TIME Mental Health/Psychology

Therapy and Antidepressants Work Better Together Than Just Pills Alone

A combination of antidepressants and therapy work to help severely depressed patients recover

Depression is a tricky, often very individual disease, which can have both physical and psychological symptoms. New research out on Wednesday shows that patients with the most common kind of depression—meaning episodes of being low as opposed to chronic depression, which can last years—recovered better if they were treated with both cognitive therapy and antidepressants, compared to people who only received drugs.

“We think antidepressants work from the bottom up on the brain, smoothing hyperactivity in the area near the brain stem where emotions are generated. And cognitive therapy may work from the top down in the frontal cortex. You learn you’re more controlled than you thought you were,” says study author Steven Hollon, a professor of psychiatry at Vanderbilt University.

In the study, which was published in JAMA Psychiatry, the researchers studied 452 depressed adults at three medical centers in the U.S. who were randomly assigned to either treatment with antidepressants, or antidepressants with cognitive therapy. While many clinical trials of depressed patients are for a fixed period of time, in this study, the end point was recovery—meaning the patients experiences 6 full months without symptoms of depression. The group who had therapy and drugs fared better.

The researchers say the impetus for the study is a growing consensus that patients with depression need more than just their symptoms treated. In a corresponding editorial, Dr. Michael Thase, a professor of psychiatry at the University of Pennsylvania, said finding treatment options for people who do not respond to conventional methods is a top research priority. “There is no debate about whether cognitive therapy should be thought of as a first-line option, but what should a psychotherapist do when it doesn’t work?” he asks.

Beyond cognitive therapy and antidepressants, Thase, among others, wants more research into the efficacy of methods like mindfulness, interpersonal psychotherapy, and dialectical behavior therapy.

TIME Religion

Christianity Can’t Replace My Zoloft

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Chris Gallagher—Photo Researchers RM/Getty Images

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This article originally appeared on Patheos.

I have been taking Zoloft (anti-depressant) for four years. I began taking it during my freshman year in college because I had been suffering from severe panic attacks for about five years and they were beginning to severely interfere with my ability to function in school. Before I became a Christian at the age of twelve, I suffered from severe anxiety, depression, and suicidal thoughts. When I came to Jesus, I was told that I would be healed and finally find joy and lasting peace.

For the first few months it worked. I didn’t have any panic attacks, my suicidal thoughts went away, and my depression vanished. It was a miracle! But slowly, as the new-Christian buzz wore off, my struggles began to reemerge. I would suffer regular panic attacks almost every day and would experience severe bouts of depression. When this began to happen, I was sure that I was doing something wrong. Jesus was, after all, the Prince of Peace. I was told that if I would just cast my anxieties at the “foot of the cross” then I would be released from the burdens that weighed so heavily on me. I so desperately wanted the formula that I had been taught to work- read my Bible, pray everyday, and go to church and all will be well. But the problem was nothing I was doing was working. In fact, it was causing me more anxiety and depression. I hung crosses around my room, only listened to Christian music, and would never lay down in bed to sleep unless I had spent time reading my Bible. When nothing worked, I began to suppress and hide my struggle. I was, after all, one of the leaders in my Youth Group. I wanted to be a Pastor. I had to have it all together.

This struggle has plagued me for years. The fact that my depression and anxiety didn’t go away when Jesus “came into my heart” and the reality that I had to be medicated to live a normal life made me feel like a second-class Christian. I have been told multiple times that God doesn’t want me on depression medications. I have been told that the root issue of this all is my sinfulness and the Jesus would heal me when I dealt with my depravity. But as I have grown in my faith and studied more about psychology and theology, I have finally come to a realization that has been liberating for me:

Jesus isn’t going to take away my Zoloft and none of us will ever find lasting satisfaction in life.

Now I know that this may sound pretty cynical and well…depressing. But in the words of philosopher Peter Rollins, “I am not making you depressed, I am just telling you that you already are depressed and just don’t know it.” Just think. What if Jesus didn’t come to make us happy? What if his message and mission has less to do with improving our “quality of life” and more to do with equipping us with ways to cope and live within our various neuroses?

