tried therapy where you talk about your life and analyze your relationships, and it kind of pissed me off. I don't think it was anything that happened to me that made me depressed. It was just bioloby. CBT is not about examining your life. It's all about learning to logically deal with illogical problems by facing them.
posted by croutonsupafreak at 8:47 PM on October 28, 2006

You need to go see a therapist. drugs aren't as helpful alone as they are with therapy. If you're angry and cutting yourself, there's a reason, and even if that reason is you're simply chemically imbalanced, you're still having those extreme feelings that are perpetuating themselves. I highly recommend therapy. I've been in it for years, and my life is better than ever before. I also was on antidepressants for years, and have since quit the drugs and continued the therapy. Good luck.
posted by bash at 8:48 PM on October 28, 2006

I'm not a doctor or a psychiatrist, but I was once a patient, and cognitive behavioral therapy didn't work for me either. At all. I would even go so far as to say it made me feel worse. I really, really tried, too. I stuck it out with the first therapist way longer than I should have, and later on I tried again with a different therapist. No help whatsoever. Either therapy is bullshit (and I don't want to believe this, since I know people who claim to have benefitted from it), or there are some people that it just doesn't work on, and you and I are unlucky enough to be those types of people.

Not only was I not getting any relief from the depression, but I also felt betrayed by my therapist and doctor, since they insisted that therapy should make me feel better. When I asked my therapist what percent of patients were actually helped by therapy, she couldn't give me an answer. In my opinion, valid treatments are backed up by numerical statistics.

What I do think you should do is call your psychiatrist and be very insistent about the fact that you are not feeling better. Your doctor should switch your meds: nine weeks is more than enough time to see if a drug is going to work.
posted by Violet Hour at 9:00 PM on October 28, 2006

CBT got me over the hump when I was trying to treat depression and anxiety. Medication helped; other therapy helped ("What did your mother do when you were 10, exactly?"), and I improved, felt like I understood the mix of personality and upbringing that had contributed to bring about my problems, but I couldn't really get better. An excellent cognitive-behavioral therapist was recommended to me, and I tried her out. I started seeing improvement within days. I came out of my first session with a list of things to do differently, and when I tried them, they helped. Over the long term, CBT helped me get to the point that I think of myself as someone who is recovered from depression and anxiety, though I am always vigilant to watch for early signs of slipping.

You say, "CBT seems to assume depression is commonly founded in the individual's life experience." On the contrary, one thing that was refreshing about my CBT was that the therapist didn't really care too much about my childhood, for instance--she was focused on the here and now. What were my actions in the present, what were my thoughts in the present, and how could they be modified to reduce my anxiety and help me be happier and more functional? After years of "how my mother did my wrong" therapy--which was helpful in its own way but limited in its concrete effects in life--it was a breath of fresh air.

I know that when a person is depressed it's hard to take action. But it will help if you can stay in touch with your doctors--tell them what's happening to you right now. Your meds might be adjusted, or you might try a different med that would be more effective.

I would also recommend that before you write off CBT, you give it a good-faith try--or even two, if the first therapist you see is not helpful. You're "worried that CBT isn't relevant" to you, but what you are going to get in this thread is a bunch of people saying, "didn't help me," and a bunch of other people saying "saved my life!" You can't know which of those people you are until try. What's the worst that can happen if you see a CB therapist? It doesn't help much, and you need to seek other treatment. The best? It turns things around.
posted by not that girl at 9:16 PM on October 28, 2006 [1 favorite]

Are these feelings another symptom of the illness?

Yes!

That said, at 9 weeks I would say the Prozac isn't working. Time to try a different anti-depressant.

As far as CBT is concerned, all I can say is it worked for me.

Various studies have put the success rate of anti-depressants and therapy at 80% if done together. A major symptom of depression is the firm belief that you must belong to the other 20%.

(Which is to say that there are some unfortunate souls for whom this approach does not work, but roughly 100% of depressed people believe it won't work for them personally)

Hang in there.
posted by tkolar at 9:40 PM on October 28, 2006 [1 favorite]

10 years ago, during my divorce, my depression became an issue relevant to child custody. So, even though I 'didn't need it' I took a round of Zoloft and therapy 'for show'.
It was a pleasant experience which proved to be of continuing benefit... as I experience recurrences of depression I have learned to identify my symptoms early and modify as necessary my habits to avoid bottoming out.
I actually had something of an epiphany that summer... glad I tried it!
posted by dkippe at 9:45 PM on October 28, 2006

No words on CBT, but if the Prozac is making it worse, stop taking it. The point of drugs is to make you feel better and if it's doin' the opposite, it's not working. There are lots of anti-depressants out there and you may have to try a few before finding what works. Right now it's making the obstacles you have to overcome seem more difficult, not less. Call your doc about switching meds and stop taking the Prozac.

also, re Are these feelings another symptom of the illness. Yes, absolutely.
posted by wemayfreeze at 9:51 PM on October 28, 2006

Oh yeah:
CBT also seems to assume that depression or lack of self belief is commonly founded in the inividual's life experience.

My understanding is that the specific life experience is: being depressed. No matter how you got that way (i.e. biological or environmental depression), being depressed gets to be a self-feeding mental habit. My understanding is that CBT is about breaking that habit.

