For Depressed Teens, Should Therapy Be the First Treatment Choice?

A recent study concluded that the first treatment option for teens and young adults should be solely psychotherapy. We discuss whether we agree with this conclusion (take a guess).

Transcript

Hi I’m Deborah and today we’re going to talk about a study that came out about a week ago and also about therapy’s, therapy’s role in treating moderate to severe depression.

So this study came out and it – they looked at, I think, 153 people aged 15 to 25 and what they did is they divided the group into two parts and it, you know – it was double-blind so, so even the people who were running the study didn’t know who was in what group.So one group had Cognitive Behavioral Therapy and, and a placebo – so, in other words, a sugar pill. And the other group had Cognitive Behavioral Therapy and an SSRI, which I think was Prozac. So their conclusion was that there was no difference between the treatment that was just the CBT, the Cognitive Behavioral Therapy and the CBT with medication.

And so, basically their conclusion was that therapy alone should be the first, the first line of defense, you know, the first, the first treatment on its own for moderate to severe depression.

And already I disagree with that.

And I do too. Now, now let let me just point out that neither one of us has any kind of medical degree, so we’re not giving medical advice.

I’m a sixteen-year-old and you were an English Literature major.

Yeah. I mean, well, I’ve been writing about depression since 1995 and some of my stuff has been in textbooks.

But you’re not med – well –

And published –

Okay, you’ll need to show me that then. Because I have not –

Okay. Well, I didn’t get a copy of it, though. Anyway –

That’s –

They wrote and asked permission. Well, I didn’t care. Actually, they may have offered, but it wasn’t important. I’m going to cut that.

No, don’t.

Okay.

That’s interesting.

You want me to leave the weirdest things in.

It’s interesting.

Anyway, but so we’re not giving medical advice in any way, shape or form. This is our opinion. We do both have a lot of experience with depression treatment and that’s also what we’re going to draw on.

So my first problem with this is just that these patients had moderate to severe depression, okay? So, moderate to severe depression. I mean –

And they’re experimenting on them.

Well, yes. I mean, granted, they –

I just want to raise the ethical dilemma, first of all.

I, I agree with you. I, I was very concerned about that. I mean, I would have been much more comfortable if they were talking – if they were – if the patients had mild to moderate depression. Um, but if you have moderate to severe depression your life is very likely, to some extent, a mess and your days are basically hell.

And having people run tests on you just to figure out, “Oh, is this gonna work?” it’s not –

I mean –

Yeah, no. I don’t think that’s ethical.

I mean, it’s the way that we find things out, and –

Yeah, that’s true but it’s still – doing it this way is unethical for sure.

So it does bother me and the way I looked at it is – let’s say these were people who had had heart attacks, um, or had heart failure of some kind. Would – I, I really hope they wouldn’t -but would they do a study in which they had one group do diet and exercise and a sugar pill and another group do diet and exercise and heart medicine?

Exactly. That – you know nobody would be –

I hope, I hope not.

I mean, everybody would be like, “Oh, the ethics.” That’s exactly they’re doing. They’re screwing with people’s lives.

I mean, the problem is – and these should know better than anyone, who were running the study – depression could be a fatal disease.

Exactly.

So two-thirds of the people in the study – in, in both groups – had suicidal ideation, okay? No, actually, it was three-quarters. It wasn’t two-thirds, two-thirds is 66 percent. It was, it was seven – it was over 75 percent. So that’s three-quarters of the people had suicidal ideation.

Now, so, so the group with the – just therapy and the sugar pill – there were five suicide attempts. The group in – that had CBT and Prozac – one suicide attempt.

Yeah, exactly.

Granted – okay, now, granted – that’s, you know, that’s probably within the margin of error.

But still.

So you have a total of six people, but still. But still.

You’re risking people’s lives to do this stupid experiment.

Exactly. But still.

It is putting people’s lives at risk. And it’s, it – I think that’s horrible.

But it’s not just that – I mean that’s the worst thing –

Yeah.

