When Antidepressants Aren’t Enough – A Q&A with author Dr. Stuart Eisendrath

Seventeen years ago, Dr. Stuart Eisendrath piloted research into the therapeutic effects of mindfulness-based cognitive therapy (MBCT) on people experiencing clinical depression. Ever since, he has been helping those who struggle with depression dramatically improve their symptoms and quality of life by changing how they relate to their thoughts and feelings. In When Antidepressants Aren’t Enough: Harnessing the Power of Mindfulness to Alleviate Depression (New World Library, October 1, 2019), Dr. Eisendrath outlines an easy-to-implement MBCT program that has been scientifically proven in a National Institute of Health study to bring relief to chronic sufferers of depression by helping them realize that their thoughts are not their reality.  We hope you’ll enjoy this Q and A with him about the book.

What is Mindfulness Based Cognitive Therapy (MBCT)?

MBCT is a blend of some aspects of cognitive behavior therapy with mindfulness meditation.   Mindfulness meditation is an ancient Buddhist technique that has been secularized so it can be used by all people regardless of their background.  It teaches that in depression thoughts are often negative ones like “I’ll fail at whatever I try”. I’m not good enough” or “I’ll never get better”.  In MBCT, you learn that such ideas are just thoughts, not facts.

You say in the book’s introduction that you aim to help readers change their relationship to depression. How so?

In traditional cognitive behavior therapy, you are taught to try and answer back to negative thoughts.  This can be challenging because if you have been depressed for a long time you tend to believe the negative thoughts.  In MBCT you learn a different approach.  One by learning how to focus your attention you can let go of negative thought.  For example if you can learn to focus on your breath, there is no bandwidth available to focus on negative thoughts.   Secondly, MBCT is focused on the present moment.  If you are focused on the present moment you let go of ruminations about the past or anticipation about the future.  This is important because in depression you are often focused on past regrets and losses while with anxiety you are focused on upcoming catastrophes.  Focusing on the present moment has a natural antidepressant and antianxiety effect.

How has your own relationship with depression informed your work?

With my first experience with depression I tended to believe the negative thoughts when they occurred.  For example, when I felt guilty I tried to figure out why I was feeling that way.  Had I down something in the past that warranted  guilt? As I became more mindful, I realized such negative thoughts were symptoms of depression not facts that had to be investigated as actual realities.  Moreover I began to see depressive moods as being similar to the weather.  For example, if it is raining out today, it may mean I can’t go on a picnic but I realize it is a transient event and I can pursue alternatives for the day.  So when I experience depression I can realize it is transient and not be completely flattened by it.

You say in the book that when a depressive episode hits that it is important to see them for what they are: recurrences of an illness and not a personal weakness or moral failure. Tell us more about that please.

When depression hits, as part of the syndrome, you are often filled with self-recriminations.  There is a tendency to blame yourself and see yourself as having a personal weakness or failure.  This is a rather specific aspect of reaction to an illness.  You don’t see people with asthma or diabetes blaming themselves when they have an exacerbation.  With a mindfulness approach you learn to accept things as they are.  Winston Churchill embodied this approach when speaking of his depression; he said “the black dog is back today”

What advice do you have to offer someone who is interested in starting a mindfulness practice with the intention of healing from depression?

If you want to learn mindfulness techniques to heal from depression, MBCT is a proven technique.  I’d recommend taking an organized approach.  This might be by taking a class or by following the program outlined in the book, When Antidepressants Aren’t Enough.   Either way will serve as a guide that can offer a path to healing while helping avoid pitfalls.

Tell us about the science behind Mindfuless- Based Cognitive Therapy (MBCT)?

MBCT not only has powerful psychological effects, it also has effects on the brain itself.

In the PATH-D study we investigate participants by looking at how their brains functioned before and after treatment.  We did this by using functional magnetic resonance imaging of the brain.  This technique shows second by second changes in the brain.  In our studies, we found that areas of the brain associated with emotion regulation were enhanced while areas of the brain associated with emotion production—such as anxiety and depression—were reduced.  Although research on the effects is still being investigated, it is clear that MBCT has definite brain effects.  These effects appear to reverse the changes typically found in depression.

What do you hope readers will take away from your book?

I hope readers will gain a better understanding of depression including both its effects and ways of dealing with them.  I hope that readers will learn to treat themselves with more self-compassion in realizing depression is a widespread illness.  It is not a moral weakness or personal failure.  There are new and powerful techniques like MBCT that offer hope in healing depression and empowering the individual with skills that they can utilize rapidly and effectively.


Stuart Eisendrath, MD, is the author of When Antidepressants Aren’t Enough and the founding director of the University of California San Francisco Depression Center.  Visit him online at http://www.stuarteisendrath.com. Excerpted from the book When Antidepressants Aren’t Enough. Copyright ©2019 by Stuart Eisendrath. Printed with permission from New World Library — www.newworldlibrary.com.

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