“Many of the benefits of CBT (cognitive behavioral therapy) can be obtained without going into therapy. There are a number of self-help books, CDs and computer programs that have been used to treat depression and some of these have been tested in clinical trials with positive results. I can particularly recommend these two books. One is 'Control Your Depression', the lead author of which is Peter Lewinsohn, a Professor of Psychology at the University of Oregon. ... The other book that I can recommend with confidence is 'Feeling Good' by the psychiatrist David Burns. 'Control Your Depression' emphasizes behavioral techniques like increasing pleasant activities, improving social skills and learning to relax. 'Feeling Good' puts greater emphasis on changing the way people think about themselves. But both books include both cognitive and behavioral techniques.”

“Depression is a serious problem, but drugs are not the answer. In the long run, psychotherapy is both cheaper and more effective, even for very serious levels of depression. Physical exercise and self-help books based on CBT can also be useful, either alone or in combination with therapy. Reducing social and economic inequality would also reduce the incidence of depression.”

“When people recover from depression via psychotherapy, their attributions about recovery are likely to be different than those of people who have been treated with medication. Psychotherapy is a learning experience. Improvement is not produced by an external substance, but by changes within the person. It is like learning to read, write or ride a bicycle. Once you have learned, the skills stays with you. People no not become illiterate after they graduate from school, and if they get rusty at riding a bicycle, the skill can be acquired with relatively little practice. Furthermore, part of what a person might learn in therapy is to expect downturns in mood and to interpret them as a normal part of their life, rather than as an indication of an underlying disorder. This understanding, along with the skills that the person has learned for coping with negative moods and situations, can help to prevent a depressive relapse.”

“For people who are depressed, and especially for those who do not receive enough benefit from medication of for whom the side effects of antidepressants are troubling, the fact that placebos can duplicate much of the effects of antidepressants should be taken as good news. It means that there are other ways of alleviating depression. As we have seen, treatments like psychotherapy and physical exercise are at least as effective as antidepressant drugs and more effective than placebos. In particular, CBT has been shown to lower the risk of relapsing into depression for years after treatment has ended, making it particularly cost effective.”

“Depression is not caused by a chemical imbalance in the brain, and it is not cured by medication. Depression may not even be an illness at all. Often, it can be a normal reaction to abnormal situations. Poverty, unemployment, and the loss of loved ones can make people depressed, and these social and situational causes of depression cannot be changed by drugs.”

“Depression is partly a nocebo effect, in the sense that it can be produced by negative exceptions about oneself and the world. The way in which these negative expectations develop and produce their negative effects provides some clues as to how they can be reversed. Expectancy effects grow, feeding upon themselves. One reason this happens is that our subjective states - our feelings, our moods and sensations - are in constant flux, changing from day to day and from moment to moment. The effects of these fluctuations depend on how we interpret them, and our interpretations depend on our beliefs and expectations. When we expect to feel worse, we tend to notice random small negative changes and interpret them as evidence that we are in fact getting worse. This interpretation makes us actually feel worse, and it strengthens the belief that we are getting worse, leading to a vicious cycle in which our expectations and negative emotions feed on each other, cascading into a full-blown depressive episode. .. Positive expectancies have the opposite effect. They can set in motion a begin cycle, in which random fluctuations in mood and well being are interpreted as evidence of treatment effectiveness, thereby instilling a further sense of hope and countering the feeling of hopelessness that are so central to clinical depression.”

“Not only are poor, unemployed, less will-educated and non-white people more likely to become depressed, but they are also least likely to benefit from treatment by either antidepressants or psychotherapy. That is why combating depression requires more than merely providing effective treatment for those who are already suffering from it. We also need the change the social conditions - such a racism, unemployment, poverty, unaffordable housing, and lack of adequate education - that put people at increased risk of becoming depressed.”