MYTH NUMBER 2: "These drugs are extremely dangerous." Wrong. If you are receiving medical supervision and cooperate with your doctor, you will have no reason to fear 395
David D. Burns, M.D.
the drugs. Adverse reactions are rare and can usually be safely and effectively managed when you and your doctor work together as a team. The antidepressants are far safer than the depression itself. After all, the illness, if left untreated, can kill you—if you commit suicide!
M Y T H N U M B E R 3: "But the side effects will be intolerable." No, the side effects are mild and can usually be made barely noticeable by adjusting the dose properly. If in spite of this you find the medication uncomfortable, you can probably switch to another which will be equally effective with fewer side effects.
MYTH NUMBER 4: "But I'm bound to get out of control and use these drugs to commit suicide." These drugs d o have a lethal potential, but this need not be a problem if you discuss it openly with your physician. If you feel actively suicidal, it might be helpful to obtain only a few days' or one week's supply at a time. Then you will not be likely to have a lethal supply on hand. Remember that as the drug begins to work, you will feel less suicidal. You should see your therapist frequently and receive intensive therapy until any suicidal urges have passed.
M Y T H N U M B E R 5 : "I'll become hooked and addicted, lice the junkies on the street. If I ever try to go off the druz.
I'll fall apart again. I'll be stuck with a crutch forever."
Wrong again. Unlike sleeping pills, opiates, barbiturates, and minor tranquilizers, the addictive potential of antidepressants is quite low. Once the drug is working, you will n o t need tc take larger and larger doses to maintain the antidepressant ef-f e c t , and in most instances the depression will not return when you discontinue the drug. When it is time to go off the medicine, it would be advisable to do this gradually, tapering off over a week or two. This will minimize any discomfort that might occur from abruptly stopping the medicine, a n : 2
will help you nip any relapse in the bud before it becomes full-blown.
Some doctors are now advocating long-term maintenance therapy for certain patients. A prophylactic effect can ' r e achieved if you take a low dose of the antidepressant over a 396
FEELING GOOD
period of a year or more after you have recovered. That will minimize the probability of your depression returning. If you have had a significant problem with recurrences of depression over a period of years, this might be a wise step for you. At the lower doses used for maintenance, the side effects are usually negligible.
M Y T H N U M B E R 6: "I won't take any psychiatric drug because that would mean I was crazy." This thought is quite misleading. Antidepressants are given for depression, not for "
craziness." Antidepressants actually have no place in the treatment of insanity per se. Thus, if your doctor recommends an antidepressant, that would indicate he is convinced you have a mood problem and are not "crazy." However, it i s "crazy" to refuse an antidepressant on this basis because you may bring about greater misery and suffering for yourself. Paradoxically, you may feel "normal" quicker with the help of the medicine.
M Y T H N U M B E R 7 : "But other people are bound to look down on me if I take an antidepressant. They'll think I'm inferior." This fear is unrealistic. Other people will not know you're taking an antidepressant unless you tell them—there's no other way they could know. If you do tell someone, they're likely to feel relieved. If they care about you, they'll probably think m o r e of you because you're doing something to help eliminate your painful mood disorder.
Of course, it is possible that someone might question you about the advisability of taking a drug, or even criticize your decision. This will give you the golden opportunity to learn to cope with disapproval and criticism along the lines discussed in Chapter 6. Sooner or later, you're going to have to decide to believe in yourself and to stop giving in to the disabling terror that someone might or might not agree with something you do.
M Y T H N U M B E R 8 : " I t i s s h a m e f u l t o h a v e t o t a k e a p i l l .
I should be able to eliminate the depression on my own." In our research on mood disorders, we have found that most individuals c a n recover without pills if they engage in an active, structured, self-help program of the type outlined in this 397
David D. Burns, M.D.
book. However, we have also found that in some cases an antidepressant appears to provide some needed leverage that can facilitate your efforts to help yourself. In fact, some recent evidence indicates that antidepressants may actually help reduce negative thinking. Thus, these drugs could speed up your personal effort to modify your attitudes and help you change behavior patterns. Does it really make sense to mope and suffer endlessly, stubbornly insisting you must "do it on your own"? Obviously, you must do it yourself—with or without a pharmacological boost. An antidepressant may give you that little edge you need to begin to cape in a more productive manner, thus accelerating the natural healing process.
398
Suggested Reading
Beck, A. T., Rush, A. J., Shaw, B. F., and Emery, G. Cognitive Therapy of Depression. New York: Guilford Press, 1979. This book is intended for the professional counselor or therapist and lays out the actual course of treatment in a step-by-step progression.