The thought here is that even if the drugs lift the biological depression, recovery will be difficult if you're still in the habit of being depressed. Conversely, all the CBT in the world won't help if you're biologically depressed and not doing something about that.

What hope do you now have for the future?

Personally, I hope for a permanent cure for biological depression. It sticks in my craw to have to take medication every day.

However, that wasn't really your question. To answer: I'm going on eight years of solid, balanced life now. There have been a few stumbles back into the black pit of depression, but I now know the drill and readjust dosages as required. I expect to live a long, healthy, and generally content life.
posted by tkolar at 9:54 PM on October 28, 2006

Because you are cutting yourself and developing specific suicidal intent, please see your psychiatrist as soon as you can. If you don't have a psychiatrist, talk to your doctor and ask for a referral to one. Your reactions to the Prozac need to be monitored carefully to ensure that the drug is working for you. SSRIs can cause an increase in self-harm and suicidal impulses in the early stages of treatment, and it sounds like that might be happening to you. In any case, if you're not seeing improvement after 9 weeks it may be time to try another drug and you really want the knowledge of a psychiatrist to build a new medication strategy.

If you're interested in learning more about CBT, Feeling Good by David Burns is a good book. You can learn how the process works by reading this book. Working with a therapist is helpful because it gives you support and structured accountability. You can get familiar and comfortable with the concepts of CBT before you begin a course, though. CBT courses typically last only a few months because the goal is to give you tools you can use on an ongoing basis. Perhaps it will be easier to try it out understanding that you're only committing to a specific number of weeks and that you should start seeing changes within that period of time.
posted by rhiannon at 9:58 PM on October 28, 2006 [1 favorite]

But I fear that it is not the case for me. It seems to me that the things I believe about myself are not only negative but absolutely true. Therefore examing them is a waste of time and could potentially make me feel worse.

Are these feelings another symptom of the illness? Did anyone else face this hurdle at the beggining of CBT?

Actually, there is a respectable body of thought in Psychiatry and Clinical Psychology that depressed people do, indeed, see the world and themselves more accurately than non-depressed people.. Google "depressive realism".

Having said that, CBT can help a lot in identifying destructive thought patterns and nipping them in the bud. Realism is good, feeling bad about seeing the world clearly is not good. And, as noted, the combination of pills and talk therapy of some flavour -- probably CBT -- is the treatment with the best clinically-demonstrable results. CBT is not about examinign your relationship to mom, it is about tools for thinking, in fact, tools for thinking about thinking. Power tools. And who doesn't like a few power tools?

key things:

* you need the right therapist. probably you'll know in the first meeting or two. Its far easier to switch early rather than later, so use the beginning motivation to get a therapy (if you can get that motivation up!) to get the right one
* you need the right drug, or combination of drugs. this can be hard. Its good to have quite frequent appointments to monitor the dose and cocktail
* you do have to want to get better. Even a little bit of wanting can be leveraged by loved ones, compassionate doctors, and even the pills, into a lot of wanting to get better. Nurse the flame of "wanting to get better" very carefully - it is the foundation on which all else is built.


I have also been advised to persevere with a course of Cognitive behavioural therapy ..........
I have been trying to cure myself of depression scince about June. Despite the fact that I have been taking the drugs for nine weeks I feel I am getting worse not better. I feel increasingly angry. I have lost the ability to cry. I have been cutting myself. My suicidal thoughts are developing structure and intent.

This is important: who has advised you? Have you been regularly seeing a professional? Or did you get prozac from a GP and some friend is saying get CBT? It is troubling you feel you are on a downward slope and that you have been cutting yourself, and that your suicidal ideation is becoming mroe precise. I urge you to see, or continue to see, a specialist and to be honest and frank about your state of mind, your cutting and your intentions. Please continue to get help.

You have my best wishes for success -- I have had cyclical major depressive episodes for 20 years including multiple suicide attempts; at the same time I have raised a wonderful daughter and have a great career and wonderful friends. It is not either-or. You can lick this disease; indeed youmay get to lick it more than once. Assemble all the tools you can as early as possible.
posted by Rumple at 10:25 PM on October 28, 2006

. . . seems to assume that depression or lack of self belief is commonly founded in the inividual's life experience.

This can be regarded as true in a very broad sense, i.e.., you may use your former experiences as "proof" of your beliefs about yourself. For example, if you see the future as hopeless, that may be because you are remembering certain events in your past that you regard as failures and then assuming that these unhappy events will inevitably recur.

Thoughts don't just appear in the mind out of nowhere; a lot of what we think is a kind of editorializing on events out of our past. But the important thing is not the event per se but rather your interpretation of it, what you tell yourself the event "means."

A therapist friend of mine (not my own therapist) told me that an antidepressant like Prozac is most useful in relieving the enervating symptoms of depression so that one may have the energy and persistence to work through the problem in therapy. And in CBT, that energy is used to question and dismiss certain long-held assumptions that sustain the state of depression.

