A widely used treatment is drug therapy such as the anit-depressant drug prozac which is a selective serotonin re-uptake inhibitor.
These drugs have side effects, for example...
Ferguson et al (2005)- found that young people who take prozac are twice as likely to attempt suicide.
Electro-convulsive Therapy (ECT)
Alternatives to drug treatment are physiological treatments such as ECT.
ECT is a process by which an electric current is passed through two electrodes attached to the patients head.
This current (70-150v) sends the patient into a seizure that lasts between 0.04 to 1 second.
The patient is given muscle relaxants to prevent fractures and this procedure is carried out 3 times a week for uo to 5 weeks
How does ECT treat depression?
It may be that it makes the patient forget why they are depressed
Or that it works by restoring the brains ability to regulate moods by enhancing the transmission of neurotransmitters, or by improving blood flow in the brain.
Side -effects of ECT
ECT has side effects.
Before muscle relaxants were given patients bones were broken and fractured due to the seizure.
It also causes servere headaches, cardiovascular changes and memory loss.
Effectiveness of ECT (Sackheim)
Sackheim (1986)-compared ECT with placebo ECT and found that the real ECT was more effective.
However, bilateral ECT was more effective than unilateral ECT suggesting that bilateral ECT is effective for depression but associated with side effects and unilateral ECT is less effective but has fewer side effects.
Sackheim concluded that ECT is more effective than anti-depressant drugs but that medication after ECT may prevent relapse.
Effectiveness of ECT
A review of 18 studies with 1,144 patients showed that ECT is more effective than drug treatment in the short-term treatment of depression (Scott 2004).
This was not compared with anti-depressants like SSRI's and so we cannot see the effectiveness of ECT to it's full extent.
Problems with ECT
ECT ignores the role of psychological factors and social/family situations.
It focuses on treatment, not on the cause.
BUT Johnstone (2003)- reported that in 1999, 11,000 patients were given ECT.
It can allivate symtoms of 50% of cases where all other options have failed.
Cognitive Behavioural Therapy (CBT)
A psychological treatment for depression is CBT.
CBT aims to change the way a person thinks.This is often done by altering maladaptive, negative thoughts.
Patients may be asked to make a dysfunctional thought diary. They will write down their negative thought, and then rate it on how much they actually believe it. They then give a rational response to this thought, and rate their belief in it. Finally, they re-rate their belief in the automatic thought.
Athernatively, patients may be asked to challenge their dysfunctional thoughts when the therapist asks ''where is the evidence for X?'' and ''what is the worst that could happen if X came true?'' By answering these questions the negative thought can be replaced by more positive and constructive ones.
There is also the theory of behavioural activation which is based on the idea that being active leads to rewards that act as an antidote to depression.
Effectiveness of CBT
Dobson (1989)- showed that Beck (who proposed ideas about the causes depression and CBT) achieved greater short-term improvement than any other therapies, such as drugs and behavioural treatment.
Butler et al (2006)- reviewed studies of CBT and found 16 published meta-analyses and concluded that CBT was highly effective for treating depression.
Holmes (2002)- said that CBT is less effective than anti-depressants and other psychological therapies, which raises questions over the effectiveness of CBT.
Kuyken and Tsivikos (2009)
Suggested that effectiveness is down to the therapists competence, with 15% of the outcome down to the conduct of treatment by the therapist.
Bias and problems
Attrition can bias results into CBT research as when people drop out the remaining participants will be more positive.
But, dropping out of the therapy after improvements biases results as those remaining are probably doing less well.
While CBT takes into full account the patients thoughts, attitudes and feelings, it focusus more on treating symtoms rather than getting to the causes of problems.
There are many ways that depression can be treated.
Perhaps the best treatments varies from person to person as everyone reacts differently to treatments and it's all about finding the best treatment for the individual.
Alternatively, both physiological and psychological treatments work best when used together.