Yesterday, a study published by The Lancet medical journal made waves in the media. It reported that mindfulness-based cognitive therapy (MBCT) might be as effective as antidepressants in stopping the reoccurrence of major depression in sufferers. The study revealed that, between two groups – one on medication, one treated with MBCT – the rate of relapse was similar: 47 percent and 44 percent, respectively.
This is quite the occurrence. With antidepressants making £7.5 billion per year in the US alone, the ability to treat sufferers with something just as effective – and something that's theoretically free once they learn to master it – would be hugely beneficial to everyone but the pharmaceutical giants.
As someone with experience of using both methods to treat depression, I thought I could add my voice to this. But first let's make clear what mindfulness actually is: mindfulness is the method of being aware of one's thoughts, learning to disengage from them – if negative – by placing oneself in the present moment, learning to acknowledge the "bad" thoughts and do something different with them. It's common practice in eastern philosophies like Buddhism, where adherents focus on tasks such as cleaning, eating and – during meditation – deep breathing. They claim this allows them to negotiate life on a more even keel.
Today, this has been combined with cognitive behavioural therapy methods and developed into MBCT – which encourages individuals to challenge their negative thoughts by doing things against their grain. However, the depressive brain is rarely logical and these high-minded activities don't work for everyone. Often, in the moment, it's simply a matter of getting into bed to feel better, and that's okay.
I first went on medication at 21, a year after my mum's unexpected death. Despite being depressed my whole life, I'd refused to take anything up to that point, the stigma of it holding me back. After her death, however, I needed something to help me cope, so I began practicing mindfulness and meditation.
Initially they both worked, but after a year that culminated in a full-scale nervous breakdown, I felt not only that I needed medication but also that the mindfulness had bottled me up, giving me permission not to think and process things. The present-moment awareness – supposed to deliver me peace – ultimately did the opposite.
Don't get me wrong, antidepressants aren't always an easy ride, either. The side-effects can make you feel iffy to begin with and, when doses are missed, can cause awful headaches. They can also make you last for ages during sex, which – though I'm sure sounds great initially – gets old quick. But they can be very effective.
Antidepressants certainly don't cure anything, but they do provide breathing room and make life liveable, giving us enough perspective to make some changes. For me, mindfulness created a level of distortion, an unreasonable belief that I could control my illness with a philosophy. People still build a stigma around antidepressants, too; "chemicals" are taboo in relation to mental health, but OK in our food, drink and cosmetics.
This contradiction has left many of us avoiding them for fear of seeming weak and impure, me being one. In the real world, believing that mindfulness can treat depression as effectively could suggest an unwillingness to admit our weakness and lack of control. For some people, medication will be a necessary lifeline in order to function with some semblance of normality. The chemical imbalance vs circumstantial debate surrounding mental health conditions will no doubt continue long into the future, but for now, whatever works should be good enough.
Considering how multicausaldepression is, we cannot assume that there will be some kind of definitive "cure" or treatment for it. We have to explore what is right for us at any point in time. In my experience, mindfulness contained my depression once its symptoms had occurred. Medication contained my depression to a point where they didn't occur. It's not a case of pride; simply – having been on both sides of the fence – I know which one I'd rather live on.
People with depression are just as unwilling to waste their lives as anyone – we want what works best and quickest for the cheapest price, the thing that lets us do the most without the barrel of depression's gun pressed to the backs of our necks.
Regarding the study, am I wrong, too, to think the results could be weighted? It was implicitly carried out to prove that MBCT is more effective than antidepressants, the mindfulness group engaging in "daily" exercises, which, if they weren't being studied, I wonder if they'd be so eager to do.
The effectiveness of any cognitive behavioural therapy (CBT), in my experience, largely depends on the therapist and their willingness to cater exercises to one's particular needs. How often I've left places thinking I've been lumped in under some huge umbrella, told to do things which made logical sense but which I needed to do so intensely and frequently that the stress incurred was sometimes worse than the illness.
Being referred for CBT on the NHS can come with lengthy waiting times, too – if you want therapy quickly, you'll may need to go private, although many therapists offer concessionary rates if you ask. In an ideal world, high-quality MBCT in combination with antidepressants would probably be a great way to go. People with depression are just as unwilling to waste their lives as anyone – we want what works best and quickest for the cheapest price, the thing that lets us do the most without the barrel of depression's gun pressed to the backs of our necks.
Antidepressants aren't a miracle drug for everyone, and we don't even know completely how they work. But for me, like many, they're the best thing compatible with a fulfilling life. I'm not advocating taking medication before trying other methods first – like depressive disorders manifest differently for every individual, people respond to a variety of treatments in very different ways – I'd be worried if this new study in any way increased the stigma that still surrounds antidepressants. Why? Because you're not a failure if you can't treat depression with the power of your own mind.
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