Treatment Alternatives of Clinical Depression - Essay Example

Psychology Disorders Clinical Depression: A Review of Treatment Alternatives   Clinical Depression or Major Depressive Disorder is one of the more prevalent of mental illnesses, with approximately 20 – 25% of the population experiencing some symptoms of depression as some point in their lives (Barlow, 2005). At any given point, between 6 – 7% of the adult population in the United States of America suffers from depression and may need treatment (Barlow, 2005). This makes Depressive disorders an important issue that needs to be studied and understood in detail. An individual suffers from depression due to one or more of a number of reasons. These causes span and combine biological, psychological and social concerns; and include reduced neurotransmitter activity in the brain. Serotonin, norepinephrine and dopamine are among the primary neurotransmitters implicated in depressed behavior (Nutt, 2008), and reduced levels of these hormones are associated with lowered mood and energy, a lack of interest, and increased anxiety and distress (Nutt, 2008). Reasons postulated for lowered levels of hormones are genetic reasons, increased environmental stress and interaction theories that postulate that there is an interaction between genetic predispositions and environmental factors that lead to lowered levels of neurotransmitters (Barlow, 2005). Other theories favor environmental causes; and a number of psychological theories have attempted to explain depression as occurring due to triggering factors like adverse or stressful events, combined with lower resilience, and inadequate coping style (Raphael, 2000). The work of Bandura, Ellis, Freud, Beck and others has resulted in a number of hypotheses for depression, and consequently, to treatment measures that would prove effective with individuals coping with depression (Barlow, 2005). A number of these hypotheses attempt to explain depression as being a result of interactions between historical factors contributing to vulnerability and stressful life events or circumstances, or as being the byproduct of the inability to achieve goals and provide meaning to life events (Barlow, 2005). Social theories focus on concerns like abuse, isolation and lack of resources along with stress causing factors as being among the triggering factors for depressive episodes. Major Depressive Disorder manifests itself through a number of possible symptoms. Symptoms essential to the diagnosis of depressive disorders include significant periods of lowered mood or reduced interest in activities that were previously considered interesting (APA, 2000). Other symptoms include (APA, 2000) • Fatigue and/or loss of energy on an everyday basis • Consuming feelings of worthlessness or guilt on an almost daily basis • Reduced concentration and impaired decisiveness and increased anger. • Either Insomnia or hypersomnia on a regular basis • Reduced interest or pleasure (anhedonia) in everyday activities, as well as events considered enjoyable before. • Restlessness or a feeling of being slowed down or being leaden. • Recurring thoughts of death or suicide • Weight loss or gain of more than 5% within a period of a month. Not all depressed individuals show all symptoms; and the diagnosis requires that the individual exhibit at least five of these symptoms including a lowered mood or reduced interest for a minimum of two weeks (APA, 2000). The closer the diagnosis is to the onset of symptoms, the easier it is to treat the individual effectively. A number of treatment options are possible, including pharmacological treatments, psychological treatments and other experiential treatments. Most pharmacological treatments attempt to replace neurotransmitters or block receptors so that the levels of the neurotransmitters in the brain increases to required levels. The different compounds typically used in the treatment of depressive symptoms include Selective serotonin reuptake inhibitors, Serotonin and norepinephrine reuptake inhibitors, Noradrenergic and serotonergic antidepressants, Norepinephrine-dopamine reuptake inhibitors, serotonin reuptake enhancers, Norepinephrine reuptake inhibitors, Tricyclic antidepressants and Monoamine oxidase inhibitors (Barlow, 2005). Of the various treatment options, Selective serotonin reuptake inhibitors or SSRI’s are among the most commonly used treatment option (Nutt, 2008). These medicines have been developed on the assumption that depression is a result of reduced levels of Serotonin in the brain, which inhibits the effective relay of signals within the brain. The SSRI’s work by inhibiting the reuptake of the neurotransmitter by a presynaptic neuron (Nutt, 2008). This results in higher levels of serotonin in the synapses; and thus in time increases the levels of serotonin in the brain. Systematic research has shown that the SSRI’s show fast and consistent results, and often shows a significant effect within a week of beginning medication. They are significantly more likely than traditional modes of treatment to bring about a reduction in symptoms as gauged by the Hamilton rating Scale for Depression (Taylor, Freemantle, Geddes and Bhagwagar, 2005). These medicines have been found effective with different subject groups and are also easy to deliver for both hospital and individual use (Frazer, Christensen and Griffiths 2005). The SSRI medications do cause a number of possible side effects like increased or decreased appetite, drowsiness, dry mouth, reduced sexual