Treatments of depression

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  • Created by: gracepxx
  • Created on: 30-05-16 10:14

P1 - Intro

Frequency of depressopm and suffering is causes is on increase

With increasing evidence for physiological causes of disorder, more pressure to develop effective forms of treatment 

However, as with treatments for other disorders such as schizophrenia, these physiological treatments are most effective when combined with psychological methods 

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P2 - Chemotherapy

Use of antidepressant drugs is one of main physiological treatments - help relieve symptoms

Both the older form, "tricyclic" antidperessant and newer "SSRIs" used to reat moderate to servere depressive illness

Taken for 4-6 months although sometimes last much longer 

Depression thought to be because of insufficient amounts of neurotransmitters such as noardrenaline and serotonin 

Normal brains, neurotransmitters are constantly being released at synapses, stimulating the neigbouring cells 

To terminate their ction, neurotransmitters are reabsorbed into nerve endings or are broken down by an enzyme

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P2 - Chemotherapy

Antidepressents work by reducing rate of reabsorption or by blocking enzyme which breaks down neurotransmitters - increase amount of neurotransmitter avaliable to stimulate neighbouring cell

Tricyclics block transporter mechanism that reabsorbs both serotonin and noradrenaline into pre-synaptic cell after it has fired - more neurotransmitter left in synapse, prolonging their activite and making transmission of next impulse easier 

SSRIs - work in similar way but instead of blocking re-uptake of different neurotransmitters they block mainly serotonin so increse quantity avaliable to excite neighbouring cells and reducing depression

Example of SSRIs = Prozac

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P2 - Chemotherapy

Treatment of depression using chemotherapy has 3 phases 

Treatment of current symptoms takes place during acute phase of treatment 

Once symptoms have gone, gradually enter continuation phase for 4-6 months, after which medication is gradually withdrawn to prevent relapse 

Final phase is maintenance - reccommended to people who have history of recurrent depressive episodes 

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P3 - Chemotherapy evaluation

Kirsch et al (2008) - reviewed clinical trials of SSRIs - only in cases of most servere depression was it advantageous - moderately depressed individuals showed same improvement when given placebo, possibly because it "offered them hope" which contributed to lessening symptoms - for most depressed group, expectation of anything working lessened, diminishing placebo effect and increasing difference between treatment and control conditions 

Ryan (1992) - may have something to do with developmental differences in brain neurochemistry and highlights importance of having multiple treatments avalible

Concern with saftey of SSRIs, particularly in increase of sucidal thoughts their use may cause - Ferguson et al (2005) - compared SSRIs with other treatments or with placebo - those treated with SSRIs were twice as likely to commit suicide

However, Barbui et al (2008) - although this was the case among adolescents, risk decreased among adults - maybe drug should just be used in older people - more effective with less side effects 

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P4 - CBT

Psychological treatment used to treat depression - emphasises the role of maladaptive thoughts in the cause and maintenance of depression 

When people think negatively about whemselves and their lives it often leads to depression - aim of CBT it to identify and challenge these cognitions as well as any dysfunctional behaviours that may be contributing to illness 

CBT intended to be brief - 16-20 sessions focused on current problem rather than the past - also included elements such as "thought catching" and "behavioural activation"

Thought catching - individuals taught to see link between thoughts and feelings - asked to record any emotion-arousing events, the automatic negative thoughts that are associated with event and then their realistic thoughts that might challenge negative ones - taught to replace dysfunctional thoughts with constructive ones and try out new ways of thinking

Behavioural action - based on idea that being active leads to rewards that combat depression - many sufferers no longer participate in activities previously enjoyed - therapist and clinet identify activities they'll potentially enjoy and anticipate any cognitive obstacles that may hold them back

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P5 - CBT evaluation

Large body of evidence supporting effectiveness of CBT to treat depression

Butler et al (2006) - found 16 published meta-analyses - based on all info, concluded CBT was effective and high validity suggest this is reliable 

However, Holmes (2002) - claimed the largest study into the effectiveness of treatment showed that CBT was less effective than antidepressants and argues the studies supporting effectiveness come only from Ps with just depression and no other additional symptoms 

Nevertheless, NICE reccomends CBT is the most effective treatment for servere to moderate depression

Therapist competence explains variance in CBT outcomes, Kuyken and Tsivrikos (2009) - as much as 15%of variance in outcome may be attributed to how effectively therapists conduct their research

CBT less suitable for people who have high levels of dysfunctional beliefs that are both rigid and resistent to change 

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