Burns, D. D. "Nobody is Perfect." This tape describes common self-defeating thought patterns and explains how to replace them with rational thinking to help boost self-esteem, increase joy in life, and combat bad feelings such as depression, anger, anxiety and frustration. Available for $10.95 postpaid from Psychology Today cassette series, Tape #20268, Dept. A0720, P.O. Box 278, Pratt Station, Brooklyn, N.Y. 11205.
Burns, D. D. "Feeling Good About Yourself." This tape helps you identify perfectionistic tendencies and shows how they work against you. It explains how to stop setting unrealistically high standards as a means to help increase productivity, creativity and self-satisfaction. Available for $10.95 postpaid from Psychology Today cassette series, Tape #20269, Dept. A0720, P.O. Box 278, Pratt Station, Brooklyn, N.Y. 11205.
Ellis, A., and Harper, R. A. A New Guide to Rational Living. No. Hollywood: Wilshire Book Co., 1975. Published by arrangement with Prentice-Hall, Inc., Englewood Cliffs, N.J. A classic self-help book which describes the system of rational emotive psychotherapy which shows you how to solve emotional problems by modifying the thinking processes that create them.
Emery, G. A New Beginning. New York: Simon and Schuster, 1981. This book describes the principles of cognitive therapy and shows how they can be applied to the treatment of depression.
399
Index
A
Anger, 135-77
as adaptive, 148-49
A. E. Bennett Award for
cognitive therapy and, 138
Basic Psychiatric Research,
Freud on, 138
2
frustration and, 176-77
Accomplishments, self-esteem
internalized, 138
and, 288-91
irrational statements, 143-
advantages of, 288-89
45
disadvantages of, 289
labeling, 141-42
does work equal worth,
magnification, 143-44
291-98
as maladaptive, 148
Accurate empathy, 167-72
methods for reducing
Achievement
accurate empathy, 166-
DAS test score and, 251
72
worth and, 288-91
anger hierarchy, 172-73
advantages of, 288-90
cognitive rehearsal, 172—
75
disadvantages of, 289-
90
cooling hot thoughts,
does work equal worth,
151-54
291-98
developing the desire,
Achievement trap, 304-308
149-52
Action, motivation and, 114-
enlightened manipula-
15
tion, 160-63
Action, motivation and,
imaging techniques,
114-15
153-56
Active death wish, 340
learning to expect crazi-
Adapin, 379
ness, 158-60
Adaptive anger, 148-49
negotiating strategies,
Adler, Alfred, 11n
163-67
Adolescent rejection, 266-67
putting it all together,
Air-traffic controllers, 359
171-75
Alcohol, 290
rewriting the rules, 156-
All-or-nothing thinking, 31-
58
32, 40
"should" reduction,
Amine theory of depression,
163-64
377
Amine transmitters, 389
Amines, 376-77
mind reading, 142-43
Amitriptyline, 377
Novaco anger scale, 136-
Amphetamines, 290, 387,
38
398
as productive,147-49
403
David D. Burns, M.D.
ten things to know about,
side effects of, 383
175-77
switching to M.A.O. In-
thoughts and, 139-40
hibitors from, 384n,
Anger Cost-Benefit Analysis,
394
150
L-tryptophan,
380-81,
Anger hierarchy, 172-73
389-92
Angry rejection, 268
benefits of, 390
Anhedonia, 83
dosage prescribed, 390-
Antidepressant drug therapy,
91
9, 11-17, 354, 375-98
potential risk of, 391-92
cognitive therapy and, 12-
serotonin levels and,
18, 394-98
389-90
lithium, 26, 387-89, 393
where to obtain, 390-91
dosage prescribed, 388
Antidepressant drugs, 21,
effectiveness of, 388
354
major uses of, 386
addictive potential of,
side effects of, 389
396-97
M.A.O. Inhibitors, 378-81,
the brain and, 377-81
384, 385-86, 393
caution in prescribing, 393
dosage ranges for, 386
myths about, 394-98
foods and medications
pregnancy and, 393
to avoid when taking,
treatment of suicidal pa-
387
tients, 337-38
side effects of, 386
See also Lithium; M.A.O.