I have had very positive results using cognitive therapy.
posted by La Cieca at 10:27 PM on October 28, 2006

CBT is definitely about the present rather than the past. I've been doing it for almost six years now, and while it was definitely bumpy at the beginning (when I was so depressed I couldn't get up the energy to kill myself), it has been tremendously helpful.

Just for example, when you're depressed or anxious, you may behave in certain ways. Me? I stop washing my hair, sleep all day and don't answer the phone, leave the house or even check the mail. (In psycho-babble, this is avoidant behavior.)

My homework from my therapist may be something very simple and concrete. "Check the mail this afternoon at 4 p.m. and then call me. Do it again tomorrow."

The idea, really, is that by changing the way we respond to things, we can change the way we think about them.

You should at least have an introductory session with a cognitive behavioral therapist before rejecting it outright. You might find it is helpful after all.

Good luck. You can get through this.

Please do see your psychiatrist asap.
posted by brina at 10:58 PM on October 28, 2006 [1 favorite]

Yes. I felt exactly the way you do. I was depressed, very angry, and had a suicide plan. I didn't want to hurt myself, but it was a contingency plan. I hope that you are seeing a psychiatrist to help you with the meds. You need to do this. Your primary care MD can get you started on medication, but you obviously feel very bad. You have an illness that can be made better, and you will not feel this way forever. There will be colors and music again. You will not feel angry and hopeless anymore.

CBT did help me, although I didn't stay with it long. The meds are what has been the greatest help for me. But, CBT did help me start to recover. My therapist showed me that the ways in which I was saw the world were distorted by my level of depression. I would encourage you to give it a try.

I can't tell you strongly enough that you need a psychiatrist. If you are only seeing your primary care doctor, then you must call them on Monday and get a referral. Good luck. Hold on. You will feel better. I felt just like you do now, and I can tell you that there is a light at the end of the tunnel.
posted by puddinghead at 11:29 PM on October 28, 2006

Maybe I'm reading this wrong, but when you say "persevere" with a course of CBT, I assume that you've already started and you're not finding it helpful. In which case I think you should change your medication and your therapist. It's not uncommon to go through several therapists before you find one who suits you well; try getting a recommendation for a new therapist when you discuss getting new meds.
posted by stefanie at 11:29 PM on October 28, 2006

First, let me say that it's terrible that you're feeling the way you are feeling- it's a horrible experience I wouldn't wish on anyone. You ask " Are these feelings another symptom of the illness?" From what I know of depression, the answer is YES! The thought processes that you're experiencing are part of the symptoms of depression, and are part of maintaining your depression. CBT isn't a miracle cure for everyone, but it is a therapeutic technique that has been successful for others in your situation- it seems worth a try.

RUMPLE raises several important points-- first, it's really important that you feel a positive connection with your therapist. Even though it sounds like a lot of work, you need to shop around and find a therapist that you connect with.... a clinical psychologist is a likely a good choice, but not the only choice. Personality is important. Similarly, a therapist that practices CBT is likely a good choice (from what I understand, the origin of negative thought patterns doesn't have to based clearly on your personal history; it matters more to understand your current thought processes and how they affect your mood, than to identfy where they come from). That being said, CBT is not the only therapeutic choice- other modes of therapy might also be helpful to you, if the underlying philosophy of CBT doesn't make sense to you.

RUMPLE also says "you do have to want to get better" This is critical. Loved ones who support you, want to help you, etc. can help with that motivation, but they can only do so much. I have a close friend who was in a long-term relationship with a man who expereinced depression. Despite lots of encouragement and understanding from my friend, her partner ultimately wasn't able to see the depression as something that could be fought, and he ended the relationship (for her benefit, he believed, with much regret on all sides). This was really too bad since she would have been a supportive and patient partner to him in his fight against depression. I think a key to successfully treating depression is that YOU feel that the depression is something external to yourself that should be addressed, rather than a part of who you are in the world.

Finally, it sounds like you need another consultation with your psychiatrist (or a first appointment with a psychiatrist, if you've only been prescribed medication from a GP). The dosage of Prosac does not appear to be working for you-- the issue may be with the dosage, or with the Prosac itself- a psychiatrist would have the best opinion on that- but there are lots of different forms of anti-depressants to try.

Please don't give up and just accept your situation. You shouldn't have to live with thoughts of suicide and self-harm. As hard as it sounds, try whatever options are available to you. And also trust your instincts if something isn't working, and try new, different options if that's the case. Just don't give up- something will help. Best wishes.
posted by waterfall at 1:31 AM on October 29, 2006

RUMPLE also says "you do have to want to get better"

I'm sorry, but this makes no sense. Of course the OP wants to get better: why else would s/he be posting here? However, the implication is that the OP must have the right attitude in order to be treated. I'm sure you didn't mean it that way, but that's actually kind of insulting. Treatment either works or it doesn't. Wanting to get rid of depression is no different from wanting to be rid of cancer or heart disease.
posted by Violet Hour at 1:22 AM on October 29, 2006

It seems to me that the things I believe about myself are not only negative but absolutely true. Therefore examining them is a waste of time and could potentially make me feel worse.