desire, weight gain, anxiety and weight gain (Nutt, 2008). For most individuals, these symptoms are mild and temporary, though for some individuals they may persist over a longer period of time. SSRI’s have a high success rate, and tend to have lesser and less intense symptoms as compared to Tricyclic antidepressants and Monoamine oxidase inhibitors (Nutt, 2008). Individuals who do not respond to SSRI’s can be easily shifted to other kinds of medication, a step that is often met with success. New research has shown that although the SSRI medicines are effective, the hypothesis upon which they are based may not be accurate. There are doubts about the nature of the link between reduced serotonin and symptoms of depression; and there is also a concern that the drugs may interact with other factors leading to addiction and possibly obesity (Taylor, Freemantle, Geddes and Bhagwagar, 2005). This concern is held up by the high possibility of relapse shown by some studies. Other treatment possibilities include Psychological treatments like REBT, CBT, Psychodynamic therapy and other techniques like mindfulness therapy and interpersonal psychotherapy (Barlow, 2005). These therapies are developed on the hypothesis that there are significant events in the individual’s present or past that cause the individual to experience depressed mood and other symptoms. Resolution of the issues and concerns of the individual results in better mood, as well as increased self acceptance and self esteem (Beck, Rush, Shaw and Emery, 1987). Depression is typically manifest through negative thoughts and emotions that affect the way the individual perceives themselves as well as others around them. A depressed individual experiences a lot of anger or guilt that is directed inwards, and is likely to experience low self esteem (Barlow, 2005). Often, such people become extremely sensitive to feedback, and believe that each mistake they make is a glaring example of their worthlessness. They are afraid of losing those close to them, and may inadvertently distance the same individuals through behaviors that are associated with this fear (Beck, Rush, Shaw and Emery, 1987). Given this background, it becomes necessary to help an individual coping with depression to examine and reorganize their thoughts and feelings. Cognitive Behavioral therapy or CBT is a useful method that helps an individual reassess the validity of their thoughts and opinions. Cognitive Behavioral Therapy is based in the work of Aaron Beck, and emphasizes a focus on developing a rational view of events as well as the learning of cognitive and behavioral habits that help the individual assess their own experiences in a realistic manner (Beck, Rush, Shaw and Emery, 1987). According to Beck, depressed individuals develop a set of negative schemata of their self and the world and hold certain cognitive biases against themselves like magnification, over generalization, and selective abstraction. These biases and schemas fuel each other and form a never-ending circle. Through the use of CBT, the individual can be helped to asses these schemas and biases, and review them in context to the way they view other people and events that are distanced from themselves in order to establish a more rational framework of assessment (Cooper, 2008). They are helped to reframe opinions and requirements that they have about themselves and the world, and in consequence, to change the way they view themselves and others. CBT works on the rationale that negative thoughts and biases feed negative emotions and provide a reduced opportunity to experience positive emotions (Cooper, 2008). An individual with biases against the self and a negative schema of experiences predominantly experiences guilt, anger, shame and other negative emotions. Through the restructuring of these thoughts, it is possible to help the individual allow themselves to experience more positive feelings like pride, happiness and satisfaction. They are also able to assess mistakes and weaknesses more realistically (Cooper, 2008) and thus feel less guilt for the same. Reducing the opportunities for experiencing negative feelings and increasing those for experiencing positive feelings helps elevate the depressed mood. Research has found that CBT when used alongside pharmacological treatment has a significantly higher (73%) success rate; and even when used in the absence of medicines provides relief to over half of those who opt for CBT alone (Keller, McCullough and Klein, 2000). Although the success rates are lower and more gradual for CBT administered alone, it is nevertheless a valuable tool for treating Depression (Frazer, Christensen and Griffiths 2005), and has been documented by the APA as the most effective Psychotherapeutic tool in treating Major depressive Disorder(APA, 2000). Although pharmacological and psychological treatments are widely available and enjoy considerable success; a number of individuals are cautious of availing them. The main concerns against the use of pharmacological treatments is the possibility of addiction and other side effects that could inhibit the daily functioning of the individual(Barlow, 2005). People also hold many biases against psychological treatments, particularly about the speed at which results are seen, the cost and the social stigma associated with taking psychological help. At such times, people are likely to explore alternative treatments like herbs, aromatherapy, acupuncture, meditation and several others that aim at providing the user with a