Undoing Depression:
What Therapy Doesn't Teach You and Medication Can't Give You:
online conference transcript

Dr. Richard O'Connor: psychotherapist and the executive director of a mental health clinic. He oversees the work of twenty mental health professionals in treating almost a thousand patients per year. Dr. O'Connor also has been through some very deep depressions himself.

David: HealthyPlace.com moderator.

The people in green are audience members.

BEGINNING

David: Good Evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. Our conference tonight is on "Undoing Depression". We have a wonderful guest: Richard O'Connor, Ph.D.

Dr. O'Connor is a practicing psychotherapist and the executive director of a private, nonprofit mental health clinic. He oversees the work of twenty mental health professionals in treating almost a thousand patients per year. He has also written a book on depression entitled: "Undoing Depression: What Therapy Doesn't Teach You and Medication Can't Give You."

Good Evening Dr. O'Connor and welcome to HealthyPlace.com. Thank you for agreeing to be our guest. You went through several periods in your life where you experienced what you described as "powerful depressions". Can you tell us a bit more about that?

Dr. O'Connor: There is a history of depression in my family. My mother took her own life when I was 15. In my 20s and again in my 40s, I went through periods which I would call "major depression." I'm in my 50s now and feel pretty stable, but I live with the after-effects of depression.

David: During the very depressive periods, please describe what it was like for you.

Dr. O'Connor: I was drinking too much, irritable and alienating everyone close to me, withdrawing. Mornings were very bad, I would wake up hating the thought of facing the day and my life. There were times when I thought of suicide but couldn't bear to repeat what my mother had done.

David: What did you do about your depression?

Dr. O'Connor: I got help.  In the first episode I saw a therapist who really helped me find direction.  In the second, I went through an analysis and got on medications.  I still use antidepressants and have a trusted senior colleague I consult with when I need help.  It's a shame that there is so much stigma about getting help.

David: Do you find that the medications help and which ones are you taking? 

Dr. O'Connor: I think I'm like Mike Wallace, who says "I'm on these for life."  I take Zoloft and Trazodone to help me sleep.  But that's no endorsement.  People's reactions to psychiatric medications are so idiosyncratic that it's impossible to say what works for me will work for anyone else.  Besides, I may change them some time when I feel adventurous.

David: On your site, you say that "I believe now that depression can never be fully grasped by mental health professionals".  That would be a scary thing, considering that's who many people who suffer from depression turn to.  Why is that?   And what is it that they "don't get"?

Dr. O'Connor: The rest of that sentence was "...who have not suffered from depression themselves."   I didn't say that you have to have had it to be able to help people.  But I don't think you can really understand the terror and absolute hopelessness that goes with depression unless you've been there.

David: Here are some audience questions, Dr. O'Connor:

debb: Do you think the psychiatric medications change the chemicals in our brain so that we will always need them?

Dr. O'Connor: The chemicals in our brain have been changed by our depression. We shouldn't think of brain-body as a one-way street.  Every experience we have, every memory is stored in a chemical change in our brain.  Bad experiences change our brain chemistry and make us depressed; good events can reverse the process.  Medications make it easier for that to happen.

Riki: How does one function with depression when no medicines work?

Dr. O'Connor: Find a good therapist and join a depression support group. Unfortunately, there are a lot of people for whom the psychiatric medications don't work.  Only about 60% of users will be helped.  If we really want to recover from depression, we have to change how we go about living.  Depression is something we get good at, something that reinforces itself.  We have to "undo" the bad habits that depression has taught us.

Michael: I have a theory that depression is a call to challenge some core belief which we find in conflict with our current living condition or concept of reality.  What do you think triggers depression?

Dr. O'Connor: Depression is a response to stress. Often a loss of a relationship, but other stresses as well.  There is a vulnerability that is partly genetic, partly the result of childhood and adolescent experience.  Enough stress in a vulnerable individual means depression.  But I agree with you, depression is also a signal that we're not doing something right.  Some basic assumption we've been making doesn't work for us anymore.

funlady: Do you find exercise as beneficial as antidepressants, medications?

Dr. O'Connor: If people have the energy to exercise, it certainly is very helpful. You have to have recovered a certain amount from the depths of depression to have that kind of energy. I do believe it helps prevent future episodes, though.

tami: Where is the best place to start when you have no support system left?

Dr. O'Connor: Look for a depression support group in your area.  I see that HealthyPlace has a list of resources on the depression community page.  Find a good therapist, someone you trust and feel safe with, who knows about depression.  Make sure the therapist works with a pharmacologist.

Sylvie: Dr. O'Connor - You spoke of episodes - How long were they, were you able to carry on with your life, and how were you when you were not having a depressed episode?

Dr. O'Connor: My episodes were gradual and long--years.  I was able to go on with my life, but I made some bad decisions.  Between episodes, I felt pretty good.  In between those episodes, my own children were young.  Being a parent to them was a great joy to me.

David: For the audience, I'd like to know if anyone has found significant relief from depression, what helped the most? 

Dr. O'Connor, did you find that your depression led to other negative behaviors or that the negative behaviors led to your depression?