CBT doesn't ask you to challenge facts. It asks you to challenge the implications you draw from those facts. It's a fact that Beethoven went deaf. But that didn't imply his life as a composer was over. It's a fact that Lance Armstrong contracted cancer. But that didn't mean he had to stop riding a bike.

Of course, those are such amazing example that they are almost intimidating. But you see my point. The key to CBT is being clear about the difference between facts and implications. No matter what the fact is, the implication that your life is over, that you are worthless, or that you must commit suicide is *always* wrong.

Accept the facts. Challenge the erroneous implications. And don't confuse the latter with the former.
posted by mono blanco at 1:49 AM on October 29, 2006 [1 favorite]

I am being treated for severe depression, and did an 8 week CBT course for depression through the hospital my doctors are affiliated with.

I guess I can see some of the worth in it, but in all honesty, I don't think I really gained much out of it. It's possible it's because we were given massive amounts of "homework" and even though I wanted to, I just never did it.

Although, my philosophy is that it's always worth giving everything a fair shot. I think CBT is more useful for people with anxiety though.
posted by tastybrains at 6:01 AM on October 29, 2006

I had a major depression. I didn't know it though. I just thought I had logically concluded that I was thoroughly bad and had a complete, logical set of reasons for this. But I couldn't bring myself to commit suicide. I was at an impasse.

So, I thought "I can't go through life like this, but I can't die either." I was in therapy at the time, with a student in psychiatry. I had sought it out because I was flunking out of school, and needed a doctor's note to extricate myself from the mess I had made because, as I thought, I lacked the courage to go through with the only logically course open to me.

So, I thought there was one more possibility. Although I believed all the terrible things I thought, I had, at best, conflicting evidence as to their empirical truth. If there was a remote possibility I was wrong, I had nothing to lose by exploring it. So I decided to *pretend* I was wrong, since I couldn't stop believing. My idea was that I was currently facing a choice between being a bad, sad person or death. Instead I would compare life as someone pretending to happy and death, and see if that made a difference. If the experiment failed, I would have no doubts any longer.

I pretended the things I believed about myself weren't true. I pretended, in fact, to be happy. I imitated what I perceived to be happy people. I wouldn't allow myself to do or think anything that made me feel bad. It wasn't easy -- it was bloody hard work and I had to give up a lot. But what ended up happening is that I started to feel better.

It changed my life. Sure, I have slips, but my crazy logical system has more or less collapsed on itself, now that the premises it was built upon have been more or less proven untrue. I now go to psychotherapy, to explore the deeper issue -- how did i end up believing all that crap in the first place?

Are these feelings another symptom of the illness? Did anyone else face this hurdle at the beggining of CBT? How did you overcome it? Did it take long? What hope do you now have for the future?

1. For me yes. 2-3. I faked it (see above). 4. It took a couple of months to get to the point that I could see a positive outcome. 5. Tons, I went back to school, and now am in law school, a degree I thought I would never be able to pursue after depression screwed my first degree.

The one caveat I would put forward is that I had a pretty crap childhood, with psychological abuse for a few years, so maybe CBT works better for me than someone who didn't have someone messing with their self-esteem as a kid?

My bottomline advice: don't worry about whether you believe the stuff they teach you in CBT. It is behaviour therapy, not belief therapy. Changing behaviour provides a space begin enough to let a bit of light in. Then you can work on the beliefs. YMMV, of course. As with any drug/therapy, if it doesn't work, try something else.
posted by girlpublisher at 6:15 AM on October 29, 2006

If you are cutting yourself and having suicidal ideations, you need to talk to your doctor ASAP, like in the next hour. Not Metafilter. Get off the computer and go to a phone.

You can try lots of other things. There is no silver bullet for everyone. A psychiatrist can help you with this. You will find a different regimen that will help you with time. You need to let your doctor know when something is not working. What you are experiencing now qualifies as "not working." Let them know and they will help. If it doesn't work again, keep telling them and keep trying.

Take care of yourself and all the best.
posted by Marnie at 6:36 AM on October 29, 2006

If you have been on Prozac for 9 weeks without it helping and your doctor/therapist hasn't said you should try something different, you should switch doctors/therapists, IMO.

I tried Prozac, Zoloft, Effexor, and Paxil. I wasn't on any one of those that didn't work for more than 3 or 4 weeks before we switched to another one to try. After about 6 or 8 days on Paxil, I woke up and it was like someone flipped a switch in my brain that turned the depression off.

I've tried therapy (I don't know if it was CBT or not) several times, but didn't get anything out of it. Of course, I was biased going in (thinking my problem was chemical), so I may have not had the right mindset or may not have given it enough of a chance.

I've been on Paxil for about a decade. I tried coming off of it about a year ago and things were going fine until I switched jobs. Then I got anxiety that was nearly crippling. I've been back on Paxil since.

BTW - if you decide to just stop taking the Prozac cold turkey, be aware that the SSRIs (of which Prozac is one) can have some pretty bad withdrawal side effects. Flu like symptoms combined with what can only be described as a sort of shock or buzz in your head. You are better off cutting back the dosage over time than stopping cold turkey.
posted by Bort at 6:53 AM on October 29, 2006

Violet Hour: I'm sorry, but this makes no sense. Of course the OP wants to get better: why else would s/he be posting here? However, the implication is that the OP must have the right attitude in order to be treated. I'm sure you didn't mean it that way, but that's actually kind of insulting. Treatment either works or it doesn't. Wanting to get rid of depression is no different from wanting to be rid of cancer or heart disease.