What if “becoming a Christian” doesn’t actually psychologically change us in any real way and that “Sanctification” is really about living and loving in the midst of our brokenness? What if the cross isn’t there to offer us satisfaction but rather to show us love amplified in suffering?

For far too long, Evangelicals have preached a Gospel that says if you come to Jesus that you will find shalom, satisfaction, health, wholeness, rightness, certainty, a foundation, clarity, abundance, and direction. This message doesn’t belong to the “Prosperity” churches, but also to the neo-reformed, the mainstream, and the progressive Evangelical communities. We have promoted a Gospel that says peace and wholeness can be yours today, when in fact, they cant. We have said that “God is most glorified when we are most satisfied in him” when the reality is “God is most glorified in our reliance on him in the midst of our brokenness, dysfunction, and lack of satisfaction.” There isn’t a single human being on earth who has “perfect peace” or “total wholeness”. And maybe that’s a good thing.

Everyone is searching for meaning and satisfaction and no one has ever found it. Not even in Jesus. Because that’s not the point. Throughout the Bible the narrative of Exile is found in almost every story. The reality that we have not arrived at home and that we are, in fact, wandering aimlessly in the wilderness. We all are hoping for the Promised Land. We even get to taste glimpses of it- in our manna from heaven, water from the rock, and seeing it from a distance like Moses. In our wandering, we see glimpses of God to remind us that we are not alone and that there is more than this. The pillar of fire by night and the cloud of smoke by day. God is guiding us. But the reality still exists- we are not satisfied. We aren’t in the Promised Land. We are still dry, thirsty, and lost. I’m still depressed. You still have you’re struggles. None of us are “Whole”. None of us are “satisfied”. But very few of us are humble enough (or free enough) to admit it.

The truth is, I will probably always need my Zoloft.

No, I am not “limiting God’s ability to heal me”, but rather am admitting that maybe “healing” would be the worst thing God could do. As Christians, we have over-realized our eschatology. We believe that the full benefits of salvation are meant to be experienced today. But that’s not true.

The Christian life and indeed, the human life, is one of sojourning and traveling through brokenness and pain. It’s one of struggling and failed expectations that are occasionally interrupted by a glimpse of “the Kingdom”. We all live for those moments of joy, peace, and fulfillment. Whether that is the embrace of our lover, the satisfaction of a job well done, our the moment of peace we experience in worship. But the embrace ends. Another job comes along. And the worship experience will pass. And the fallenness of this world will become our reality once again. It’s in this fallenness that God is most present. It’s in this suffering that our longing and motivation to work for the Kingdom of God is fueled. It’s in this brokenness that faith becomes essential- we must hope for a better day. And it’s that hope that quenches our soul in the desert of life. The hope that we will one day be united with God and neighbor. The hope for no more fears, tears, or suffering. The hope of lasting satisfaction. But until then, I’m going to take my Zoloft. You’re not going to be satisfied. Life is going to be hard. We all will continue wandering. But take heart- Jesus wanders with us. And maybe its time that we start to admit that. Live into that. And embrace that. Because that’s Good News.

Brandan Robertson is the host of the Project:Awaken Podcast and the director of an action-oriented social justice initiative called Revangelicals for a Better Tomorrow.

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TIME celebrities

Remembering Robin Williams (1951–2014)

TIME will publish a special commemorative issue on Robin Williams to hit newsstands and tablets on Friday, Aug. 15. The issue includes tributes from Dick Cavett, Alan Alda, Joan Rivers, Patch Adams, Jim Norton, Gilbert Gottfried, Margaret Cho, Lewis Black, Nathan Lane, Bill Maher and more, as well as remembrances from TIME critics Richard Corliss and James Poniewozik.

The cover features a photograph of Williams by Nigel Parry taken in 2007. This is the second time that Williams has appeared on the cover of TIME; he was first on the cover as the character Mork on March 12, 1979.

Corliss writes in Williams’ obituary, “He could play anyone, but not just one: not ‘just’ Robin Williams. All those voices in the head of this comic Hamlet must have told him it was time to be quiet. The rest is silence.”