Dr. O'Connor: Depression is, above all else, a vicious circle.  We do things that make us more depressed, and that resulting depression means we do more self-destructive things.  It's pointless to argue which came first, chicken or egg.  The important thing about appreciating the circularity of depression is that we can intervene anywhere.  If we change our behavior, we can feel better.  If medications or music or relationships help lift our mood, we can feel better.

David: Here are some audience responses to my earlier question about "what helped relieve your depression the most " :

Scatter: I have suffered from depression on-and-off throughout my life.  I'm in a good place emotionally right now, and I agree that you have to "get right with yourself" at least for myself!  I am in therapy, but feel that I relate better to some of the people I have met online.  I was wondering how you feel about the internet and it's power of support.

grandmabb: I have behavior treatment and exercise and medication

Kay5515: Some mild relief with good family doctor, therapist, and surrounding self with POSITIVE supportive friends ONLY.  Oh, and getting a DOG was the best thing I EVER did.

Dr. O'Connor: I agree with Kay, just got a new dog, it's wonderful.

sad: MOST POWERFUL COMMENT SO FAR...REALLY POWERFUL.... "Depression is something we get good at, something that reinforces itself.  We have to undo the 'bad habits' that depression has taught us", Dr. O'Connor

Helen: I really appreciated reading your book What Therapy Doesn't Teach You and Medication Can't Give You a few years ago as I was coming out of my first episode (manic/mixed).  I especially appreciated the "tone" - it really helped that you'd "been there".  Thanks for what you shared in there.  Anyway, my question:  What can we do when people regard us as "too risky" purely because of our diagnosis - in my case my request to be a lay counselor at my church was just turned down, although I've had no episodes now for 3+ years, because of my single manic episode.

Dr. O'Connor: Let me comment to Helen: depression is also a social problem, it's a legitimate response to the way society treats us.  There are discrimination laws on the books now; you should really talk to your pastor about this.

David: What about the idea of "self-help" for depression?  Is that a good thing and does it work in your estimation?

Dr. O'Connor: I'm afraid that depression is a lifetime disease, like alcoholism or heart disease.  So if we don't learn to help ourselves, we're doomed.  Self help can come from groups, from reading, from family and friends--but we have to accept the responsibility of helping ourselves. 

David: Here are some additional audience comments to my earlier question and then onto more questions:

daffyd: A combination of Prozac and a concentrated effort to look for even the smallest good things in my life turned me around.

roses27: Homeopathic remedies work quickly and much better than traditional medications. Doesn't last, but at least it works in the first place.  Best to find homeopath, MD.

Fran52: Tricyclics have always helped me along with therapy intermittently and a lot of self -education about AD and other areas of interest.

ipayu2000: Paxil worked the best for me.

Ashton: Yes.  Getting close to my Lord and Savior Jesus Christ has helped me tremendously!

funlady: I am happy to say that I've been through major depression, but am doing well.  I try to focus on others, so I don't wallow in my own thoughts.  Also, exercise is very helpful, and I do it faithfully at least 30 minutes, 3 times per week.

Dr. O'Connor: We see that there are many ways to recover.

AldoKnowsIt: What did you mean by "After-Effects" of depression?

Dr. O'Connor: Bad habits--stuffing feelings, isolating self, not permitting hope or joy.  Depression teaches us skills that we use to try to avoid pain.  They backfire of course.  A lot of depression is about trying not to feel anything.  I have to keep reminding myself that emotions are natural and not to be feared.

roses27: I can remember being suicidal at age five.  Now at 44, I still have those moments. This is supposed to be treatable but there doesn't seem to be an answer for me.  I've had therapy, medications, homeopathic remedies.  Are there some of us who cannot be helped?

Dr. O'Connor: Has there been no joy in all those years?  Recovery doesn't mean you'll never be depressed again.  It means putting together a string of good days.

Sunshine1: How does one find a good therapist and is cognitive therapy better for our problem with depression?

Dr. O'Connor: Cognitive therapy for depression is a good approach. You can contact the Beck Institute in Philadelphia to get a list of certified cognitive therapists in your area. But it's also very much a matter of chemistry, how you feel about a particular therapist.  You should shop around, take a few therapists for a test drive.  Our feelings won't be hurt if you don't come back.  Of course, I'm ignoring the financial aspect of all this right now.

daffyd: Is there a way to reach someone (in my case, my mom) who is depressed but will not seek help?

Dr. O'Connor: There is a good book on depression by Rosen and Amador called "When Someone You Love is Depressed."  It's the best advice I've seen.  It's very hard on loved ones to have someone who is depressed and not getting help for it.  You have to accept that there is really little you can do to make it better.  There is a lot you could be doing to make matters worse, so be proud that you're not.

David: I received a comment from an audience member who didn't want to be identified: "I would never take medication because it would be like admitting I don't have control over my life." I think many people feel this way. Could you comment on that, Dr. O'Connor?

Dr. O'Connor: It sounds to me that the audience member already knows he doesn't have control over his life, he's just afraid to admit it to himself.  People who need insulin or thyroid medication to maintain life don't feel that there's something shameful about them because their kidneys or thyroid aren't working right. Why do we feel that needing something to restore brain chemistry to normal is so shameful?