Is putting their lives at risk. The next worst thing is they – their conclusions notwithstanding and I think we’ve talked – we talked in our in our video about “Does – do cell phones and social media cause depression?” about, about trials and, and – what’s the word I’m looking for?

Experiments?

Experiments. You know, whatever – studies. That’s the word I’m looking for.

Yeah.

You, you wouldn’t know that I worked in the Department of Chemistry, would you?

No. No, not at all.

I’m tired, I’m tired.I have MS.

Yeah, so am I, but I’m still completely lucid.

I have MS and I’m forty years older than you, so. Just wait till you’re my age. You can’t take study results on – at face value.

Exactly. No. Never do that. Never.

Never. If it’s something that affects you don’t just read –

No.

The articles and the press release. Go look at the study. And actually, there was also an article that came out, I think, a couple days ago or yesterday about how studies spin their results.

Yeah.

Like, it was over 50 percent. So –

That’s, that’s obvious.Because you have –

Yeah. Yeah. My reaction was –

I mean, In a lot of cases –

Kind of like, “Duh.”

Researchers have an agenda.

Yeah, it –

A lot of the time they want to prove something.

In many cases they have an agenda. And here so, so, so, it was – now, granted, I mean, you have to – studies have to be done to make advances and to improve people’s lives, okay?

Yes, I know, but still.

So, so this was definitely a concern.

It’s still, like –

You had a very large number of a very large percentage of people in the study who were suicidal.

Yeah, it’s -that’s not okay.

Yeah. No. I mean, that bothered me intensely. The other thing was, is that – from my own personal experience, when I first got diagnosed it was recommended that I take medication, antidepressants and for reasons I’m not going to go into, I didn’t want to.

So they, you know – they wanted me to do medication, therapy, start, start both those at the same time. So I only agreed for the first six months to the therapy. Well, the problem was that I was so profoundly depressed that I really couldn’t participate in the therapy, okay? So, I mean, that’s my experience. Maybe people who have – other people who have severe depression don’t have that problem.

So, but that – that’s another thing that bothers me.

Yeah.

Um if you’re – if you have severe depression, you’re having trouble functioning.

Yeah, exactly.

How are you supposed to really participate in something and –

How are you going to be useful?

You have to be present for therapy, okay?

Exactly.

So that, that bothered me also. The other thing was there was a study that came out recently about one type of CBT – and forgive me for not remembering exactly what type it is – apparently it loses its effectiveness after two years.

Yeah, I remember you were talking about that.

So the effects of the CBT – after two years –

There’s a chance they’ll, you know, they won’t make a difference any more.

Yeah. I mean that, that’s bothersome.

Of course.

I mean, CBT is very good for certain things, but it’s become very popular and it took a while to catch on, but it’s become very popular. But it is only good for certain things. And a lot of times people who have depression have issues – childhood trauma, dysfunctional families that they grew up in – other kinds of trauma that they’ve, they’ve gone through, maybe not related to their families – and you know that they have, they have developed certain coping mechanisms and stuff and just cover it up in some cases, whatever the trauma was.

You cannot, you cannot fix that with CBT, okay? You can fix some of the effects, but you can’t fix it with CBT. So, I mean, I don’t want to go on a whole anti CBT thing, because CBT is good for, for, for certain specific things.

The other problem I have with this is, most insurance companies and employers are reluctant – you know, because the employers tell the insurers what they’re willing to pay for, okay? They develop the plan with the insurer. Therapy is expensive; medication isn’t, okay? I’m a big proponent of therapy, as you know, okay?

Yeah. I mean, it’s made a difference in my life. I –

Both of us. Both of us.

I’m all for it, but –

I feel very positively about therapy. But the thing is, let’s say you have insurance that won’t – that is very stingy with therapy, okay?

Exactly.

Or just won’t pay for it altogether. Therapy is expensive. So what are you supposed to do?

Either you let them gouge you for therapy or you don’t do anything.

I mean, the thing is, what if medication is your only option?

Exactly.