But the attitude isn't that uncommon. Nor is the "What do ~you~ have to be depressed about??" attitude. There really is more judgmentalism regarding depression than any other non-sexually-transmittable disease that I've ever seen. (You have no right to be depressed, and if you're not getting better, it's your fault because you don't really ~want~ to get better. I've had both thrown at me. And both were in all seriousness. It's really.. well, depressing.)
posted by Meep! Eek! at 7:23 AM on October 29, 2006

Therapists can really help you out, or they can really fuck you up. It's just a fact when you're in a very volatile period of time in your life that changes affect you profoundly. If you are so against the ideas of CBT it might not be for you. There are other types of therapists.
(Personally I am doing much better drug and therapist free, thanks exercise and health food).

You really need to get off a med as soon as it causes symptoms like that. With the help of a doctor, of course. It's appalling that your doctor would keep you on it with that kind of effect.
posted by shownomercy at 7:30 AM on October 29, 2006

When I was diagnosed with depression, I went on Lexapro...I was already in therapy, so I just continued with that. My therapist helped me identify my habits & behavior patterns that were screwing me over, and to change them. The meds quieted my mind so that I could separate the "depressive" thoughts & consciously contradict them. That was really really helpful for me. I'm not in therapy right now, but I'm still able to contradict the "depressive" patterns.

First, I agree with others who say that Prozac doesn't seem like the right meds for you. After 9 weeks, you should be feeling a significant improvement, not significantly more depressed. Absolutely call your doc. Today.

Second, if you're on the wrong meds, any therapy is going to be less then helpful. Maybe take a break while you're finding the right meds for you, maybe stick with it, I won't tell you what the right thing to do here is. Once you are on something more helpful then Prozac, you'll probably have better therapy sessions/results. If you don't like CBT, or your therapist, you can always try something different.

Good luck anon -- depression is enough of a pain in the ass without things making it harder for you.
posted by good for you! at 8:03 AM on October 29, 2006

When I've been depressed — and I seem to fall into it every few years and then drag my way back out again — I've found it to be worth trying anything that seems like it might help.

People will tell you that therapy is flawed and doesn't always work. People will tell you the same thing about drugs, meditation, exercise, religion, philosophy, self-help books, and all the rest. And they're all right — no solution is perfect, and nothing works for everyone.

Fortunately, you don't need a perfect solution that works for everyone. You need a good-enough solution that works for you.

Who knows? Maybe an especially good conversation with a C-B therapist will give you the insight you need to jolt you out of this. Give it a shot and see what you can get out of it.
posted by nebulawindphone at 8:17 AM on October 29, 2006 [3 favorites]

It seems to me that the things I believe about myself are not only negative but absolutely true. Therefore examing them is a waste of time and could potentially make me feel worse.
Just want to re-emphasise that, from what I know of depression, this is an absolutely classic symptom. The belief that others are just ill with depression but that you are actually right about yourself and therefore beyond help is one of the beliefs that can keep people stuck in that awful place for far longer than they need to be. That said, someone I know was advised to leave the CBT until a little later in their treatment, after they'd passed the worst times and were a little stronger and better able to handle the CBT. If you don't feel like it now, maybe leave it a little while and come back to it when your meds are working for you.

I dont think that I actually have the strenght to overcome this.
You don't have to summon up all of the strength to overcome all of this right now. Just keep on taking the little steps and do what you can, and the load will gradually lighten from your shoulders.

Good luck.
posted by penguin pie at 9:47 AM on October 29, 2006 [1 favorite]

CBT has certainly been helpful for me, but only after I'd gotten through the deepest, darkest periods of depression with drugs (Serzone, in my case -- if the Prozac isn't working for you, feel free to talk to your doc about alternatives!) and standard talk therapy. Changing my thought patterns simply didn't work until I'd really gotten through a lot of deeper emotions I had been unable to deal with for quite a long time -- grief, anger, etc. And grieving or feeling angry, for example, are not just some aberrant thought pattern to be altered -- they are genuine human emotions that need to be experienced in order to give them a real beginning, middle, and end. So for me, I had to deal with things on a more basic, emotional level with a non-CBT therapist before the mental/intellectual benefits of CBT became applicable.
posted by scody at 9:49 AM on October 29, 2006

You should talk with your psychiatrist right away about the Prozac. SSRIs do have, as a side effect, a tendency to increase suicidal ideation in some patients. It's something that has gotten warning put on the boxes here in the US, and gotten the British Medical Journal to suggest that they aren't necessarily the best first-line treatment for depression. You don't mention you age, and that particular side effect (now confirmed in multiple studies) is more prevalent in adolescents and children, but you should take the worsening of that symptom very seriously.

