I'm glad you found something that works for you.
This is a good meta-study, diving into guesswork and hypothesis on mechanisms of depression. Here's some science. TL;DR: pills, long-term (24 month), have over a 3/4 relapse rate; cognitive therapy, discontinued after 4 months, show just over 50% relapse in total after 24 months. Initially, PILLS ARE EXACTLY AS EFFECTIVE, IN EXACTLY THE SAME WAY, AS COGNITIVE THERAPY. Exactly as effective. You can do absolutely no worse without drug therapy than you can by just talking to depressed people to make them feel better, and you do far better by talking to them and telling them how to get over it.
In a more recent CT -ADM placebo-controlled comparison, 240 severely depressed patients were randomized to ADM (n=120), CT (n=60) or a (pill) placebo control (n=60) treatment.
Big, randomized trial of people with ungodly hell depression (monopolar).
At the end of the 16-week treatment phase of the study, there were no differences in outcome between ADM and CT, with 58% of patients in both treatment groups meeting the criteria for ‘response’. Curiously, there was no indication that the two treatments affected different symptom clusters of depression: patients treated with either ADM or CT showed comparable rates of change of both cognitive and vegetative symptoms of depression.
Cognitive therapy (therapist nicely telling you how to get over it) is about exactly as effective in exactly the same way as taking pills. YOU WON'T BELIEVE WHAT HAPPENED NEXT!
In the continuation phase of the recent CT versus ADM study, patients who responded to 16 weeks of ADM were randomly assigned to either continue the treatment or change to a (pill) placebo condition. Patients who responded to 16 weeks of CT were withdrawn from treatment and allowed no more than three booster sessions (never more than one per month) during the first year of the follow-up period.
We took their meds away, and kicked all the therapy people out of therapy. Kept half the pill-heads on pills as a control, switched the other half to sugar pills, and didn't tell anyone.
As shown in FIG. 2, 76% of the ADM responders relapsed following medication withdrawal, compared with only 31% of the patients who had been treated with CT. Patients who continued ADM also fared better than patients who were assigned to the placebo treatment, with a relapse rate of 47% (which did not differ significantly from the 31% relapse rate in the CT group). After the continuation phase had ended, the patients who had not relapsed while on ADM were withdrawn from medication. Of these patients, 54% experienced a recurrence (the onset of a new depressive episode), compared with only 17% of the patients who had previously been given CT.
Like 3/4 of the pill-heads became severely depressed once we took the pills away; about 1/3 of the CT people had the same trouble. Half the people who stayed on pills relapsed, although in this study that's roughly equivalent (i.e. assume 47% == 31%): STAYING ON PILLS IS THE SAME AS QUITTING YOUR THERAPY AFTER 4 MONTHS. Of the pill users who didn't relapse, half of them relapsed after we took their meds away
Overall, just a hair under 50% of the patients who had CT for 4 months and then quit were, at 24 months, still cured. Just under 25% of patients who had drugs for 12 months came out of the 24 month period without having another depressive episode. Just under 10% of sugar pill patients were doing fine, no drugs and no therapy.
Drugs are facilitating: they provide you a baseline of feeling, which can help retrain your brain to behave in this new way by restricting its undesirable behavior. That can help; in the most extreme cases, drugs are *required*, because you simply can't pull yourself up by your bootstraps if your head is six feet under the muck; knee-deep in the muck is a different story, and this shit was tried on people who were *chest*-deep in muck. What people need, by and large, are *tools*: they need mental techniques and training to reform their brains. Some of us go slack and let ourselves get back into bad habits; continued follow-up sessions can provide a sort of tune-up if you want to be lazy like that.
Notate what I said about training executive functions:
Both CT and ADM probably affect limbic and prefrontal circuitry, although their proximal mechanisms of action might differ. A primary goal of CT is to replace automatic emotional reactivity with more-controlled processing. CT might thus increase inhibitory executive control, helping to interrupt or dampen automatic limbic reactions. In fact, functions of the PFC that are impaired in depression, such as task-related direction of attention, willful regulation of emotional responses, and reappraisal, are the focus of therapeutic activity in CT.
Do this like I do: think about it introspectively. You've sat in front of the TV and ate Cheetohs, thinking about how you're gonna get fat if you keep eating junk, and about how you should really clean the house... and just continued watching TV. You know that feeling. Your self-monitoring system is working--you know you're doing it wrong--but your initiation system has failed you: you have the intellectual understanding that you should get up and do a different thing, and you
I'm sure you can see that when you reflect on it. Take that reflection and go find science. Science talks about this a lot. It's how we treat retards, like those people with asperger's, so they can function exactly like normal human beings--you didn't think they were hopelessly broken, did you? It's how we turn mundane, poverty-stricken children into visionary geniuses and executive-management material. It's what people crudely recognize and work to improve when something so shocking happens in their lives that they must stop the pain and the damage to their self-esteem by putting their lives back together. It may be the most minor of things if you're pretty well-off mentally, but it's there, and you'll find a defect in those functions somewhere; we're all lacking a bit.
It's the same system we muck about with when we train anxiety and depression out of people. If pure cognitive therapy works for you, continuously, then it's a matter of training: you can handle relapses by putting yourself on therapy maintenance, taking booster sessions as needed, and constantly trying to ween yourself away from them. This is one of the rare cases where you can make yourself stronger; that's not common, just like we know weening yourself off Synthroid pills won't make your thyroid man the fuck up and get working properly. The fact that just over half of people relapse eventually in two years with only THREE SESSIONS between 4 and 12 months and NONE after 12 months should plainly tell you to try more therapy, since it apparently works for 90% of cases for those first 4 months (which, by the way, I dislike: I want an experiment like this where booster sessions are freely available for the full 2 years).
I guess you just like to watch people suffer, and have no high ideals. The right way, the effective way, to do things isn't important; throwing a tantrum about your feels is more important than helping people.