My history with depression stretches back over 30 years at this point, although I didn't really understand that until two years ago. My current understanding of my own experience is that depression masked everything else, for decades. And I was good at masking even the depression for long stretches, except when it completely took over and I would be unable to work, or do much of anything. My past is a bit of a wasteland of false starts as a result.

Anyhow, a couple of years ago, when everything fell apart and PTSD became a huge part of the picture, it soon became apparent that until the thickest fog of depression was lifted (in my case with the help of medication), no real progress in any kind of therapy was going to be possible. That was what allowed me to decide in favour of trying medication again.

I also read a lot of stuff about depression at that time. It was frightening but also very motivating to understand that depression in and of itself is a life threatetning illness, not some weakness of mind or character.

As for the cognitive approach, again, my own experience is that there is a point at which that is not workable. Depression to the point that one can barely formulate a thought and can hardly speak, let alone comprehend what even the most well-meaning therapist is talking about, requires different tactics.

That said, once the total fogging of everything has lifted, I am left with instances of depression 'within wellness' which are indeed amenable to cognitive approaches. They can be seen to have begun with an event or thought pattern, and while they still have a rythmn of their own, they often do lift in a few days. There is always the fear that I am sinking back into the morass of clinical depression, but, thankfully, for about 18 months now, that has not happened.

Most recent example of what I mean was the recent holiday period. I was plagued with constant thoughts of ways to kill myself and felt very tempted to do so. Fortunately the thought of how that would affect my neice and nephew stood in my way. But, I also had the awareness in the back of my mind, that mid-november to mid-january is always a dark dark time for me, so the hope that this too would pass was not totally missing. Anyhow, without any need to change my medication or anything, once we got to about Jan 2nd, the triggers of this episode began to recede. The hated holidays were over, I had made it into a new year (year end life review is always a major cause of 'cognitive' depression for me) the anniversary of a beloved life partner's death had passed. The world came back to life, and me with it...

One final note...one of the yardsticks used to measure depression is interest level in 'activities you used to enjoy' This one crosses over into PTSD territory for me. Or some other realm. Never having developed a sense of 'self' my interest in activities has always been externally motivated. When I stop doing what I think I should and doing what ohers are doing, I am left with a void. But that does not mean I am depressed.

Hope something here might be helpful...

DLR