@notmoses and others - perhaps of interest:
…
I want to pass on a few clips from a piece by Friedman, summarizing work by Mayberg and collaborators at Emory University, who looked for brain activity that might predict whether a depressed patient would respond better to psychotherapy or antidepressant medication:
http://well.blogs.nytimes.com/2015/01/08/to-treat-depression-drugs-or-therapy/
and
“Patients who had low activity in a brain region called the anterior insula measured before treatment responded quite well to C.B.T. but poorly to Lexapro; conversely, those with high activity in this region had an excellent response to Lexapro, but did poorly with C.B.T.”
“The right anterior insula aids interoceptive awareness of body states, such as the ability to time one’s own heartbeat. Moreover, greater right anterior insular gray matter volume correlates with increased accuracy in this subjective sense of the inner body, and with negative emotional experience.” – Wikipedia
Interesting, considering how psychotherapy is moving more & more in the direction of CBT (or thought revision) + mindfulness (interoception).
The slicker diagnosticians I know assess nowadays for the “cause” of depression on a spectrum from “mostly cognitive” to “mostly physiological” (usually meaning “autonomic imbalance” wherein the ANS is “stuck” in “freeze” mode; see Sapolsky in …Zebras…).
If the suspected cause is more towards the cognitive end, CBT is the usual go-to; if the suspected cause is more towards the physiological end, an anti-D is prescribed.
Hopefully, one encounters a diagnostician who is oriented in this manner, because the odds are good that recovery will be more rapid (and less risky) as the result of such informed observation and therapeutic choice-making.
So - the question is how do they determine this?
How can you possibly understand the “cause” of a person’s depression?
I wonder this, too - what about people with both a genetic predisposition and also a history of demoralizing events (asking for a friend 
)? Is a combination of both effective in this case, or does one factor override the other?
cc: @Rhubot
I guess I’m a little surprised by the question.
All one who is versed in cognitive theory and autonomic nervous system operation has to do is ask the pt a few questions. One can pretty quickly establish whether or not the pt has distorted logic and/or delusional beliefs. One can also determine quickly whether or not the pt is locked in an autonomic imbalance by means of taking his or her vital signs and then asking a few questions about how the pt has “felt” for a while.
Virtually any pt who is stuck in helpless anxiety and/or lethargy is going to be so with some combination of a learned helpless thinking style and/or a tilt towards the parasympathetic branch of the ANS trying unsuccessfully to bring the body back to homeostasis. The question is, “Is it more due to their misinterpretation of reality… or more due to their serotonin-dopamine-norepinephrine imbalance?”
One can effect the other, and induce a feedback loop, of course. But if the pt is largely on one end or the other of the spectrum, the treatment has to fit the circumstances to produce a result.
Grasp of this goes clear back to Selye and Wolpe in the '50s and '60s, but McEwen, Lupien, van der Kolk, Levine and Sapolsky have all written about it in more recent times.
Thanks. In the past, I was treated with both, and my experience was that the meds took enough of the edge off to allow the therapy to be successful. This seems to be my psychopharmacologist’s plan this time, too.
In the cooler months, my depression can linger for days, even weeks. I’m in a depressive phase at the moment and I’m not sure how long it will take to mentally recover.
I don’t want drugs, though, nor do I talk about it with my therapist. I think depression is something I have learned to accept on my own. Typically wholesome food & lots of rest will do the trick.
Yes; this is widely understood “best practice.”
I don’t blame you, because of the “invasion factor,” as well as the sfx. Trust of therapists upon whom we may (or may not) transfer notions about parents or other intimates is difficult, especially for psychotic spectrum pts. (If we tried to tell the truth to parents who demanded it and then punished us when we did, shouldn’t we be expected to distrust others who might do the same thing? It’s probably the #1 reason pts who are neurotic, borderline and/or psychotic push back against psychotherapy. Sigh.)
therapy…drugs as a very last resort.
humans are lazy and pop a pill to avoid mental pain and pyhsical pain…of any kind.
humans are programmed to experience pain…also love.
you should not deny your mind the experience.
it makes you stronger. 
take care 