Major New Development in the Treatment of Depression!

NYT

I had a queasy feeling as I read that headline. I was pretty sure I was going to read about some Dr. Frankenstein sticking electrodes into Area 25 of someone's brain, or about some drug trial involving glutamate enhancers (or antagonists, take your pick). But no, it's just this:

The therapy that Dr. Manber, Dr. Carney and the other researchers are using is called cognitive behavior therapy for insomnia, or CBT-I for short. The therapist teaches people to establish a regular wake-up time and stick to it; get out of bed during waking periods; avoid eating, reading, watching TV or similar activities in bed; and eliminate daytime napping.

The aim is to reserve time in bed for only sleeping and — at least as important — to “curb this idea that sleeping requires effort, that it’s something you have to fix,” Dr. Carney said. “That’s when people get in trouble, when they begin to think they have to do something to get to sleep.”

This kind of therapy is distinct from what is commonly known as sleep hygiene: exercising regularly, but not too close to bedtime, and avoiding coffee and too much alcohol in the evening. These healthful habits do not amount to an effective treatment for insomnia.

In her 2008 pilot study testing CBT-I in people with depression, Dr. Manber of Stanford used sleep hygiene as part of her control treatment. She found that 60 percent of patients who received seven sessions of the talk therapy and an antidepressant fully recovered from their depression, compared with 33 percent who got the same drug and the sleep hygiene therapy.

Yup, CBT-I really is that simple, as are most cognitive-behavioral interventions. Here's the sickening part -- most doctors who prescribe antidepressants don't discuss sleep with their patients -- hell, they don't even ask if they are thinking about killing themselves. The doctor prescribing your antidepressants is only seeing you for 11 minutes, during which you will have the luxury of speaking to your doctor for 4 minutes. The typical doctor interrupts a patient after listening to them for 12 seconds.

No wonder people value psychotherapy, and no wonder it works so well. Most people have never had the experience of being listened to and feeling understood.

By the way, I do "CBT-I" with all of my depressed patients, and I have for done so for over a decade. I don't call it CBT-I, though; I call it caring enough about your patients to think about how small improvements in their lives might positively affect their mental health. I would have assumed that any psychotherapist worth his salt would already be doing this intervention as a matter of course, but then again most people are not terribly good at what they do.

I wouldn't advise going to bed while wearing so much make up.