The facts about therapy, again, confirmed by many, many studies, is that it works quite well as a treatment for depression. What many of the same studies also suggest is that no one type of therapy works better than another type, which is inconsistent with the easily reported news that CBT works for depression, but other forms of therapy don't necessarily. Basically, therapy works through contextual and not specific ingredients, and some types work for some people better than others, but no one type is the best. It matters a lot what type of therapy accords with your model of the mind and your own theory of change. Pay attention to those two things, and choose a therapist that accords with your ideas, and you're likely to get better through therapy. ~80% of people in distress who enter therapy do better than untreated controls, and folks respond to therapy pretty quickly. I say all this because a couple of widely reported studies suggest that CBT is the best, so it often gets suggested to people with depression, but the results of those studies don't hold up well to scrutiny (which is not to denegrate CBT: it works, and it works well, it just doesn't work any better than other types of psychotherapy).

I am a therapist, but I'm not your therapist. My suggestion is that you talk to you psychiatrist immediately about your suicidal ideation, and that if it gets worse before you have a chance to do that, that you go to the ER. I'm happy to discuss this more at the email listed in my profile.

Take care of yourself.
posted by OmieWise at 11:28 AM on October 29, 2006

Is it not also possible that therapy has a "placebo-effect" kind of benefit, that what matters is someone taking an interest in you and trying to help you, rather than any specific method, rationale or educational degree? "When Adam delved and Eve span, who was then the therapist?"

As for any specific advise I might give the questioner, I am not a therapist but I second OmieWise. Prozac can't possibly work well for everybody; there are a few other types of antidepressants on the market now. And remember, it's the doctor's job to help you, it's what s/he gets paid for.
posted by davy at 12:16 PM on October 29, 2006

I am not a pscyhiatrist nor am I a therapist. I'm just speaking from my own experience.

How long have you been taking Prozac? 40mg of Prozac doesn't seem like a lot to me. I'm currently taking 200mg of Zoloft a day and supplementing it with Wellbutrin.

Before I ever took my first med I spent a long time in talk therapy, not necessarily CBT. At the end of all the talk I had figured a lot of things out but I still had an overall depressive feeling.

I would talk to whoever's prescribing your meds about this issue. You may feel better if you up the dose of Prozac or switch to something different.

I've also tried Prozac and Paxil before settling on Zoloft. The Zoloft worked fine for awhile and then I added the Wellbutrin after about a year because the Zoloft lost it's kick.

Ultimately you're probably going to have to try a lot of different things to figure out which ones work the best. The answer could be CBT by itself, CBT with meds, meds by themselves, standard therapy with meds, etc.

Unfortunately I know from experience it's hard to judge these things from the inside. You need to give the professionals as much information as possible. When I had trouble keeping my motivation up the thing that helped me was to mentally tell myself that if I couldn't do it for myself I could hitch my wagon to someone I love and do it for them.
posted by dgeiser13 at 12:22 PM on October 29, 2006

davy wrote...
I don't understand how CBT differs from "brainwashing".

Brainwashing: 1. Intensive, forcible indoctrination, usually political or religious, aimed at destroying a person's basic convictions and attitudes and replacing them with an alternative set of fixed beliefs.

I'm not sure how you would confuse that with sitting on a couch and chatting with someone about how your brain works. A couch that you're free to get up and walk away from at any time, if you feel like the conversation isn't for you.

BTW, I've never heard of any credible therapy that included destruction of someone's beliefs. As far as I know, therapy as it is practiced today is about expanding the set of tools that people have to work with, not imprinting them with some view or another. That would be the realm of cults...
posted by tkolar at 12:32 PM on October 29, 2006

davy writes "Is it not also possible that therapy has a 'placebo-effect' kind of benefit, that what matters is someone taking an interest in you and trying to help you, rather than any specific method, rationale or educational degree?"

Yes and no. Yes, there is a placebo effect at work, no, that does not mean that there is no effect or a fake effect. The placebo effect, basically the anticipation and expectation of change, produces real change that helps people to feel better. It's certainly part of the effect of the anti-depressant medications.

Yes and no. The research indicates that therapuetic interventions have an effect, many of the studies have been conducted with a therapy group and a group that "just talks" as the control. One might also legitmately figure that many of the people wanting treatment but not getting it (and not doing as well as people in therapy) are talking with friends and family. Basically, if you want to accept the research conclusions (which is that therapy works for most people reasonably quickly because of general and not specific ingredients), then those conclusions are reached with therapy and not random talk with random people. If you don't want to accept those conclusions, then you can assume anything you want about therapy, none of which is scientifically valoidated.
posted by OmieWise at 1:05 PM on October 29, 2006

I haven't been through CBT with a therapist myself, but I've read the Feeling Good book that Rhiannon recommended, based on CBT, and have found it enormously helpful.

CBT also seems to assume that depression or lack of self belief is commonly founded in the inividual's life experience. (I dont feel that anything has happened to me to explain the way I now feel.)

No, if anything that's what CBT is not, and that's what many people (including myself) find so much more helpful about it. Unlike many other forms of therapy CBT is very much based on the present, and based on concrete, logical things you can do to actively change your life and the way you see yourself and the world around you.

Intellectually this makes perfect sense. I can totally see how this may be the case for lots of people. But I fear that it is not the case for me. It seems to me that the things I believe about myself are not only negative but absolutely true.

