Information provided in the “Ask the Doctors” column is not meant to take the place of individual consultation with a qualified health care provider. See your health care provider to discuss specific questions about your health, medication and treatment plan.

Question: How is cognitive therapy used to treat depression and bipolar disorder, and is it helpful to be able to cry?

Martha Manning, Ph.D.: Certainly, we know that depression does not affect just one system – it affects our thinking, our feeling, the way we interact with people, sleeping, eating, physical health – it hits us on every level. On the thinking level, depression causes trouble with our memory, focus and attention, as well as the quality and direction of our thinking – the way we interpret the world. When this is untreated, it can “feed on itself” and worsen. I’ve seen cognitive therapy work very well for a lot of people, especially those with dysthymia (chronic, moderate depression) and those who are having their first major depressive episode. For people who are more seriously ill, I have seen cognitive therapy play a good part in overall treatment.

Therapy that works with your thinking is a very important part of recovery. Because recovery can take a long time, a person can experience a lot of cognitive dysfunction when trying to get out of the “hole” that is depression. When a person is helped to change old patterns of thinking, chances of successful recovery are greatly improved.

Crying is both a symptom and a release, so for some people, the fact that they are crying a lot is one of the first symptoms that they may report to a doctor as a sign that something is wrong. A person with depression might notice he or she is crying for no reason, or crying over things that would not have brought tears in the past. To cry as a release is a cleansing act. As far as I’m concerned, when you feel horrible, to do anything that’s not against the law as a release is an excellent thing. Crying uses up energy and is a way of expressing and purging the fear and frustration so many of us feel with a mood disorder. Like windshield wipers on a car, it can clear things for a while.

Charles Nemeroff, M.D., Ph.D.: Cognitive therapy, focused on the right issues – treatment adherence, family relationships, protecting your sleep cycle and eating habits – can make as much as a twofold difference in recovery success.

Martha Manning, Ph.D., is a clinical psychologist and author. Her work includes Undercurrents: A Life Beneath the Surface, an account of her own experience with depression (available from the DBSA Bookstore), and The Common Thread: Mothers, Daughters and the Power of Empathy. She works frequently with DBSA in educational and advocacy efforts.