Dick Cavett: “Robin and I agreed once that it’s galling to hear — when you’re ‘in it’ — the question: ‘What have you got to be depressed about?’ The great British actor and comedian, Stephen Fry, a fellow sufferer, replies ‘And what have you got to have asthma about?'”

Alan Alda: “For years, we had watched with awe as a Niagara of wit poured from his unconscious. Where did that manic waterfall of funny have its source? … Unfortunately, sometimes the mind that runs so fast it can’t keep up with itself also has its downtime. I didn’t know he suffered from depression, although it doesn’t surprise me. But it makes me want to do something. I hope it makes us all want to do something.”

Joan Rivers: “Robin was one of the great interviews. You’d see him coming down that red carpet and you knew, O.K., now we’re gonna have fun. We’re not gonna hear the usual, ‘Yes, we all love each other on the set.’ The one I remember most is, I had this incredible dress, I think it was Dior, with great big gold feathers on the top, absolutely beautiful. I was looking so snappy, I thought. And he came up and did five minutes on looking for eggs in my top, because I looked like a chicken. It was fabulously insane. He made like a chicken, and was clucking, and looking for eggs. Hilarious.”

Patch Adams: “While watching him work on the set of the film based on my life — Patch Adams — I saw that whenever there was a stressful moment, Robin would tap into his improvisation style to lighten the mood of cast and crew. Also, I would like to point out, Robin would be especially kind toward my children when they would visit the set … I’m enormously grateful for his wonderful performance of my early life, which has allowed the Gesundheit Institute to continue and expand our work.”

Jim Norton: “The funniest people I know always seem to be the ones surrounded by darkness. And that’s probably why they’re the funniest. The deeper the pit, the more humor you need to dig yourself out of it … There is simply no way Robin could have understood the way the rest of us saw him. And there is simply no way he could have understood how much respect and adoration other performers had for him. At least I hope he didn’t understand. Because it’s too sad to think that maybe he did understand, and it just wasn’t enough anymore.”

Gilbert Gottfried: “He worshipped Jonathan Winters, and you definitely could see the similarities. One big one is that they were the same on stage and off. Every now and then he would talk seriously, but more often than not, he was that guy. Every now and then, another part of him would pop up that was quiet.”

Margaret Cho: “When I started comedy in San Francisco in the ’80s, Robin would hang around the clubs I started doing shows at and grew up next to … He was the patriarch of our little clan of comedians in San Francisco. All of us looked at him, in a way, as a father figure. That’s why this is so upsetting.”

Nathan Lane:One day in 1995 while riffing in the character of a snobby French toy-store owner, Robin made me laugh so hard and so long that I cried. It seemed to please him to no end. Yesterday I cried again at the thought that he was gone.”

Lewis Black: “[On the USO tours], the amount of energy he brought when we would get off of a helicopter and walk toward the troops — the amount of energy he gave to them was unbelievable. It was really incredible to be in that kind of giving presence … It’s proof again that the good die young, and pricks live forever. He’s gonna be missed. There’s a hole, and it’s gonna take a long time to be filled.”

See TIME’s ongoing coverage of Robin Williams here.

TIME health

Dick Cavett: Robin Williams Won’t Be the Last Suicidal Star

"The Crazy Ones" Press Conference
Robin Williams at "The Crazy Ones" Press Conference at the Four Seasons Hotel on Oct. 8, 2013 in Beverly Hills. Vera Anderson—WireImage/Getty Images

"The non-actor has a major advantage because it’s harder to hide the symptoms"

Robin Williams will not be the last cherished performer to be snatched from our midst by depression and suicide.

It’s a melancholy fact that what a musician friend calls “the real blues,” and Churchill called “the Black Dog,” seems to have a much too close affinity to a performer’s life. Depression seems to stalk the lively arts like Jack the Ripper, accompanied by depression’s hand-maiden, suicide.

No one I know claims to know why.

Is there something in the brain chemistry of the actor/performer that produces this woeful result?

I could fill this page and another with the names of famous and less so actors, comics, and musicians who live miserably — and die — in association with that demon of a hound.

