This is the first part of a four-part series on depression, and my first guest in the series is Dr. Steven Hollon. As you’ll hear, Steve is extremely knowledgeable about the current state of depression research, and he shares some kind of mind-blowing findings that go against some of the core assumptions about depression, like that it’s caused by low serotonin. We also talk about how well medication and cognitive behavioral therapy, or CBT, work to treat depression, and why therapy is so much better at preventing the return of depression once treatment ends.

In case you’re not familiar with CBT, it’s a short-term treatment that addresses the way we think and the activities we do, and it’s been shown to be really effective at treating conditions like depression. Steve clearly knows his science, and he also understands depression from the inside. He had a series of episodes of depression in his twenties, though thankfully he’s been depression free since he started treating patients with cognitive therapy.

Topics we discussed included:

• Recent developments in depression research
• Equal efficacy of medication and cognitive behavioral therapy (CBT) for acute depression treatment
• The superiority of CBT over medication for preventing depression relapse after treatment ends
• The major elements of CBT for depression
  • Doing activities that one would typically do if not depressed (as much as possible)
  • Don’t believe everything you think
• Integrating behavioral and cognitive components in CBT
• How it is that CBT works as well as medication without addressing the “serotonin deficit”
• The presence of high serotonin in depression
• Research by the evolutionary psychologist Paul Andrews on depression and serotonin
• The idea of depression as an evolutionary adaptation
• The effect of depression on directing energy toward the brain and triggering rumination
• The tendency of depression to resolve on its own with the passage of time
• Serotonin as the regulator of energy between approach and avoidance behavior
• The common misperception that serotonin is a “feel-good chemical”
• The possible role of depression in motivating us to address complex social problems by thinking through them carefully
• Possible effects of depression medication on the long-term course of depression
• The risk of prolonging the underlying depressive episode when treating with medication

Steven Hollon, PhD, completed his bachelor’s degree at The George Washington University, where coincidentally I did my master’s, and his doctorate at Florida State.

He worked closely and was good friends with Dr. Aaron Beck, the father of CBT, and he was a professor at the University of Minnesota before moving to Vanderbilt University where he continues to teach and do research.

Steve has led multiple groundbreaking depression research studies, many in collaboration with Dr. Rob DeRubeis, who was my clinical mentor and was previously on the podcast.

Steve has published hundreds of research studies, and has a long list of awards including an Excellence in Graduate Teaching award from the College of Arts and Science at Vanderbilt, and the Distinguished Scientific Award for the Applications of Psychology from the American Psychological Association.

Learn more about Steve here.