It is often the case that meds are the only help available or offered. Not everyone has access to the full range of treatments and sometimes the lack of motivation, concentration and sheer depth of the depression put self help strategies beyond reach. I do self-help when I'm well enough and have managed 8 years med free up until this episode, but right now all my efforts are directed towards not offing myself and staying physically safe. At the moment I need something that will lift my depression sufficiently for me to be able to benefit from less agressive treatments, that something is most likely chemical but ECT is an option too.