And booze is the favored self-treatment. Not surprising, because you will feel a little better, for a bit — but it’s a costly temporary reprieve, since alcohol is a depressant of the central nervous system.

I guarantee you that thousands, hearing of Robin’s death, asked how he could do it when he had everything: fame, wealth, adulation, family love. And another supposed insulator against the worst of the blues, plenty of work. No combination of those adds up to insurance. And the hectic, nerve-wracking ups and downs of fortune in show business are, of course, a major factor for emotional disequilibrium.

You yourself may have thought, “How could he do this to his wife and kids?” Easy. Because what’s been called the worst agony devised for man doesn’t allow you to feel any emotion for kids, spouses, lovers, parents … even your beloved dog. And least of all for yourself.

I know Robin knew this. His death recalled a moment with him years ago in a small club. He came off stage after bringing a cheering audience to its feet. “Isn’t it funny how I can bring great happiness to all these people,” he said. “But not to myself.”

The non-actor has a major advantage because it’s harder to hide the symptoms. The actor knows how to act. To play having fun. Too often it’s “He was the life of the party that night. And then he went home and…”

Robin and I agreed once that it’s galling to hear — when you’re “in it” — the question: “What have you got to be depressed about?” The great British actor and comedian, Stephen Fry, a fellow-sufferer, replies “And what have you got to have asthma about?”

Robin, like his idol Jonathan Winters, must have had one of the world’s hardest talents with which to live and retain personal balance. Sitting next to him on my old PBS show was like sitting in the Macy’s barge next to the fireworks going off. He was at full, manic, comic frenzy for an hour without let-up. (We even improvised a short Shakespeare play together, with and without rhymed couplets.) I caught his manic energy. It was exhilarating. And exhausting.

When it ended, I was wet and spent. It took him a while to come (partially) down, and I thought, “Can this be good for anyone? Can you be able to do all these rapid-fire personality changes and emerge knowing who you yourself are?

But can any of us really see ourselves? I was unable to watch a show I did with Laurence Olivier while I was virtually blinded with depression. I told Marlon Brando I could never watch it, knowing I’d look dead, slow, and stupid. “Do me a favor,” he said. “Watch it.” I made myself watch. I looked fine. My eyes were bright and the silences I recalled were gone.

I called Brando and I asked him what explained that. “Automatic pilot. We all get by on it when the clouds roll in. Too bad they roll back in when the performance ends and you get back under the bed.”

This will not brighten the picture: I said to a brilliant psychopharmacologist recently that there must be a lot of progress and new medications since I suffered depression back in the ’70s. The answer: “No, we’re really not making much progress I’m afraid.”

Some day, will some chemical link be found between great, great performing talent and susceptibility to that awful conqueror of the talented performer?

Are the gods jealous? Do they cruelly envy the greatly gifted and, in the classic Greek manner, smite them low?

The somewhat grim answer: We’d better enjoy them while we can.

Cavett was the host of The Dick Cavett Show, which appeared on ABC, PBS and CNBC. He is the author of the forthcoming Brief Encounters: Conversations, Magic Moments, and Assorted Hijinks (Henry Holt and Co.).

MONEY

Why You Probably Have More Mental Health Care Options Than You Think

Rorschach test with dollar signs
Sarina Finkelstein (photo illustration)—William Andrew/spxChrome/Getty Images

The suicide of comedian Robin Williams shows how tough it can be to overcome mental illness. The good news is that mental health care coverage is now more widely available, thanks to recent insurance rule changes.

The apparent suicide of comedian Robin Williams, who had reportedly suffered from depression, shows how tough it can be to overcome mental illness. His struggles are shared by millions of Americans—some one in four adults in a given year.

The good news is that mental health care coverage is now more widely available and at least somewhat more affordable, thanks to recent changes in federal law. And there’s reason to believe these rules can have an impact on suicide rates: Ken Duckworth, medical director of the National Alliance on Mental Illness, told USA Today that about 90% of people who commit suicide suffer from an untreated or under treated mental illness.

