Depression: A Critical Evaluation of Different Treatment Methods

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Depression A Critical Evaluation of

Different Treatment Methods

Karen Upham

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The University of Southern Queensland

Depression A Critical Evaluation of

Different Treatment Methods

Depressive disorders are commonly diagnosed in western cultures. Mood disorders impair individuals of all ages and gender, social, occupational and personal functioning (Olfson et al 00). Causes of depression range from biological, psychological and social factors (Feldman & Feldman, 17). In its mildest form depression may present as a passing period of sadness following a personal disappointment or loss (Burton, 00). Clinical depression occurs when depressive symptoms persist for a long period of time and are severe enough to merit professional help (Burton). Depression is characterised by feelings of sadness, shame, guilt, anxiety, helplessness, and hopelessness, accompanied by symptoms such as insomnia, loss of energy, enthusiasm, poor self-image, changes in appetite, and for some, thoughts of suicide (Feldman & Feldman). This essay evaluates three treatments of depression in adults psychotherapy, pharmacotherapy, and group treatments. Research evidence indicates that each modality has particular strengths and weaknesses. It will argue that whilst these treatments are effective, an integration of both psychotherapy and pharmacotherapy are complementary treatments for depression (Feldman & Feldman).

Psychotherapy is the treatment of emotional disorders by psychological means. It involves the verbal interaction between a trained professional therapist and a patient with emotional or behavioural problems. Using non-drug techniques based on established psychological principles, the therapist helps the patient identify and change maladaptive thoughts, feelings, and behaviour or adjust to problems in living (Rathus, 00).

Types of psychotherapy have proved effective in the treatment for depression for individuals, couples, and groups, targeting the underlying factors associated with depression (Feldman & Feldman, 17). Comparative efficacy research indicates that Cognitive, Interpersonal, and Behaviour Therapy are effective treatments for depression, particularly when symptoms are mild or moderate in severity (Beach, Whisman, & O'Leary, 14; Hollon, 1; Karasu, 14; Scogin & McElreath, 14, as cited in Feldman & Feldman).

Cognitive therapy focuses on cognitive functioning by helping clients alter irrational thinking and beliefs. Techniques encompass challenging irrational thoughts and cognitions to reduce depressive symptoms, by generating more productive and accurate thoughts, reducing emotional stress (Feldman & Feldman, 17).

Alternatively Interpersonal therapy enhances understanding in relationships using empathy skills to allow clients grief and loss issues to be resolved (Feldman & Feldman, 17). Another technique, Behaviour therapy aims to change behaviour by building coping strategies and appropriate social skills (Feldman & Feldman).

According to Feldman and Feldman (17) cognitive, behaviour and interpersonal therapies are limited when depressive symptoms are severe. Especially when significant disturbances of sleep, appetite, or concentration exist (Elkin et al., 18; Robinson, Berman, & Neimeyer, 10; Thase et al., 14 as cited in Feldman & Feldman). Therapists are unable to engage patients who are too tired, dominated by obsessional thinking or consumed with feelings of hopelessness (Feldman & Feldman). Furthermore, depending on the client's ability for example, cognitive therapy is limited for intellectually impaired people.

Another treatment option is Pharmacotherapy, which uses medication as the primary intervention for treating patients. As depression maybe a biological disorder it often requires medication to overcome chemical imbalances to stabilise moods. Drug therapies such as tricyclic antidepressants (TCAs) or Selective Serotonin Reuptake Inhibitors (SSRI's) have proved effective in treating depression (Kennedy, Lam, Cohen, Rowindran & Canmat, 001). In most instances it takes one to three weeks before the benefits of medication become apparent, relieving depressive symptoms such as sleep or appetite disturbance, fatigue, concentration difficulties, irritability, and obsessional thinking (Feldman & Feldman 17).

Up until the 10s, TCAs were the most frequently prescribed antidepressants (Ainsworth, 000). However, in a review article Ainsworth (000) points out the potential side effects of tricyclic antidepressants. Side effects can include dry mouth, blurred vision, constipation, dizziness, increased appetite and weight gain, sleep disturbance, high blood pressure, severe headaches, strokes and even death (Ainsworth). Sexual side effects have commonly included low libido and orgasm or ejaculatory impairment (Kennedy, Lam, Cohen, Ravindran & CANMAT, 001). Moreover, TCAs are often common agents used in suicide by poisoning (Ainsworth). SSRIs are a newer, safer antidepressant. However side effects can include; agitation, sleep disruption, nausea, weight gain and sexual problems (Kennedy et al.).

Research indicates depressive relapse can also occur when treatment is stopped (Greden, 1; Rush, 1 as cited in Mundt, Clark, Burroughs, Brenneman & Griest, 001). However, inadequate dose, duration and medication compliance is often the cause of relapse (Katzelnick, Kobak, Jefferson, Greist & Henk, 16, as cited in Mundt et al.). Patients may stop medication due to the lessening of depressive symptoms, side effects, costs, and peer pressure (Mundt et al.).

A study involving two hundred forty-six depressed outpatients, claimed successful treatment of depression of seventy percent of patients who complied with treatment (Mundt et al., 001). Participants were prescribed antidepressants and randomly received educational materials by mail. These patients were assessed at baseline, four, twelve, and thirty weeks later for depressive severity and functional impairment. Medication compliance was analysed by prescription fill date and results indicated that medical compliance is crucial to the effectiveness of pharmacotherapy (Mundt et al.).

