Nik name says it all

This is long and … it’s my two cents but … your post brought up some thoughts.

Some background: I’ve had depression and OCD for as long as I can remember – the OCD even earlier than the depression. Panic Disorder started later.

Is ‘treatment-resistant’ a conclusion based on the effectiveness of only trying various medications? I use medication, but I find that the foundation of treatment needs to be using one or more of the therapy modalities that psychology has shown to be effective (via studies). I realized this when I was still on a therapeutic dose of meds and stopped doing the non-medication therapy work (I hadn’t yet achieved the results of the non-medication therapy) and … the problems came back. I found that Cognitive Behavior Therapy (CBT) is highly effective for various disorders, with the sub-category, ‘exposure and response prevention’ (ERP), being very good for panic disorder and obsessive compulsive disorder (other parts of CBT are used for depression). Another highly effective treatment for depression is Acceptance and Commitment Therapy (ACT). Both of these are not long-term, open-ended therapies like talk therapy is. And … talk therapy has very little – if any – effectiveness for mood (depression) and anxiety disorders (this is supported by the professional book, ‘Guide to Treatments that Work’, which is meant to show mental health practitioners what treatments are most effective based on studies).

The key is to find someone well-trained in the latest, evidence-based treatments. E.g. I know from my own experience that CBT/ERP and ACT work for my disorders but … there are other tools that a well-educated psychologist knows and can apply. Finding a therapist who actually knows this stuff takes some research. I went to a number of therapists who said/thought they knew CBT/ERP, and it was a waste of time — so many think or say they know these things but they don’t. I also had psychiatrists who did ‘talk therapy’ (like the kind you see on the Sopranos) — not effective for mood & anxiety disorders. They also didn’t know how to properly guide me to psychologists for the non-medication treatment. If I had stayed with them and had I went through every medication trial without help, they would have potentially labeled my response as ‘treatment resistant’.

I found that I had to look outside of network (ok because these treatments are not long and drawn out and … my life depends on this) and to do some research by calling people up and asking the right questions. I found the best solution for me was using rutgers psychology phd & psyd students — rutgers university (like some other universities and some cognitive behavior centers in NYC and other cities) provides well-trained and very knowledgeable phd + psyd psychology students for a much-reduced cost. The key is to find someone who knows ACT and CBT/ERP and other parts of CBT very well so that they know what treatments they can use based on what the patient is presenting. For example, I was stuck w/ doing the CBT/ERP homework and … my therapist switched to using ACT to address the depression-related issues that were getting in the way. The latter got me over the hump and helped my depression. My thoughts are to go with a PsyD — and if you can get a PsyD student, very good b/c they’re eager and the cost is cheaper. Note: PsyDs are psychology doctorates who focus on the therapy/clinical part for getting their doctorate as opposed to the PhD student who focuses on presenting a research thesis.

A good sign that I’ve found to see if therapists know their stuff and are applying the tools of the treatment is when they don’t let you wallow and talk for long periods of time. They focus on bringing you back to the planned agenda for the therapy session by focusing on using the tools of the treatment method. When I was in therapy with one professional PhD therapist, he let me rant about problems I had with my family, etc. and would spend time ‘giving me advice’ and talking about it — this seemed like it was the right way to go until I experienced therapists who really knew CBT/ERP and ACT — the former therapist was essentially engaged in talk therapy and thinking, maybe based on a few seminars or ‘professional training’, that he was doing CBT. These competent therapists would take what I was saying and distill it to where I was then asked to apply the tools. Because a PsyD is doing this so much – learning how the mind works, learning what treatments work because of this, and then spending so much time applying this with therapy – I can’t see how someone with a master’s in social work or psychology can do the same job effectively. And because ACT is new, I’d like to get someone whose recent, deep education has trained them for this. And … another clear sign that the therapist knows what they’re doing: they know the standard workbooks for the methods (e.g. Get Out of Your Mind & Into Your Life: The New Acceptance & Commitment Therapy – Steven Hayes) and you’re given homework that needs to be done daily. And … if your depression makes you non-compliant, you present your reasons and you work on why, using the tools.

What also helped me was some ‘spiritual’ mind training. I found something that works for me (my nature is skeptical and always questioning so … some things won’t work for me). My thought is that the key is that whatever framework it is, it should be something that works to train you to become aware of your thoughts without judgement or guilt. Again, this is what helped me – and the tools I used were complementary to the therapy.

Another note – your post had me thinking and …, again, I really appreciate your posting b/c it has helped me (I know that may not be much solace but …). Here are some of my random thoughts – sorry if this comes across as a firehose of information which can be overwhelming … I’m just writing down a bunch of things that may resonate. The point is that there are many things out there that have worked for people – and it doesn’t mean that all of these need to be tried or combined….