Here’s what you need to know:

1. If your health insurance covers mental illness, your benefits must be comparable to medical coverage.

If you’re covered under an employer health plan that offers mental health benefits—and some 85% of company plans do, according to the Society for Human Resource Management—you’re now entitled to coverage that is on par with coverage for physical illnesses. That’s the result of the Mental Health Parity and Addiction Equity Act of 2008—the final provisions of which just went into effect. (The parity act mainly addresses larger company plans.) Yet according to a study earlier this year by the American Psychological Association, more than 90% of Americans are unfamiliar with their rights under this law.

The mandate is even stronger for individuals buying coverage through the health insurance exchanges created under Obamacare. The Affordable Care Act included mental health care as one of 10 essential benefits that must be covered, expanding the parity rules to plans bought in the state exchanges.

“The parity act is a landmark law that creates a level playing field in insurance,” says Ron Honberg, national policy director for the National Alliance on Mental Illness.

2. Mental health care must have the same coverage limits as other medical care.

Before to the new rules kicked in, you would typically have had to get prior authorization for mental health or substance abuse treatment. And you would also have to cope with yearly limits and lifetime limits on treatments that were lower than for medical benefits.

“Now mental health care treatment rules have to be on par with medical care,” says Debbie Plotnick, senior director of state policy for Mental Health America.

That means you cannot be denied coverage for therapy visits or a stay in a treatment center, unless your plan also restricts coverage for comparable medical conditions. And you cannot be charged higher co-pays or co-insurance than you are for most medical and surgical services.

That doesn’t guarantee you’ll find treatment affordable. The sticking point for many people seeking counseling is that their provider may not be in their health plan’s network—far fewer mental health providers are part of an insurance network than other types of healthcare providers. If you’re in a plan that covers out-of-network treatment, you’ll still be reimbursed, albeit at lower rates than for in-network treatment. Note, though, that the entire bill may not be eligible since many providers charge more than insurers deem “reasonable and customary.”

3. Your insurance plan needs to disclose the medical criteria for denial of mental health care.

If you are denied reimbursement or coverage for mental health treatment, you will be entitled to the same appeal procedures as for medical care. The plan cannot simply refuse coverage without providing a detailed explanation that shows why the treatment is not deemed necessary, says Plotnick.

Over the past couple of years, many employer plans have already improved coverage of mental health. And there are early indications that more people are benefiting, particularly young adults who have remained on their parents’ health plans. (Adolescence and young adulthood is often when severe mental illness is diagnosed.) A recent study published in Health Affairs found that among people ages 19 to 25 receiving mental health treatment, uninsured visits declined by 12.4 percentage points, and visits paid by private insurance increased by 12.9 percentage points.

The new rules don’t cover everyone. Small plans may not be governed by these rules (depending on state laws). If you don’t have a large employer plan or one purchased on the exchanges, and if you don’t qualify for Medicaid, you may have to scramble. In many regions, and for many specialities, it may also be difficult to find a psychiatrist or therapist who takes your insurance. And if you go out of network, you will only be reimbursed for “reasonable and customary” costs that don’t cover your actual bills.

Still, for those suffering from mental illness, these new rules are major step forward. One more reason to, as late night talk show Jimmy Kimmel noted at the end of his Twitter tribute to Robin Williams: “If you’re sad, tell someone.”

TIME celebrity

WATCH: Hollywood Reacts to Death of Robin Williams

Comedians, actors and entertainers pay tribute to the late star

+ READ ARTICLE

Like the rest of the nation, actors, comedians and entertainers were shocked by the sudden death of superstar talent Robin Williams. Celebrity reactions to his apparent suicide have flooded media both social and traditional, with many paying tribute to their own personal relationships with the late star.

Steve Martin referred to him as a great talent and a genuine soul. Kathy Griffin tweeted of how every moment shared with Williams was a pivotal one, and that it was a comic’s dream to be in his presence. Judd Apatow wrote about the lengths he went to simply be near the legendary comic, saying that he took an internship at Comic Relief at the age of 18 in order to work with Williams.

Billy Crystal wrote poignantly, “No words.”

Other comedians such as Jimmy Kimmel and Chelsea Handler marked the tragedy by attempting to raise awareness of depression, telling those in need of support to not be afraid to reach out for help, and to remain strong.

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