According to the Sequenced Treatment Alternatives to Relieve Depression (STAR*D)study, an unbiased investigation funded by the National Institute of Mental Health, at standard doses of the most commonly used class of antidepressants (SSRIs), only 30 percent of people with severe depression achieve remission with the first medication prescribed. Switching to a new drug — and it often takes twelve weeks to achieve an adequate response to medication — is effective about 25 percent of the time. So after 24 weeks (close to 6 months), only 55 percent of people with severe depression will experience a remission of symptoms.
That isn’t exactly good news to me.
What about the other 45 percent?
Every day on Project Beyond Blue, my depression community, I hear from someone who has unsuccessfully tried 20, 30, or 40 different medication combinations and is hanging on to life by a very thin thread. I know that desperation myself, which is why, in the last two years, I have spent a lot of time and money exploring different alternative therapies.
Here are 10 non-drug therapies for depression that have provided some relief to members in my community or to friends I know battling this beast. Even if you don’t have treatment-resistant depression, they are good to know about and can be used in addition to taking medication to build extra resiliency. Remember that I am just a highly-opinionated (but well-researched) writer, not a doctor, so consult with your physician before changing the course of your treatment.
1. Transcranial Magnetic Stimulation
I can’t count on my fingers the number of people I know who have been saved bytranscranial magnetic stimulation (TMS). Former advertising executive Martha Rhodes certainly was. In her riveting memoir, 3000 Pulses Later, she shares her journey back to health with this new technology. TMS involves a non-invasive procedure that stimulates nerve cells in the brain with short magnetic pulses. A large electromagnetic coil is placed against the scalp which generates focused pulses that pass through the skull and stimulate the cerebral cortex of the brain, a region that regulates mood. The procedure was approved by the FDA in 2008.
I first heard about TMS two years ago. I investigated it for myself, but my insurance didn’t cover it, and all 30 sessions can run about $15K. However, due to efforts made by Neuronetic, Inc., a leader in TMS technology, insurance coverage for patients has increased from 100 million to over 200 million people, in both government and commercial insurance plans. A recent study in the Journal of Clinical Psychiatrydemonstrated the long-term effectiveness and durability of NeuroStar TMS Therapy in adult patients for over a period of one year. Just this morning the company announced that it has $34.4 million (including an investment from GE Ventures) to spend in order “to broaden treatment accessibility for existing patient populations in need of a non-drug therapy option.”
2. Dialectical Behavioral Therapy
Dialectical behavioral therapy (DBT) has become another popular topic in my depression community. A kind of cognitive-behavioral therapy developed in the late 1980s by psychologist Marsha Linehan, it once was reserved to treat borderline personality disorder. Today it is used to address all kinds of mood disorders. “As someone who has suffered from depression and anxiety, I use many techniques that I learned from my DBT support group in my daily life,” one woman in Project Beyond Blue told me today. “The behavioral exercises and visualizations I learned in the group help to calm me and have been extremely effective, especially when I’m feeling an anxiety attack or overwhelming sadness coming on. Breathing techniques, distracting and interrupting myself from negative thoughts, and total acceptance of my strong emotions without judgment give me a sense of control and self-love when I’m feeling most out of control and unlovable.”
Many studies have confirmed that yoga helps relieve depression. For example, in a 1993 study, 50 female university students with severe depression practiced Shavasana yoga for 30 minutes daily for 30 days. There was a significant reduction in their depression score mid- and post-treatment. Teagan Fea has been teaching yoga and facilitating retreats for 15 years in New Zealand, Australia, Peru, and Mexico. She has designed a comprehensive online meditation and yoga program to help free people from depression, especially those who have tried medications. “When yoga is applied therapeutically,” she explained to me, “the practice can be specifically designed to reduce the symptoms of depression. Moving and holding postures while focusing on the breath discharges stored and depressed energy, allowing it to move through the body and be released. The visualization, breathing, and meditation components of the practice assist in rewiring the brain and strengthening new thinking patterns. Yoga is a powerful tool that can assist with deep transformation.”
4. Mindfulness-Based Cognitive Therapy
As I mentioned in my piece on mindfulness the other day, a new study from the University of Oxford found that mindful-based cognitive therapy (MBCT) is just as effective as antidepressants for preventing a relapse of depression. Studies indicate that both MBCT and mindfulness-based stress reduction (MBSR) programs “have broad-spectrum antidepressant and antianxiety effects and decreases general psychological distress.” I took the 8-week course last year. As a result, I am more aware of my stress reactions and am proactive about reducing my stress before I break down. I can identify the thinking patterns that lead to depression, like the inner critic and jumping to the future. Especially beneficial is locating tension in a certain region of my body, and trying to relax it.
