Medical Model & Intro:
- Depression is caused by deficiencies in the neurotransmitters noradrenaline & serotonin - would mean that treating depression through drugs would be the most suitable.
- A survey (1998) found that 67% of patients diagnosed with depression were prescribed an antidepressant drug.
- There are 3 main types of antidepressant: monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants (TCAs) and selectrive serotonin reuptake inhibitors (SSRIs) - all aim to treat depression by increasing the levels of available serotonin and/or noradrenaline.
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- Tricyclic antidepressants i.e. Imipramine block the transported mechanism that reabsorbs both serotonin and noradrenaline into the synaspe after its been fired, so more of these neurotransmitters are left in the synaspe - prolonging their activity & making the next transmission easier.
- TCAs are milder than MAOIs and slower acting - however fewer severe side effects - may cause cardiac problems.
- In 2001, the WHO reported that TCas are as effective as SSRIs & less expensive however less effective in severe depressive episodes.
- Beck compared depressed patients having CBT with those given TCAs - no difference in the benefits after 6 months but over a long period of time - less relaspes with the CBT than with TCAs.
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- i.e Prozac and Seroxat work in a similar way to TCAs - more selective than TCAs because they work by only blocking the reuptake of seroonin - although have been some court cases in the USA where patients found to develop suicidal thoughts & violent outburst.
- In 1998, Donald Schnell killed his wife, daughter & grandaughter and then himself, only two dayys after being given the SSRI, Paxil - clinical trials have found antidepressants to be effective in reducing symptoms of severe depression in 65-75% of cases compared to around 33% for placebos.
- Studies have consistently found that antidepressants are less useeful for children & adolescents - no better than placebos.
- A problem with all types of antidepressants is that there is an increased riskof suicide in the early stages of use.
- Another criticism of drug treatments is that while they may reduce the symptoms of depression, they do notthing to address the cause of the problem e.g. if they've experienced negative life events.
- While antidepressants may be useful in the intial stages for the short-term relief of severe depression in adults, perhaps most useful if used in combination with psychological treatments.
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Psychological Treatment: CBT:
- Aim is to identify negative thinking & change people's beliefs, thoughts & attitudes which are believed to be important in maintaining depression - aims to identify and change dysfunctional behaviours that amy also be contributing to the depression.
- CBT for depression focuses on current problems & dysfunctional thoughts and behaviours (unlike psychodynamic) - clients are expected to keep a daily diary of thoughts e.g. "thought catching" - where patients record any automatic negative thoughts & during CBT challenge them - dysfunctional thoughts are replaced with rational, logical & positive ways of thinking.
- Behavioural theory suggests that depression is a consequence of a reduction in positive reinforcement as being active & doing things is rewarding as many depressed people no longer participate in activities that they previously enjoyed. In CBT, the client & therapist identify pleasurable activities.
- One critism - (in depressed teens) - increase risk of suicide - March et al studies 300 teenagers with depression, randomly assigned 1/3 treatment groups: antidepressant only, CBT or a combo. Over80% of participants in all 3 groups responsed positively, however, 15% of the drug treatment groups expressed suicidal thoughts compared to 6% in CBT.
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Further research evidence:
- He reviewed studies of CBT & concluded that it was highly effective for treating depression.
- However, Holms claims that treatments for depression showed that CBT was less efective than atnidepressants & other psychological therapies.
- There is signifant variation in the outcome of CBT - probably be explained in terms of therapist competence as research suggests that the therapist can engage the client in homework, they have better outcomes for their clients.
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