holistic experience that helps dispel negative thought and emotions and replacing them with positive ones(Barlow, 2005). One of the alternative treatment methods that has found some acceptance from medical professionals through empirical research is Meditation, and in particular, Mindfulness meditation. This method of meditation combines focusing on a single, (usually positive) word or phrase with breathing techniques that help in achieving relaxation (Segal, Mark, Williams, and Teasdale, 2002). The individual is required to sit comfortably and breathe deeply as they focus on the chosen word or phrase. The deep breathing causes physiological changes like lowered heart rate and pulse, increased flow of endorphins and reduced anxiety. Research done on the effects of meditation are mixed, and it has been found most effective in the maintenance of remission then in actual treatment (Segal, Mark, Williams, and Teasdale, 2002). Meditation helps in relaxing the mind and reduces the experience of anxiety. It helps in developing a mental state where the individual is more accepting of positive thoughts and the repetition of these thoughts during meditation helps to internalize them (Segal, Mark, Williams, and Teasdale, 2002). Based on the results of a number of studies, it becomes apparent that Major depressive disorder and other forms of depression are caused by the interaction between biological and environmental factors (Barlow, 2005). It is as important to help the individual regain a chemical balance in the brain, as to help him/her gain a realistic and sustainable view of themselves and their life experiences. It is also essential to help the individual maintain the newly acquired state and internalize the thoughts that help them maintain a realistic view of life. Thus, it becomes important to assess the reasons for the individual’s depressive episode. Careful pharmacological treatment with minimum dose SSRI’s will help in reducing the chemical imbalance in the brain, and help in achieving a stable emotional state in a shorter timeframe. Using a minimal dose also reduces the side effects the person experiences and the chances for addiction to set in over the period of treatment. But relying only on pharmacological treatment will not help, as research shows that there are life experiences that trigger the advent of depressive symptoms. These events can leave a long term effect on the persons thinking process, and cause relapses through increased stress and distress. Thus, in order to help the person achieve long-term resolution, it is important to help them review their experiences, reassess their thoughts and learn new ways of evaluating their experiences. Using CBT in combination with SSRI’s will allow for the highest possibility of success. A treatment structure that requires the individual to take medication that is reviewed constantly alongside regular CBT sessions would help counter both the biological as well as the psychological effects of Depression. Meditation may be used as a maintenance technique that helps in internalizing the perspective that is gained during CBT sessions. While these are not the only treatment measures available for Depression, they are among the most effective. It is important to understand the experiences of the individual before choosing to use these or other modes of treatment, as the same treatment may not be effective with everyone. Some people may not respond to SSRI’s, and other medication may be more effective with them, while others may not be ideal candidates for CBT, and REBT or Interpersonal Psychotherapy among others may be more suited for particular persons. All these factors need to be taken into consideration when deciding on a treatment plan for any particular individual. References American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR, American Psychiatric Pub. American Psychiatric Association Practice. (2000). Guideline for the treatment of patients with major depressive disorder, (2nd Ed.). American Psychiatric Association. Barlow, D.H. (2005). Abnormal psychology: An integrative approach (5th Ed.). Belmont: Thomson Wadsworth. Beck, A.T., Rush, J., Shaw, B.F., Emery, G. (1987) Cognitive Therapy of depression. New York: Guilford Press. Cooper, M. (2008). Essential Research Findings in Counselling and Psychotherapy: The Facts are Friendly. New York: Sage Publications. Frazer, C.J., Christensen, H., and Griffiths, K.M. (2005). Effectiveness of treatments for depression in older people. Medical Journal of Australia. vol. 182: pp. 627–632. Keller, M.B., McCullough, J.P., and Klein, D.N. (2000). A comparison of nefazodone, the cognitive behavioral-analysis system of psychotherapy, and their combination for the treatment of chronic depression. New England Journal of Medicine. Vol. 342 (20): pp. 1462–1470. Nutt D.J. (2008) Relationship of neurotransmitters to the symptoms of major depressive disorder. Journal of Clinical Psychiatry. Vol. 69 (E1): pp. 4–7. Raphael, B.(2000). Unmet Need for Prevention. In Andrews, G., Henderson, S. (eds). Unmet Need in Psychiatry: Problems, Resources, Responses. Cambridge: Cambridge University Press. Segal, Z.V., Mark, J., Williams, G., and Teasdale, J.D. (2002). Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse. New York: Guilford Press. Taylor, M.J., Freemantle, N., Geddes, J.R., and Bhagwagar, Z. (2005). Early Onset of Selective Serotonin Reuptake Inhibitor Antidepressant Action: Systematic Review and Meta-analysis. Arch Gen Psychiatry. Vol. 63 (11): pp. 1217–23. Read More