Treatments

How can we treat depression from biomedical standpoint?

There are two ways to treat depression from a biomedical standpoint - electroshock therapy and drug therapy.

Electroshock Therapy

This therapy is less commonly used compared to drug therapy (taking antidepressants). Electric currents are sent to brain to stimulate changes in brain's chemical function. However, this method is usually only used for patients when drug therapy seems to not work at all.

Drug Therapy

Three of the antidepressants are Monoamine Oxidase Inhibitors (MAOIs), Tricyclics (TCAs), and Selective Serotonin Re-uptake Inhibitors (SSRIs).

SSRIs are considered second class antidepressants. This means that it has been developed later than MAOIs and TCAs. SSRIs are the most commonly used antidepressant out of all. SSRIs works by specifically blocking the re-uptake for serotonin at the axon terminal of neurons, which increases the likelihood of serotonin to stay in the synapse longer and to dock onto the receptor to be transmitted.

Evaluation of Biomedical Treatments

strengths

Cost-effective and works for most patients.
Immediate effects are often seen.
More standardization which raises its validity.
More accessibility to treatment. With antidepressants, depression can be treated outside of hospitals.

Less personalized to individuals' needs
Biomedical treatment is more effective for severe patients and might not be as effective on patients with less severe symptoms. (Naelles, 19
Biomedical treatment should not be used alone but with combination of other kinds of treatments.
It does not allow patients to really consider, recognize, or to understand their sources of depression.
Patients could become too reliant on antidepressants.
There could be side-effects.

Limitations

Supporting Studies

Aim:

To see if there was any significant difference in the effectiveness among the three approaches to therapy of depression: CBT(Cognitive-Behavioral Therapy), IPT (Interpersonal Therapy), and drug therapy.

Procedure:

250 patients diagnosed with depression from three different treatment centers were used as samples. However, those clients must not have any other psychiatric disorders.

Those clients were assigned to one of the following groups and were observed over the course of four months.

1. ITP only

2. CBT only

3. Tricyclic drug and clinical management

4. Placebo drug and clinical management

There were twelve sessions. Assessment information came from client, therapist, and third-person clinical evaluator. The content of assessment included symptoms, life-functioning, and functioning related to particular treatment approaches.

Results:

Three treatments achieved significant and equivalent degree of success for treatment. Although actual treatments were more effective than placebo group, placebo still worked as a treatment to depression. Drug therapy had the most immediate effect, but the overall outcome was similar to other therapy methods. Rather than method of approaches, the overall outcome was influenced by the initial severity of the patients.

It was found that only 20-30% of patients were completely symptom-free of depression regardless of types of therapy that they have received. However, it was found that patients in IPT and CBT had greater effects on treatment in a long-term, because they were able to recognize and understand the sources of their depression.

Implications:

This study shows that combinations of multiple approaches of therapy should be used as the most effective method of treatment. Another significant finding was that treatment for depression is mainly based on individual circumstances. This is why depressed patients should seek to get help from professional psychiatrists, who can diagnose by looking at individual factors/circumstances.

Strengths:

Triangulation of assessments were seen.

The variables were highly controlled.

The study was conducted in three different regions, which raises generalizability.

Limitations:

Exclusion for some circumstance lowered ecological validity and raises the limitation of researcher bias.

1/3 of drug group have dropped out of the experiment within the session.

Low generalizability because of the exclusion of some participants.

Elkin et al. (1989)

Aim:

To examine the changes in brain function during treatment with placebo.

Procedure:

Patients who have been diagnosed with depression were used as samples. They were randomly allocated to one of the three different groups:

1st and 2nd group (Experimental group): Patients received actual active medication of SSRI (two types).

3rd group: Patients received a placebo.

This was a double-blinded study.

Participants were observed for nine weeks, and EEG was used to compare brain functions.

Results:

Significant increase in activity in the prefrontal cortex for placebo group was seen immediately after the experiment began. However, all groups were successful in treating depression at the end.

Implications:

Drug treatment is an effective method to treat depression. However, placebo seemed to be just as effective as regular medication. This questions the effectiveness on the substances itself.

Strengths:

Variables were highly controlled.

Avoided researcher bias by double-blinding.

Limitations:

Low generalizability.

Changes in brain's function is not a definite factor for completely "healing" the depression. Therefore, researcher should've triangulated the data.

Leuchter et al. (2002)

How can we treat depression from cognitive standpoint?

CBT Therapy (Cognitive Behavioural Therapy)

Focuses on how we think about what has happened to us. Brings awareness to thoughts behind us.

Uses “Thought tracking” where they keep records of automatic thoughts, underlying assumptions, in order for psychiatrists to notice the thought processes that usually might not be noticed. This is a tool used in order to analyze thoughts and find out the core beliefs behind automatic thoughts.

Treatments can be different depending on individuals

- Visualization

- Verbalization

-Thought-stopping

strengths

Limitations

Positive effects are usually seen in short-term. It is the fastest way to treat.
Unlike biological treatment, there is no side effect.
Foundational to other treatments such as counselling.
Tries to treat the "causes" of depression, not just "symptoms" of depression.
More flexibility depending on each patients.

Oversimplicity
Clients must be motivated to fix their depression.
Might induce anxiety symptoms during the process for making patients aware about their depression.

How can we treat depression from social standpoint?

Mindfulness-based Cognitive Therapy (MBCT)

Focuses on helping patients to learn how to cope and build relationship to their sadness in order to avoid relapse of depression. The practice of mindfulness allows patients to be focused directly on feeling what you've been going through, as well as noticing the "experience".

Instead of destabilising the negative emotion, mindfulness allows you to wash over those negative emotions.

It is a skill that patients need to train over and develop.

strengths

Limitations

Effective even after the suffering period of depression.
Avoids relapse
Unlike biological treatment, there is no side effect.
Tries to treat the "causes" of depression, not just "symptoms" of depression.
Positive effects on the brain seen as well. (Links to biological)
More flexibility depending on each patients.

Requires motivation and consistent effort from patients
MBCT is usually used as a treatment after they have fixed their severe stage of depression.