Open Mind

Open Mind

Open Mind is a weekly column in which questions regarding mental health issues are answered by professionals. Open Mind appears in many editions of the Suburban Journals and other newspapers in Missouri. This is an archived column. Click here to browse other archived topics.

About six years ago, a psychologist treated me for depression. He and I agreed that my depression and low self-esteem were due to many negative situations I had experienced: death of a sibling, a bad relationship, etc. Although it took a while, I believe I received good treatment from my psychologist. However, my question is: Can medication help people when depression is not caused by a chemical imbalance?


For people whose depression is due more to difficult situations than a serious chemical imbalance, medication may help, but psychotherapy may help just as much or more. Numerous medications, particularly the SSRIs (selective serotonin reuptake inhibitors), have proven effective in alleviating depressive symptoms. By themselves, though, these drugs do not address underlying issues that cause or maintain depression. Also, the drugs may have unwanted side effects, and symptoms may return when the drugs are discontinued. Psychotherapy has also been proven effective in treating depression, and its effects tend to last beyond the end of therapy. Good psychotherapy may take a little longer than drugs to reduce symptoms initially, but it can insulate individuals from future episodes of depression by empowering them to change patterns of behavior, thoughts or feelings. In recent studies, a few specific kinds of therapy have proven particularly effective for depression. Some of these therapies focus on making thought patterns more logical (cognitive); others focus on increasing adaptive behaviors, social skills, assertiveness, reinforcement for desired behaviors, or positive experiences (behavioral); still others focus on important relationships in the client’s life (interpersonal). Many other forms of therapy can also be helpful, especially when the client and therapist form a strong professional relationship. In the treatment of depression, medication and psychotherapy can cooperate rather than compete. In fact, for some individuals, a combination of psychotherapy and medication is the ideal form of treatment.

Andy Pomerantz, Ph.D., Licensed Clinical Psychologist
Associate Professor, Southern Illinois University - Edwardsville
Office: St. Louis, MO – 314-608-6089

Depression can surface from biological origin or from one or more psychosocial stressors encountered in life. It can also have a mixed origin that can combine both sources of illness. Biological depression is genetically determined and can occur out of the blue. When such episodes occur gradually, lacking the acute onset, it can create much misunderstanding in a person’s environment. In the general population, there is still a lack of knowledge and understanding regarding depressive illness. Therefore, the functional deficit caused by slowly emerging depression can be interpreted as irresponsibility or indifference. This disease can generate its own stressors and complicate the determination of its true origin and its ultimate treatment. Psychosocial stressors themselves can also activate a dormant biological depression, again producing confusion in the nature of the illness and thus misdirecting treatment. Often, one sees good psychotherapeutic effort producing poor results, as well as depression lingering for months or years when being treated only with medication. Researchers have concluded that a good treatment outcome of depression is best achieved with a combination of psychotherapy and pharmacotherapy. My goal, in my years of psychiatric practice, has been to alleviate some of the symptoms of depression that affects thinking, reasoning, decision-making and executive ability. Addition of an antidepressant regimen in a depressive illness, despite its origin, can cover enough ground to improve the cognitive functioning of a person to an extent that makes psychotherapy more efficient, and the combined effect of both types of treatment can generate a better overall outcome.

Mohammed Kabir, M.D.

posted by Robert Heard at 9:24 AM