Treatments of Depression

Side effects of ECT include memory loss, disorientation and sometimes broken bones (although this is a lot less common nowadays)

Effectiveness has been studied by many psychologists e.g. Sackheim (1998) who found that real ECT was more effective than placebo ECT and that bilateral ECT is more effective than unilateral (despite memory loss). Sackheim also said that ECT is the most effective treatment for depression and when twinned with drug treatment its good for preventing relapse

HOWEVER Scott (2004) says that ECT is only an effective short term treatment and if tested again new drug treatments may prove more effective 

• diathesis stress model
• ignores neurotransmitters and the take up of serotonin
• ignores psychological factors
• ethical issues e.g. consent
• does the possible damage outweigh the possible damage?

ECT is now only used as a last resort treatment for patients whose depression is severe (mainly women) 

Johnstone (2003) says that in 1999, 11,000 patients were given ECT (2/3 women) and 50% of the time it did alleviete some symptoms in cases where all of the options had failed

Lack of consent may be an issue if the patient isn't in a good enough state to consent who does?

Key features of CBT include the dysfunctional thought diary where patients are asked to record all the negative thoughts about themselves and then challenge them looking for evidence to support them

Behavioural activation is the idea that being active leads to rewards that act as an antidote to depression- the patient and therapist will go through activities that could potentially be pleasurable. A key characteristic amongst those who suffer with depression is that they don't take part in outside activities

Effectiveness of CBT Hollon (1996) CBT is more effective than any drug therapy in preventing future episodes of depression (life skill) & Butler et al (2002) 16 met-analyses concluded that CBT is highly effective in treating depression

However... Holmes (2002) claims that the single largest study by the National Institute of Mental Health found that CBT is less effective that anti-depressant drugs and other psychological treatments

Bryant et al (1999) the clients engagement with the homework predicts their outcome- the therapist will be able to do more to help those who want to be helped 

Kuyken and Tsivikos (2009) 15% of the variance in outcome may be due to the effectiveness of the therapist 

Drop outs can make the results bias for CBT because it is likely to only work for those who want to get better 

CBT will not be useful for those who have a lot of negative thoughts and are resistant to change- less suitable in situations where there are high levels of stress

• non invasive compared to ECT
• doesn't have any side effects
• it focuses on treating symptoms rather than getting to the cause of the problems
• therapist could be seen as blaming the patient for their problems