toxic effects of, 386
Inhibitors;
in treatment of atypical
Tricyclic compounds;
depression, 385
L-Tryptophan
tricyclic compounds and,
Antiheckler technique, 131
385, 386
Antiperfectionism Sheet,
myths about, 395-98
312-15
tricyclic compounds, 378,
Antiprocrastination Sheet,
379, 381-85
91-92
dosa2ge prescribed, 381- 8 Approval, 256-73
length of treatment with,
385
DAS test score and, 251
medical information on,
independence and self-re-
379
spect, 261-72
mood elevation resulting
cost-benefit analysis,
from, 384
261-62
response to, 384-85
disapproval, 266-72
recovering from disap-
404
FEELING GOOD
proval or rejection,
C
272
rejection, 266-72
Cade, John, 387
self-respect blueprint,
"Can't Lose" System, 112-13
262-64
Center for Cognitive Ther-
verbal techniques, 265-
apy, 11 n
66
Chemotherapy, 209
need for, 256-58
Coercion, 85, 105-106
origin of the problem,
Cognitive distortions, 180,
258-61
238, 345-46, 353
self-approval, 273
definitions of, 31-41
Archives of General Psychia-
of suicidal individuals,
try, 1
345-46, 353
Autonomy, DAS test score
Cognitive rehearsal, 172-75
and, 254-55
Cognitive therapy, 3-4, 54
Aventyl, 379
anger and, 138-39
Averageness, 310
antidepressant drug ther-
apy and, 13-14, 394-98
dialogue between client
B
and therapist, 360n
helplessness and, 368-71
Beck, Dr. Aaron T., 3-4, 9,
hostility and, 361-66
51, 52n, 104, 322, 337,
ingratitude and, 365-66,
362, 369
357
Beck Depression Inventory
mood-control techniques
(BDI), 20-27, 44, 63,
of, 10-11
223, 339, 343, 382, 384
origin of, 9-10
interpreting, 22-23
principles of, 11-12
Being alone
self-criticism versus self-
advantages of, 285
defense, 59-64, 65, 71,
loneliness and, 276-80
121, 218, 233
Black bile, 375, 377
treatment for depression,
Boosting self-esteem, 51-74
12-18
Brady, Dr. John Paul, 3
treatment of suicidal indi-
Brain, the
viduals, 337-38, 345-
antidepressant drugs and,
51, 352-54
377-81
uncertainty and, 368-71
the nervous system and,
Compulsive slowness, 316-17
377-78
Cooling hot thoughts, 151-
Brown, Helen Gurley, 294
52
But-Rebuttal Method, 98
Coping, 66-72
405
David D. Burns, M.D.
with criticism, 132
Dependency, 274
with helplessness, 368-71
need for love and, 274,
with hostility, 361-65
275-78, 286-87
with ingratitude, 365-66,
Depression
367
amine theory of, 376-77
with uncertainty,
antidepressant drug ther-
368-71
apy and, 13-17, 375-98
Cosmopolitan, 294
Criticism
antiheckler technique, 131
coping with, 132
the Beck Depression In-
fear of, 85
ventory (BDI), 19-27,
overcoming fear of, 119-
44, 63, 223, 339, 343,
23
382, 384
disarming the critics,
interpreting, 22-23
124-28
empathy, 123-25
ment for, 12-18
feedback, 128-31
effects of, 28
negotiation, 128-31
Freud on, 130
right criticism versus
hopelessness and, 341, 355
&n
bsp; identifying silent assump-
wrong, 122
tions downward-arrow
method, 239
D
Dysfunctional Attitude
Scale, 241-55
Daily Activity Schedule, 87-
vertical-arrow tech-
90
nique, 235-41
Daily Record of Dysfunc-
mania and, 25-26
tional Thoughts, 63-64,
medical science's approach
90-95, 97, 154, 186-87
to, 354-55
Death wish, 340
National Institute of Men-
Defeating guilt, 186-204
tal Health on, 16
antiwhiner technique, 200
negative self-evaluation,
Daily Record of Dysfunc-
52-53
tional Thoughts, 186-87
negative thinking and,
developing perspective,
28-29, 45-46, 56
201-204
physical symptoms of, 375
learning to stick to your
prevalency of, 9
guns, 195-99
as product of mental slip-
Moorey moaner method,
page, 12
200-201
realistic, 209
"should" removal tech-
role of genetic factors in,
niques, 187-95
376
406
FEELING GOOD
sadness and, 207-208
guilt, 86
schizophrenia and, 55
hopelessness, 81-82
search for causes of,
jumping to conclusions, 82
375-76
low frustration tolerance,
self-dislike and, 51
85
sexual drive and, 56
overwhelming oneself, 78-
suicide and, 337
83
types of depression benefit-
perfectionism, 83
ing from antidepressant
resentment, 85
drugs, 395
self-activation methods,
willpower and, 75
86-118
See also Antidepressant
Antiprocrastination
drug therapy; Suicidal
Sheet, 90,91-92
individual
breaking down task into
Depression: Causes and
component parts, 103-
Treatment (Beck), 51,
105
337n.
But-Rebuttal Method, 98
Depression: Clinical, Experi-
"Can't Lose" System,
mental, & Theoretical As-
112-14
pects (Beck) 52n
counting what counts,
Desipramine, 379
110-12
Developing the desire for re-
Daily Activity Schedule,
venge, 148-51