Judith Warner’s Sunday Times, Op-Ed The Wrong Story about Depression is the perfect response to the recent hoopla over the study on the effectiveness of antidepressants. A new study in the Journal of the American Medical Association reported that a placebo is just as likely to help mild depression as popular antidepressant drugs. The media picked up, simplified and amplified that little piece of information and left out the much more important facts about depression in America.

Warner writes, “Antidepressants do work for very severely depressed people, as well as for those whose mild depression is chronic. However, the researchers found, the pills don’t work for people who aren’t really depressed — people with short-term, minor depression whose problems tend to get better on their own. For many of them, it’s often been observed, merely participating in a drug trial (with its accompanying conversation, education and emphasis on self-care) can be anti-depressant enough.” Quite a different message than, “Antidepressants are no better than sugar pills!”

But then Warner takes it further when she talks about the death of mental health professionals who are skilled in using proven and effective methods of alleviating depression.

“In 2008, a team of psychologists brought this point home in blunt terms in the journal Psychological Science in the Public Interest. “Despite the availability of highly effective interventions,” they wrote, “relatively few psychologists learn or practice these interventions.” This is the big picture of mental health care in America: not perfectly healthy people popping pills for no reason, but people with real illnesses lacking access to care; facing barriers like ignorance, stigma and high prices; or finding care that is ineffective.”

We can’t agree more. Treatments like EMDR and Cognitive Behavioral Therapy, Dialectical Behavioral Therapy, and mindfulness based treatments are researched approaches and techniques that are proven to help with anxiety and depression. While it would be difficult for a therapist to be intensively trained in all these approaches, they should, at the very least, know about them and at best be skilled in one or more. Therapists need to be perpetual students and keep up with new developments in the field. Clients as consumers need to ask what recent training the person has. The combination of being seasoned by experience and current by education makes a worthy therapist.

Clinicians at Soho Parenting have been providing the therapuetic technique of EMDR for nearly a decade.  We are constantly awed by the results. EMDR is one of the most important discoveries in the field of psychotherapy in the last twenty years.  It is hard to describe EMDR without sounding like a “new age” nut, so first the results-and then the description of the process.

A two year old child who had seen the twin towers fall on 9/11 experienced intense tantrums ever time she heard sirens for weeks afterwards. Her mother was desperate to help her. The little girl came for EMDR, and after one session the tantrums stopped.

An adult man having trouble controlling his anger and sarcasm does EMDR in regards to losing his father when he was eight years old. In the EMDR therapy he discovers that he has been angry at himself for saying something to his dad before he died. His entire anger-ridden exterior melts and he reports two months later that he has not felt that constant agitation anymore. His wife expresses a gigantic change in their relationship.

A woman who had been in talk therapy for 15 years does EMDR for 10 sessions about childhood sexual abuse and finally feels forgiveness for herself and even for her father. She is able to move ahead in her life – opens a business, maintains a stable relationship – things she had not been able to do before.

Interested? EMDR (Eye Movement Desensitization and Reprocessing) is based on the knowledge that the two hemispheres in our brain have very different functions. Simply put, the left hemisphere is the logical, analytical, verbal part of the brain. The right hemishere governs our bodily processes like breathing, heart rate, and our “fight or flight” response –it is the more “emotional side” of the brain. When we experience something frightening or upsetting, our right brain goes into high gear and our left brain quiets down. So the experience is “held” in the right brain. Talking (left brain) about the experience can be helpful in understanding the narrative, but it does not release the emotions, bodily experiences and interpertiatons of the event that the right brain holds…still following?

EMDR makes a connection between your left and right brain by alternately sending a small signal to the right and left brain while focusing on the exact memory or feeling. You can listen to beeps on head phones or hold onto small pulsars that buzz alternately, right, left. It is a very targeted and specific protocol. As the session proceeds, the tangle of emotions, thoughts and sensations becomes untangled and integrated and the person experiences distinct relief.

Here is another way to understand it.  For those of you who run–often times when you go out for a jog there is something on your mind that you are chewing over – a fight with someone, a problem you need to solve, etc. You notice after your run that you feel better, that something felt figured out or you have even forgetten what you were obsessing about.  Endorphins are important, but think about running-left, right, left, right – feet hitting the ground. Alternating signals to the right and left brain. Something about that bilateral stimulation seems to help you resolve or move on from upsetting thoughts.