This is your depression talking. Let me say this: I'd like to think that I'm a logical, clear thinking person, and I think most people who know me would agree. I rarely, if ever, lose debates or arguments. But I've realised over the years that when it comes to the way I see myself and how I relate to the world, I can be so wrong. So so wrong. And I'll say with some confidence that you are wrong too.

Here is a list of the ten cognitive distortions mentioned in the Feeling Good book, which I believe is also central to CBT. Chances are the negative things you believe about yourself are simply untrue or blown out of all proportion. But even if they are true, they do not have to condemn you to worthlessness and hopelessness. I think that's the main aim of CBT - not to convince you that there are no negative things, but that seen from a normal, healthy perspective, these negative things can be lived with and do not have to rob all the joy out of your life.

Therefore examing them is a waste of time and could potentially make me feel worse.

You're thinking of ending your life - why are you worried about wasting time? And just how much worse do you think you can feel? Don't you think it's worth a try?

The thing is, no therapy or medication works for everyone. I've been with my depression for eight years now, and I've tried so many kinds of medications and therapy (seriously, it's been a long journey). I learned something from many different therapies and books, even though none of them "cured" me by themselves. I accumulated this knowledge and advice over the years, and it was only in the last year or so that it's looked like I'm on my way out of it.

I don't mean to suggest that it'll take you this long - we have different circumstances, and many people find their depressions lift after a much shorter period of time. But it's your life, and it will take a while - I can only suggest to you that it will be worth it, and hope you can believe me.

Please talk to your psychiatrist or doctor and tell him or her about your feeling suicidal as soon as possible. And as others have mentioned, Prozac has been known to cause suicidal thoughts in people - don't quit it cold turkey though, talk to your doctor - the side effects of going cold turkey off these things can be pretty horrific (I speak from experience). Come off it slowly, and maybe try another medication. If your current CBT therapist doesn't work for you, even if you've given it your best try for a while, look for another one. It doesn't mean CBT won't work for you. There are so many more options that can help you is what I'm trying to say. There's no reason to give up.

And give Feeling Good a try. Or maybe a couple of tries - the first time I read it I didn't like it for some reason - maybe I wasn't ready for it? The second time through I'm thinking that this book may well end up saving my life. It's the most logical book I've ever read, and I really think that at some point you'll find it really helpful.

I wish you all the best - I know how hard it is, and if you need a chat or anything like that, my email is in my profile. Take care.
posted by Ira.metafilter at 3:54 PM on October 29, 2006

Wow, you have gotten some seriously great advice here. What a great group of people! I’m a Ph.D. in psychology (and this is my first post!), so I thought I’d just add a few things that I thought needed another mention or clarification:

1. If you are having suicidal thoughts that are formulating into intent and planning, you need to get help immediately. Call 911. Alternatively, walk into the emergency room or a psychiatric receiving center. Be honest about your symptoms just like you have been here. They are more common than you know and aren’t going to shock anyone.

2. Prozac has NOT been shown to cause suicide. Prozac has shown to be correlated with suicide. This is an extremely important distinction, but it does not negate the fact that people with serious depression AND people starting an anti-depressant should be monitored for suicidality.

3. CBT (and most therapies with the exception of perhaps classic psychoanalysis) isn’t something that a therapist does to you. It is something that the therapist helps you do to yourself. You have the tools to help yourself; a good therapist helps you find, harness, and use those tools to your advantage. This is what makes psychotherapy different from something like radiation therapy in cancer treatment. (Same with physical therapy – the physical therapist does not make you walk again after an accident; the physical therapist helps you do it yourself.)

4. Milligrams in drugs do not compare in terms of strength across drugs (if that made any sense). 80 mg of Prozac is a LOT of Prozac. 100 mg of Zoloft is not a lot of Zoloft.

5. Yes, therapy can have a placebo effect in that the relationship with the therapist is the healing factor rather than the therapist’s techniques or theoretical orientation. I’m not so sure this matters, though, if the symptoms get better.

6. I think you may have the idea that when you go see a therapist for CBT, all you get is someone refuting your negative thoughts. A therapist does much more than that (a good one anyway), no matter what his/her theoretical orientation. If you decide to seek therapy, don’t be afraid to express your concerns and skepticism to the therapist up front. Also, sometimes people do feel worse in therapy before they feel better as they face things they’ve been hiding from and start working through painful experiences and feelings.

7. Some alternatives to therapy: Self-help books, dietary changes, exercise (underestimated as a treatment for depression), religion (if you’re religious, of course). Personally I’d arm myself with several treatments instead of relying on just one.

I absolutely wish you the best. Depression is incredibly painful and it feeds upon itself. Fortunately it is very treatable, and I applaud you for reaching out for help.
posted by forensicphd at 5:04 PM on October 29, 2006 [1 favorite]

I know lots of people liked Feeling Good, but while I find CBT very helpful, I found the book appalling and condescending. So when you are in a place to consider therapies, if you don't like the book, don't assume that means you don't like CBT.
posted by dame at 5:21 PM on October 29, 2006

Please see your doctor. Immediately.

It may not be that CBT isn't working for you - perhaps your THERAPIST isn't working for you. And it sounds like your meds aren't either.