A comparison of surveys in the United States between 187 and 17 indicate greater use and tolerance of newer antidepressants versus psychotherapy treatment (Olfson et al., 00). Participants were outpatients who had one or more visits for depression (Olfson et al.). Outcome measures were based on rate of treatment, psychotropic medication, use, psychotherapy, number of visits, type of service and payment (Olfson et al.). However alternative explanations of these findings show that pharmacotherapy is a faster, easier and cheaper alternative to psychotherapy. Results indicate third-party payment coverage, faster methods of diagnosing depression and accessibility of antidepressants in clinical practice (Olfson et al.). These results are valid but limited due to these findings. Therefore pharmacotherapy as a single modality to psychotherapy has no advantage.

Group treatment is an alternative approach to pharmacological therapy, often employing psychotherapy intervention, in a supportive, sharing environment. Group treatments vary in size and structure involving a small number of participants, a facilitator and co-facilitator. Structured groups emphasise learning using cognitive and behavioural interventions, or alternatively less structured groups offer a supportive environment for participants struggling with depression (Rice, 001).

Past research indicates group treatments are an effective modality for the treatment of depression (Lewinsohn, Steinmetz, Antonuccio, & Teri, 185; Marshall & Mazie, 187; Neimeyer & Feixas, 10; Teri & Lewinsohn, 186; Yost, 186, as cited in Rice, 001). While recent study indicates the effectiveness of psychotherapeutic group treatments for depression in comparison to pharmacological therapy alone (Rice).

Rice (001) did a comparative study using three group treatments. One group used a structural treatment model, another group used alterative group therapy and a control group was medicated while on a waiting list (Rice). Groups were compared using seven outcome measures on fifty-nine participants at an outpatient community mental health centre (Rice). Participants consisted of middle-aged, isolated, unemployed single women in severe depression (Rice). Outcomes for the treatment groups showed an improvement in symptoms. The structured group improved on five of the seven measures compared to the controlled wait-list, while the alternative group improved on only two (Rice). The depressive symptoms of the control wait-list group although medicated (using pharmacotherapy) deteriorated during the study (Rice).

The effectiveness of the structured group appears to have been more beneficial as cognitive and behavioural interventions were used. These interventions addressed depressive thinking patterns and problematic interpersonal relationships (Rice, 001). Participants learnt relaxation and social skills, and to engage in more pleasant activities. Whereas the alternative brief group although beneficial only offered support, sharing and emotional encouragement (Rice). Whilst group treatment appears to be beneficial for depression, this study is limited as participants only represent a minority of the population who benefited by the social contact the group provided (Rice). However findings indicate age or work did not contribute to the differences in outcome measures (Rice). Results indicate that medication without group work or psychotherapy is not effective (Rice).

All group treatments appear effective by reducing general distress levels and providing social contact. However, educational group treatments are more effective in reducing depressive thinking patterns and interpersonal relationships. Research indicates group treatments increase self-esteem, social contact and perceived support lead to a reduction in levels of depression and associated symptoms (Evans & Connis, 15; Piper, McCallum, & Azim, 1, as cited in Rice, 001). However group treatment may be unsuitable for uncooperative clients and those who cannot work with others. Furthermore, depressed clients are often unmotivated to attend group therapy and may need pharmacotherapy to relieve depressive symptoms. Group treatment is therefore an effective treatment for depression, but further research needs to look at a wider cross-section of the population and include follow-up research for short-term or long-term effectiveness.

Studies agree Psychotherapy, Pharmacotherapy and Group treatments are effective modalities for depression. Psychotherapy whether individual or group treatment offers client-healing relationships, encourages client insight and change from maladaptive thoughts, feelings and behaviour (Feldman & Feldman, 17). However, individual (psychotherapy) and group treatments are best suited to low or moderate depression. Nevertheless effectiveness is dependent on client choice and suitability. Pharmacotherapy is an effective approach to the treatment of depressive symptoms. However, given the negative side effects pharmacotherapy is suitable for short-term treatment furthermore does not address underlying psychological factors. Therefore the best approach would be an integration of psychotherapy or group treatment and pharmacotherapy, as the strengths of each approach strengthen and enhance the potency of the others (Feldman & Feldman).

References

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pharmacotherapy in the treatment of depression. In Session Psychotherapy in Practice, , -8.

Kennedy, S. H., Raymond, R. W., Cohen,N. L., Ravindran, A. V., Canadian network

for mood and anxiety treatments (001). Clinical guidelines for the treatment of depressive disorders IV. Medications and other biological treatments. The Canadian Journal of Psychiatry, 46, 8s-58s. Retrieved from EBSCOhost Database (AN 475508).

Mundt, J. C., Clark, G. N., Burroughts, D., Brenneman, D. O. and Griest, J. H. (001).

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Olfson, M., Marcus, S. C., Druss, B., Elinson, L., Tanielian, T. and Pincus, H. A.

(00). National trends in the outpatient treatment of depression. JAMA,

The Journal of the Americal Medical Association, 87, 1-15, Retrieved from Infotrac database.

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