NZ Herald Column Kyle MacDonald

Kyle MacDonald: Overcoming depression: What you need to know

This is the first of my regular weekly columns in the New Zealand Herald.  Click here for the original article…


“I’m taking anti-depressants and I’m not sure if they’re working should I see a therapist as well?” Unsure, Wellington

I’m a fan of what works: medication, therapy, acupuncture, meditation, climbing mountains or going to a boxing gym.  Whatever helps you overcome depression, including taking medication, do it.

At an individual level anti-depressants work for some, and not for others. It’s also true that certain pills will work for some, while others don’t.

However, to answer your question, if you can access therapy, you should. Most people are surprised to hear that psychotherapy, not medication, is recommended as what we call “first line treatment” for depression (and anxiety) by the big health research groups around the world – namely the National Institute of Clinical Excellence in the UK (or “NICE”, the best acronym ever), the American Psychological Association (APA) and more recently the American College of Physicians.

The next bit might freak some people out, and please don’t stop taking medication based on reading a column, but research actually suggests that the anti-depressants known as “SSRIs” (the best known of which is Prozac) aren’t very effective for mild to moderate depression. They tend to be more effective for more severe depression, but then so is therapy.

Confused yet?

When medication works, it boosts a person’s mood enough to get them going. Ultimately what always works for depression is making behavioural changes, whether that’s how you act in the world, or how you think. Medication can’t help with that, it can’t change your behaviour or the way you think. No pill can do that for you.

That’s where therapy comes in. A good therapist will help you target your efforts and over time this is what actually helps people lift their mood. Whether this involves learning skills to change your thought patterns, making practical changes in your life, or learning to slow your mind, through being more mindful, therapy can give you a wider range of tools to manage life.

It’s also true that when medication does work, it works even better in tandem with therapy. In fact on average therapy and medication together tend to work better than either on their own, and especially for more severe depression.

I think ultimately it’s just human nature to want a quick fix, and I don’t blame anyone for wanting an easy solution to emotional pain. Of course therapy can also be expensive compared to medication, and increasingly hard to come by unless you can afford to go private.

Which does beg the question: when we know it works, and is internationally recommended as the best treatment, why isn’t it more available?


• Questions will remain anonymous

Where to get help:

• Lifeline: 0800 543 354 (available 24/7)
• Suicide Crisis Helpline: 0508 828 865 (0508 TAUTOKO) (available 24/7)
• Youth services: (06) 3555 906 (Palmerston North and Levin)
• Youthline: 0800 376 633
• Kidsline: 0800 543 754 (available 24/7)
• Whatsup: 0800 942 8787 (1pm to 11pm)
• Depression helpline: 0800 111 757 (available 24/7)
• Samaritans: 0800 726 666 (available 24/7)
If it is an emergency and you feel like you or someone else is at risk, call 111.


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