Can Cbt Help ‘Biological’ Depression?

We can all feel low and poorly motivated from time to time.  But for as many as 30% during our lives, our low mood and lack of motivation just won’t shift.  Often, despite our best efforts, and the efforts of those who care for us, our low moods exhaust our ability to cope.  We have become depressed.

The question for mental health practitioners is how best to help someone who has become depressed?  One treatment strategy, the medical approach, involves prescribing an antidepressant.  These work on the neurotransmitters in the brain cells to improve our mood.  The other strategy is to use a proven psychological approach like counselling or cognitive behavioural therapy (CBT).

On the face of it looks confusing for the patient.  Is my depression a biological illness, or a psychological problem?  The reality is that depression is best seen as both biological and psychological.  Just two sides of the same coin.

It is certainly true that for some patients, their depression falls more towards the biological, and for others their depression falls more toward the psychological.  One theory suggests that the more a person excretes catecholamines in their urine, the more the depression has a biological component.

For talking therapists like myself, the interesting question is, are the interventions I use effective for people with these biological markers of depression?  In a recent study by Oei in the journal Behavioural and Cognitive Psychotherapy, patients with high levels of catecholamine’s and low levels of catecholamine’s  were each given a course of CBT.  Although the high catecholamine’s group had a higher score of depression severity at the start of therapy, both groups showed the same rate of improvement overall.

What does this mean?  Well in short it suggests that CBT is an effective treatment for depression, even for people showing evidence of a high ‘biological’ component.  This will bring some comfort for those people who are depressed and don’t want to take medication.  CBT also holds the advantage that you learn the skills to stay well which, if practiced, will help keep you well for the long term.  Unfortunately with medical approaches, the depression can sometimes return once the medication is stopped.

My own view is that antidepressants and talking therapies like CBT both have a role to play in the treatment of depression and often work extremely well together.  But if you really don’t want to take tablets, CBT or counselling really is an effective option for many people.