Hope1: Do you believe that there are some people that cannot be helped?

Dr. O'Connor: No.

David: Here are a few more comments to my earlier question "what helped you the most in dealing with your depression":

SunnyD: For me, taking my medication and seeing my psychotherapist regularly and taking care of myself is helping me over time. I am on disability now and taking one day at a time helps.

Sylvie: Becoming stable on Lithium after 10 years of refusing to take it was the first step. I still had depression though (no mania). Becoming a creative artist has resolved the depression and keeps me on a natural high most of the time.

Helen: What helped me most: people who believed and hoped for the best for me - but when they couldn't understand, knowing that God was always with me and understood me and would lead me through the "valley of the shadow of death", as it were.

Chlo: How come it is said that depression is anger turned inward?

Dr. O'Connor: It goes back to early Freudian psychiatry.  The observation was that many people become depressed after the death of someone they're ambivalently attached to--love, but also hate.  The theory was that because we couldn't admit to ourselves the hate side of the ambivalence, we turn it against ourselves.  We know now that things are not that simple, but most people with depression do have trouble with anger.  Most appropriately assertive people aren't depressed.

David: Here's the link to our journalers, depression journals in the depression community who keep online diaries of their experiences. You can read them and post your comments on their bulletin boards.

Karma1: Lately, I've been spiraling into a major depression and I find it hard to think and process, sometimes even my speech is slurred and I am so fatigued, is there a physiological reason for this?

Dr. O'Connor: Probably, but no one understands it in detail.  Loss of concentration and fatigue are primary signs of depression.  Slurred speech is unusual.  You should be sure your overall health is OK.

Ashton: Karma- you may want to talk to your doctor about Multiple Sclerosis. Just to be sure!  Those are some side-effects.

Dr. O'Connor: Good thought, Ashton.

nutwithoutashell: Why is it that a person can be doing well and suddenly suffer from major depression and not be able to function.

Dr. O'Connor: There's always a reason.  We get very good at severing the connections between what's happening to us and how we feel inside.  I have a tool in my book called the Mood Journal which I urge people to use to track the connections between their external and internal experiences.  I think a mood change is always a sign of a feeling you're trying to avoid.

sad1: If I stop my medication will I get worse or can I help myself with out the meds.

Dr. O'Connor: The guidelines are that you should go six months WITH NO SYMPTOMS AT ALL before you go off meds.  Talk to your pharmacologist.

annec: At what point do you decide that therapy is not really doing any good anymore and you should quit or find an alternative?  How much time I mean?

Dr. O'Connor: If you're starting out with a new therapist, you should have a sense within a month or two if this is working or not.  If you're in a long relationship with a therapist but feel you're in the doldrums, talk about it.  Tell your therapist why you feel it's not getting anywhere.  Ask him/her if he can do anything to help move it along.

David: What do you think about natural remedies, like St. John's Wort?

Dr. O'Connor: There is some reason to believe that St John's Wort may be effective with mild depression.  BUT, I feel like the herbalists want to have it both ways.  On the one hand, St John's Wort is supposed to be safe because it's natural.  On the other hand, it's supposed to be effective because it works just like Prozac.  It's not fair to make both claims.  Also, I've got a lot of stuff growing in my back yard that is perfectly natural but isn't safe.  The terms aren't synonymous.

David: Here's a helpful audience comment:

willowbear: I found the skills in the Dialectical Behavior Therapy course by Linehan for distress tolerance and emotion regulation continually helped me break my cycles of behaviors that would cause my depression to deepen.

Dr. O'Connor: Yes, Marsha Linehan's book on Dialectical Behavior Therapy has helped a lot of people.

DianaMaree: Is it normal to always feel as though I'm fighting hard against depression?

Karen2: What doesn't therapy teach us?

Dr. O'Connor: Therapy--at least the brief kind practiced under managed care--doesn't teach us how to undo the skills of depression.  We can go right on alienating people, being unassertive or withdrawn, stuffing our emotions, not able to prioritize our lives or make decisions. etc., etc.

David: For those of you who've asked, here's the link to Dr. O'Connor's book: "Undoing Depression: What Therapy Doesn't Teach You and Medication Can't Give You". 

I hope that everyone got something positive from tonight's conference.  It is getting late and I want to thank Dr. O'Connor for being our guest tonight.  His site is: www.undoingdepression.com.  I also want to thank everyone in the audience for coming and participating.  I think we can all learn a lot from each other.  And that's what we're about here at HealthyPlace.com. 

Dr. O'Connor: Thank you David, it's been a pleasure.

David: Here's the link to the HealthyPlace.com Depression Community.  I encourage you to sign up on our list in the depression community, that way you can be notified of events going on at HealthyPlace.com.  Since we are new on the net, I also hope that you will feel free to pass the http://www.healthyplace.com address along to your friends and others who might find it beneficial to visit.   I'm glad you came and hope you'll come back again Dr. O'Connor.  Maybe in a few months? 

Good night everyone.

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