Those are the basic mechanics of EMDR. It is a well-researched, effective method for dealing with PTSD and trauma:

“The Department of Defense/Department of Veterans Affairs Practice Guidelines have placed EMDR in the highest category, recommended for all trauma populations at all times. In addition, the International Society for Traumatic Stress Studies current treatment guidelines have designated EMDR as an effective treatment for PTSD (Foa, Keane, Friedman, & Cohen, 2009) as have the Departments of Health of both Northern Ireland and Israel (see below), which have indicated EMDR to be one of only two or three treatments of choice for trauma victims. The American Psychiatric Association Practice Guideline (2004) has stated that SSRI’s, CBT, and EMDR are recommended as first-line treatments of trauma.”

We can attest to undergoing EMDR ourselves and have practiced it for years.  It is a fast, useful and results-oriented therapy that has made a tremendous difference in many peoples lives.

Anyone who has felt the leaden weight of depression for any amount of time can only have the greatest empathy for Daphne Merkin, as she bravely writes about her lifelong battle with depression in “A Long Journey in the Dark”, the cover story for the New York Times Magazine (May 10). I approached reading the article assuming it would be moving and honest. I have been a fan of her writing for years. But as I read the article I found myself feeling annoyed and then angry about two things. One is her implication that electro-convulsive therapy be avoided at all cost.  The other is the narrowness of large swathes of the psychoanalytic community.

As a therapist and as a friend I have seen absolutely miraculous recoveries from intractable depression with ECT. The idea that ECT is the treatment of last resort and a shameful capitulation to a barbaric practice is just dead wrong. Merkin has her right to her own fears and biases, but when I reading her dramatic and sensationalistic imagery I winced imagining a client of mine reading the following paragraph.

“What if ECT would leave me a stranger to myself, with chopped-up memories of my life before and immediately after? I may have hated my life, but I valued my memories-even the unhappy ones, paradoxical as that may seem… The cartoonish image of my head being fried, tiny shocks and whiffs of smoke coming off it as the electric current went through, haunted me even though I knew that ECT no longer was administered with convulsive force, jolting patients in their straps.”

This is what keeps ECT recipients from sharing their success stories with others and from feeling proud about taking a very big step to heal themselves despite all the negative judgements.  Merkin may be able to take months to either recover or languish because of financial security, a free-lance career and only one 17 year old daughter but other people have young children to raise, jobs to do, and bills to pay. They can’t afford to take months of being in a “neuro-vegetative” state.  Merkin just set ECT back years in that one article.

My second negative reaction (that is an understatement) to the piece came when she described her therapist, “a modern Freudian analyst whom I had been seeing for years and who had always struck me as only vaguely persuaded of the efficacy of medication for what ails me.”

This is what gives psychoanalytic talk therapy the image of being self-indulgent and not that helpful to many. Helloo, Mr Analyst! You are her guide in treatment. If you are dubious about using medicine for depression you haven’t done your homework. Have you then recommended that she do EMDR (trauma processing therapy), cognitive-behavioral therapy, dialectical behavior therapy, meditation, somatic experiencing, neurofeedback, yoga or a combination of these treatments? Have you read and studied about all the incredible brain research that is out there? Or have you just rested on the elitist, narrow notion that any alternative or modern therapeutic modality is “below” the standards of analysis? Sure, I remember thinking that way because that’s what I was taught thirty years ago, too.

One should evolve as a therapist. Would a heart patient visit a cardiologist who utilized only techniques they were taught in medical school thirty years ago? No – they would choose a doctor with a breadth of knowledge, whose methods are completely current. A therapist should build on what they know. And what we know is that are an array of well-researched therapeutic tools to treat depression that can work in conjunction with the traditional forms of talk therapy. If I had been honored to be consulted by Daphne Merkin, that is what I would have said.

Now, I could be wrong. Merkin’s therapist may have suggested all of these things to her. And she may have tried them all and still have been left with paralyzing depression and a strong impulse toward suicide. But I bet it’s not true. I have heard story after story with individual and couples who endure ten, fifteen, thirty years of treatment without the transformative results that are the goal of therapy.

Here’s bottom line. If your client is not getting better, bring in other professionals, research other modalities – get more effective help for him or her. If ECT is really called for, consider helping to reduce their fear by escorting your patient — get out of your comfort zone.

Almost everyone I know, myself included, has felt the weight of depression or anxiety. It seems to be a big part of the human condition now. Fighting depression is an everyday battle for some of us, and we should use all the tools at our disposal.