So this study is saying – and could influence some people, and some medical professionals –

And that could make them make some decisions that aren’t too wise.

Yeah, I mean say, no, this – so, because what this study said is the first treatment option for –

Yeah. That’s just –

Young people should be therapy. That – okay, that just – first of all the other thing is, that doesn’t necessarily apply to – everyone is different. You cannot make –

Nobody – you can’t –

A blanket treatment recommendation. You just can’t. People are individual, their depression is individual. It just –

Exactly. One person, CBT can do wonders. Another person, it can have no effect whatsover.

Or therapy – therapy, not necessarily CBT.

Exactly. You cannot – there is no catch-all solution.

So, is – should therapy be the first line of defense? It depends, okay?

Yeah. I mean, everybody’s different.

It totally depends. Everyone is different, okay? And it depends on the severity of your depression. It depends on other things. What’s going on in your life? Well, if you’re a teenager, okay? You’re getting ready to probably apply to college or join the workforce, okay? You might be, you know, getting new skills to, to, you know, get a job after high school.

So you got a lot going on, okay? Not to mention you don’t want to miss what may not seem like the best years of your life, but it’s, it’s –

You’ll treasure them.

It’s a pretty decent way –

When you have to start paying taxes.

Well, yeah, there’s that. Um, but, I mean, you – and you’re also developing. Your, your, your body and your brain are developing. Your, your personality is developing. Your, your interests, your aspirations.

Things are changing at a rapid rate.

And, and to me it seems irresponsible to say, “Oh no, everyone should just have therapy, specifically CBT.”

Exactly.

But I think it was – maybe I’m wrong, they may have just said psychotherapy. But –

I think they just said psychotherapy in general.

Well, I mean, instead of CBT. Yeah, I think they just said just psychotherapy. Yeah, you’re right.

So um, I just feel that this was irresponsible in a lot of ways. The person who should decide the, the treatment is you and your, and your doctor, medical professional, whoever it is you see for your depression. What I think is the most important thing you can do is be well informed when you, when you work with the doctor to make that decision.

The other thing is, therapy takes a long time, okay? So I mean people, people who are severely depressed –

Yeah.

Get, get upset when they find out they’re gonna have to wait a few weeks for an antidepressant to take effect. Hey, the problem is with therapy there’s – it’s, it’s not even close to instantaneous, okay?

It can take years.

It can take years. I know this, this has been kind of a rant in some ways.

Yeah, I was about to start telling you we need to wrap this up.

Yeah. Yeah. So I realize that this has been a little bit of a rant, but we both get pretty disturbed when we see –

Yeah, no, I’m pissed off.

Yeah, yeah these studies, because we’ve both been there. We’ve both been teenagers and kids with depression and we know what it’s like and we know it’s scary and we want to make sure that you, you know – you’re in a vulnerable position, okay, as a kid or as a teen. You don’t have as much power and people don’t always listen to you as much as they should, even about your own life –

People rarely listen.

Your own life, your own health, your mental health, and so you have –

It’s up to you.

It’s up to you. So even if you have wonderful loving parents who want to support you in every way, they aren’t necessarily educated about this and they – a lot of people – I especially had this with my grandparents – everything – to them, everything a medical professional says is gospel.

So we hope this has been helpful. That, that really was our goal with this video, is to, is to try to give you the information you need, and we hope we’ve done that –

We want you to be well informed.

Obviously with, you know, some ranting too, so sorry about that. But I, we just –

Some?

Well no, but I mean, I think that it’s important that people know we’re really passionate about this.

Definitely.

We don’t have an agenda, but our point of view is we, we want what’s best for you guys who see this. Especially when you’re younger, it’s really important. So anyway, be well and we’ll see you next time. Bye.

So you can tell this bothers us.

Why did you never let me speak?

Sorry, sorry.

You always interrupt me.

I have ADHD.

Shh. I have it too. But I was waiting patiently just now.

You were.You were. Sorry.

Wow. I’m hurt.

I’m sorry.

Okay.