Talk to your doctor. This really isn't for YOU to sort out -- you have enough on your hands, surely!

A short course of CBT worked for me when I had crippling anxiety attacks. But it really only works on stuff that's very close to your conscious mind: ie I wanted to go for a walk but then sat and smoked 20 cigarettes instead: it helps you find easy ways to change your behaviour in specific situations. That said, it may not be what you need right now.

I also have been on every antidepressant on the planet and suffered a multitude of side effects until I came to the one that suited me.

But again, this isn't up to you. Talk to your doctor. Be honest. Insist that something is done to help you. Good luck.
posted by unmusic at 5:20 AM on October 30, 2006

Prozac has shown to be correlated with suicide. This is an extremely important distinction

This is incorrect. Some patients taking SSRIs have been shown to have increases in suicidal thoughts after starting the medication. In other words, patients who were depressed enough to be enrolled in a study had a worsening in suicidal thoughts after starting the SSRI arm of the study (but not the placebo arm!). This isn't something that can be argued away as a problem of correlation vs. causality, as it comes out of randomized, placebo controlled studies, and the issue isn't suicidality at the start of the study, but after the medication is administered.
posted by OmieWise at 5:42 AM on October 30, 2006

I've had incredible success with it. I cannot recommend it enough. The only drawback, as with all other kinds of therapy is that you have to want to get better.

Basically they work as well as SSRIs from the studies I've seen, with a lower relapse rate.

I can't recommend CBT enough.
posted by Ironmouth at 6:31 AM on October 30, 2006

The other thing to keep in mind is that when you first start looking at stuff, things get worse, not better, because you are actually dealing with the problem stuff.
posted by Ironmouth at 6:32 AM on October 30, 2006

Violet Hour,

Actually, I've found that when I was getting stuck with CBT recently, it was because I didn't want to get better but I wasn't acknowleging it. Essentially what happens is that you have unacknowledged feelings regarding getting better--CBT and all good therapy requires you to make changes to the way that you look at things. This requires facing problems head on instead of using bad reactions to avoid dealing with them. Sometimes until you are ready to acknowledge this, it doesn't help.
posted by Ironmouth at 6:37 AM on October 30, 2006

I don't see how you could consider such a serious chemical component as the be-all-end-all treatment for your symptoms. I also don't see how you could write out CBT, when you specifically note that your own attempts at "curing yourself" have devolved. Every one I've known who has traditionally addressed their psychological depression has done so with CBT sessions at the beginning, in conjunction with medication if necessary following a few "sessions".

All of my siblings and I were diagnosed with "chemical imbalances" by cognitive specialists. Two of them are still on Prozac, and remain chemically dependent on a drug that makes them feel like a zombie and only serves to increase their dependence on "outside solutions".

The struggle is internal, the clockwork is always running. You can ignore it, but the only way to dismantle the machinery is to examine its order of operations. If you cannot bring your internal semantic framework into focus than it will forever dominate you.

All perception is gamble. Remember that.
posted by prostyle at 7:26 AM on October 30, 2006

This isn't something that can be argued away as a problem of correlation vs. causality, as it comes out of randomized, placebo controlled studies, and the issue isn't suicidality at the start of the study, but after the medication is administered.

This isn't the place to debate this, but as I do not believe that the placebo controlled studies on this topic were statistically sound, I stand by my position.
posted by forensicphd at 7:43 AM on October 30, 2006

Today the Food and Drug Administration (FDA) directed manufacturers of all antidepressant drugs to revise the labeling for their products to include a boxed warning and expanded warning statements that alert health care providers to an increased risk of suicidality (suicidal thinking and behavior) in children and adolescents being treated with these agents, and to include additional information about the results of pediatric studies.

I dunno, it seems like precisely the place to emphasize the risks over cavils based on individual opinion about statistical analysis. The FDA, not an organization known to be very forward thinking about consumer health, seems to think the studies warrant a black-box warning. OP, get yourself to a psychiatrist.
posted by OmieWise at 10:20 AM on October 30, 2006

prostyle wrote...
a drug that makes them feel like a zombie

You should encourage your siblings to try different anti-depressants. A friend of mine reported feeling zombie-like on Paxil, so he switched over to Wellbutrin and now he feels fine.
posted by tkolar at 11:08 AM on October 30, 2006

Disclaimer, IANAD. But I wanted to add a note to say that it can take six weeks or better to realize the full benefits of an antidipressant. The meds you are on don't seem to be working for you. You might need a different dosage, or you might need a different med. Dialing in the right dosage and/or right med can take time.

But in the meantime, you should be seeing someone and giving the talking cure a try. CBT and CBT-influenced therapies are popular because the work for most people. They may well work for you, too. If they don't, other therapies might work (dialing in the right therapy can take time, too). As others have noted, therapy + meds tends to work better than either in isolation.

You need to inform your doctor that you're continuing to abuse yourself and have suicidal thoughts. If you're not in therapy already he/she will likely refer you to a therapist and he/she will likely switch your meds or reconsider the dosage. In fact, if he/she did neither, I'd get another doctor.
posted by wheat at 2:01 PM on October 30, 2006