I can honestly say I have worked very hard on changing my thinking patterns, the way I perceive things, the way I behave, how I react to others, how I process my emotions, and so on for twenty years. The techniques I have used for twenty years are CBT, prayer, meditation, mindfulness, self help, journaling, therapy of different kinds, AA's 12 steps, a good support network, and yes medication. I can say these things have helped me immensely in my life and even allowed me to overcome very bad alcoholism and addiction.

I am sad to say they have not really put a dent in my depression. In fact it has gotten worse in recent years. Those techniques allow me to cope with it better but it still comes full force with all the symptoms in regular cycles. The only time this isn't true is if a med is working good. Sometimes if I am in moderate to mild those techniques will bring me out of it. With severe I have to ride the cycle out. Nothing seems to work when in severe unless a med works. 37 years of cycles and I know it well. That is how it is for me. It is very biological, organic, genetic, and physical for me. My brain shuts down without any intervening external triggers or stresses. It just happens for no apparent reason. Obviously something causes those genes to turn on or off or not function right in the proteins and peptides they produce but I have not idea what. It seems to be much more related to seasonal circadian rhythms. Not SAD but similar. It is a year round cycle. The first hot week in spring usually always triggers one for example.