5. Hanna Somatic Education
“You translate everything, whether physical, mental, or spiritual, into muscular tension,” said F.M. Alexander. Our muscles have memory. They tell our story. We respond to life events with physical tension. With repetition and trauma, this reflexive physical tension can continue into chronic muscular tension. Hanna Somatic Education, developed by Thomas Hanna, is a system of neuromascular education (mind/body training) that gently addresses chronic pain, restores freedom of movement, and relieves stress. Somatics works specifically with sensory-motor amnesia — teaching the brain how to relearn muscle motions. Ryan Moschell, a long-time Annapolis massage therapist, is now a somatic educator. Instead of manipulating muscles for his clients as he did as a therapist, he now teaches clientshow to do the work themselves, how to move specific muscles to relieve pain and tension. “Learning HSE from a certified Hanna Somatic Educator empowers you to have more control over your own body and lifelong neuromuscular wellness,” he explained to me.
6. Binaural Beats
When Anneli Rufus, author of Unworthy (possibly my favorite self-help book), interviewed a scientist who studied the brain activity of Buddhist monks, she mentioned that “brain-entrainment music” employing binaural beats can create different effects on mood (depending on the kind of low-frequency tones). The technology has actually been around for well over a century, but it has taken us a while to apply it to mainstream medicine. A few recent studies show that the use of binaural beats, or audio therapy, can significantly reduce anxiety, at least during cataract surgery, and can even help symptoms of ADHD in children and adolescents.
Rufus was skeptical, but thought she’d try it out. “As the sounds pulsed through my head,” she explained to me, “I almost immediately felt changes: easier breathing, inner warmth and brightness, a profoundly soft smiley mellowing-out is the only way that I — a complete non-scientist, non-expert, ordinary and occasionally anxious and depressed rube — can describe it.” The feelings didn’t last all day, but for her, “listening to binaural beats provides quick, merciful, wonderful, short-term relief.”
7. Eye Movement Desensitization and Reprocessing Therapy
Two years ago I called up my friend Priscilla Warner in tears. Disillusioned with psychiatry, I was done trying new medications. However, I wasn’t benefitting from any alternative remedies either: not diet changes, not meditation, not acupuncture or yoga. I had gone down the list and nothing was working. Priscilla told me to try eye movement desensitization and reprocessing (EMDR). Of all of the things she tried to get rid of her anxiety (she chronicles this is her bestselling memoir, Learning to Breathe), it was the EMDR that she feels made the most difference.
Eye movement desensitization and reprocessing is a psychological therapy originally designed by Francine Shapiro that uses eye movements and other procedures to process traumatic memories. With studies supporting its use as an effective intervention for post-traumatic stress disorder (PTSD), EMDR is now recommendedfor PTSD by the Department of Veterans Affairs and other organizations. For persons whose depression is triggered or aggravated by any kind of trauma, it seems to be a wonderful tool. For example, Grace, a woman in my depression community, explained to me, “EMDR helped to take the intensity out some of my trauma memories and flashbacks. It processes trauma memories so they are more fully integrated into your life narrative and decreases the likelihood of triggers and flashbacks from trauma.”
Biofeedback is a process that trains you to have better control over your mind and body by using electric sensors that provide feedback. You are able to see on a screen how certain thoughts produce subtle changes in your body, and how relaxing or tensing certain muscles, in turn, impacts your thoughts. With just a little success manipulating your mind and body, you become empowered to use your thoughts to control your body (and vice versa). Biofeedback is used to help a variety of physical and mental health issues, including high blood pressure, chronic pain, irritable bowel syndrome, and Raynaud’s disease, and is especially helpful for people who can’t tolerate medication or for whom medications haven’t worked.
9. Transcendental Meditation
In his book, Transcendence: Healing and Transformation Through Transcendental Meditation, celebrated psychiatrist Norman E. Rosenthal, MD, presents the impressive science behind this specific kind of meditation. A twenty-year researcher at the National Institute of Mental Health, Dr. Rosenthal knows the brains of patients with severe mood disorders. In fact, he conducted one study just on patients withbipolar disorder to see how transcendental meditation (TM) might help them. He writes, “Several patients reported increased calmness, improved focus, and improved ability to stay organized and set priorities — no surprise given TM’s known effects on the prefrontal cortex. TM helped bipolar patients improve their executive function, just as it did for people with anxiety disorders and ADHD.”
10. Tai Chi
Back before I read the studies demonstrating the benefits of tai chi for depression, anxiety, and stress management, I was on to it. For five years before she died, my neighbor did tai chi at the senior center at least twice a week. I witnessed the profound change this ancient Chinese martial art made in her. She twitched less and smiled more. She was increasingly more comfortable in her body. The combination of slow movement, breathing, and meditation seems to especially benefit the elderly, as a study by researchers at UCLA indicates. “When they combined a weekly tai chi exercise class with a standard depression treatment for a group of depressed elderly adults, they found greater improvement in the level of depression — along with improved quality of life, better memory and cognition, and more overall energy — than among a different group in which the standard treatment was paired with a weekly health education class,” reports Mark Wheeler for the university.