1. On another blog, 2 people said that what helped them with depression was psychotherapy, with one person saying that CBT didn’t do anything for them (I don’t know the particulars so … dunno if their therapist was very competent w/ CBT or how much homework compliancy, etc.). It shows, though, that different things can be tried and that what I posted is just my limited set of knowledge at this point.
2. A friend of mine saw some article in NY Times about a guy who resolved his depression & got off meds — my friend tried it and it worked for him (he was uber depressed, on meds, etc.). It involved changing his diet (i forgot what he did but he lessened the simple sugars, simple carbs, no processed foods… I think), did cardio daily, and did mindfulness meditation. It reminds me of integrative doctors — western medical doctors who are integrating evidence-based alternative agents and therapies. E.g. Columbia psychiatrist Dr. Richard Brown writes on this (has a book). Harvard-trained Dr. Richard Podell (website) integrates as well. There’s also research being done on ‘resonant breathing’ techniques for treating depression — Harvard-trained Dr. Lehrer of Robert Wood Johnson in NJ used to head some research there and 2 friends of mine participated in some free studies. One found the results remarkable.
Not that we have to go to these people — just that there’s info out there that can potentially be used in terms of nutrition, etc. as part of a multi-pronged approach.
2a. What I found helpful is if I’m interested in something or interested in finding a well-trained practitioner, I call up or email them — and I’ve done some research for people in academia in psychology departments, asking for any recs they can give.
3. Expanding on the meditation, I found help w/ some retreat intensives for zen — zen mountain monastery has a good lineage there and I found their 6-day intensives helpful – on one of them, I was super depressed doing it but kept with it for some reason and … at the end, it was helpful.
4. Another buddy of mine was in a horrible accident (35+ major operations, couldn’t walk, broke lots of things including his face, etc.) and, while he didn’t have depression, he found that going to a Vipassanna intensive retreat for 10 days (!) helped immensely. He actually moved back to India & did 6 10-day intensives over the course of 3 years (his parents told him that after his first one, he came back remarkably different). There’s literally a free one in Shelburne, MA — you only pay if, at the end, you are able to pay and the payment is for the next person. Both of these things are about mind training — and they don’t require any religious conversion or religious buy-in.
5. One of the things that I found very helpful is when I did the lessons in ‘A Course in Miracles’ and listened to some tapes from Ken Wapnick on youtube explaining it . This is NOT an endorsement – just mentioning it b/c it helped me by having a good mind-training program that was in sync w/ where my head was (other paths work better for others). What it also helped with is that it said that hitting a point where the world offers nothing is actually an ok place to be – it is usually the starting point for the spiritual path. One of the Zen teachers (the late John Loori) used to comment on almost the necessity of seeing how there’s just something wrong and inherently painful in our collective perception of life (born, die, etc.). He used to refer to the collective delusion that we’re convinced that our reality is this particular body / self as thinking we’re the ‘bag of skin’ (and how mind training can yield an experience that says otherwise — an experience as opposed to a belief). It looks like most spiritual paths say the same thing. By ‘spiritual path’, I mean any path that trains the mind and offers the potential of what seems to be a universal experience (enlightenment) that is independent of any path (e.g. atheists, etc. have experienced it). If this sounds like religious mumbo jumbo then … what I found helpful is psychology research that focuses on how the mind works and what it says about the nature of the self (ACT gets into this). I found the zen and a course in miracles stuff helpful but — again — these are things that resonated with me. ‘3 Pillars of Zen’ also resonated with and motivated me — one woman was in a high state of despair, with no faith or belief, and having gone from different teachers and … when she worked w/ the zen teacher in the book, there was a great breakthrough. **** Sorry if this comes across as endorsing — I loathe religious and spiritual preaching so … if this comes across in any way that way, then mea culpa … people have kept their religion and used some of these mind-training paths…
6. I woke up this morning, depressed (again, I’m in the middle of treatment — the ACT that I did was very helpful but I let it go and didn’t fully integrate it) b/c of insomnia, mortality thoughts, the fragility of the body, etc. I then remembered ACT and … applied it and … it worked. So …

** My point in this rambling is that there’s stuff out there. That if lots of things fail then we can reframe them not as failures but as points of learning — my mind tends to focus on the past and see my ‘failures’ but some of the tools have helped with reframing and not seeing them as failures or wastes of time.

To summarize what I found helpful: 1. Simple daily mindfulness w/ ACT techniques integrated as needed; 2. Lessons in A Course in Miracles & practicing its concepts; 3. exercise; 4. CBT 5. Some sporadic zen intensives

I’ve tried other things listed but didn’t give them their due diligence so …