Treating Depression - Essay Example

TREATMENT OF DEPRESSION Introduction: Mental problems are a growing concern for the people in the modern world. It has been noticed that mental problems, such as depression and anxiety have over taken unemployment as the biggest social problem in the United Kingdom. Economically depression is a huge burden for the government. An estimated 15% of the UK population suffers from mental disorders such as depression, which costs the government around £ 17 billion or 1.5% of the GDP. Further estimates suggest that around 800,000 depression patients need treatment per year. With the passing years the mental problems are increasing which means that more therapists would be needed to treat the patients (Bosley, 2006). Therefore it would be pertinent to discuss the nature and treatment of the disorder in this paper. What is Depression? “Depression can be defined as a mood disorder in which individuals experience extreme unhappiness, lack of energy and several other symptoms” (Baron, 2006). Mood swings are a common phenomenon experienced by almost everyone. However, for some people the changes in mood brings changes in their emotional states that is much more extreme and prolonged. “Their highs are higher, their lows are lower, and they spend most time in these states than most people”. Such people are known as depressed (Baron, 2006). Depressive people have often reported feeling “run down”, having no strength or concentration and nothing that could cheer them up. If such a condition continues for two weeks and interferes with ones daily life then such a person can be declared clinically depressed. In some people symptoms of depression may come before the beginning of the full episode of depressive behavior (www.help-for-depression.co.uk). The symptoms of depression are different in every individual. It is very essential to understand the symptoms before the disorder worsens the situation beyond one’s control. Symptoms of depression: Psychologists believe that certain criterion needs to be fulfilled before a person can be declared depressed. Firstly, depressed persons feel extremely unhappy and remain in such a state for a long time. Secondly, psychological studies indicate that depressed persons lose interest in all the usual pleasures of life such as eating, sports, hobbies and sex etc. Thirdly, depressed persons often experience significant weight loss or gain (Baron, 2006). Other symptoms of depression include tiredness or no feeling, loss of strength; sleep disturbances, feelings such as hopelessness, helplessness, guilt or uselessness and thoughts about deaths and suicides. Some other symptoms also include inability to focus or making decisions and inability to keep a track of things. Other psychologists have also linked restlessness, crying, irritation and other chronic pains with symptoms of depression (Argyle, 1990). Any person who experiences five or more of these symptoms at a time during a period of two weeks is classified by the DSM-IV as undergoing a “major depressive episode” (Baron, 2006). Causes of Depression: Depression is a very common problem in the modern world. The statistical analysis of the people suffering from depression show that approximately 21.3% of women and 12.7 of men experience depression at some in their life. Females appear to experience depression more often than men. Among females, the major causes of depression are the traditional low status, power and income as compared to males. At the same time sexual harassments and assaults also become a major source of depression. Women tend to remember such incidents more often then men due to which they fall into depression more often (Baron, 2006). Biological Causes: Depression is a hereditary problem and is capable to run in the family. It is believed that depression is “four times more likely to occur in both members of identical twin pairs than in both members of non-identical twin pairs”. Convincing evidence suggests that genetic factors play a much major role in bipolar depressions (Baron, 2006). Disturbances in brain biochemistry also cause depression. A normal brain controls all the major activities of the body such as heart activity or movement etc. Messages are received and sent by the brain chemicals called neurotransmitters. Depression occurs when the brain chemicals are not able to communicate the messages properly between the brain cells (www.help-for-depression.co.uk). Two neurotransmitters, norepinephrine and serotonin are found in low levels in the brain of a depressed person when compared to the non-depressed person (Baron, 2006). Psychological Factors: The psychologists have identified a number of psychological factors that cause depression. One such source is the helplessness or the individual’s own belief of helplessness. This belief enables a person to believe that he has no control over his or her own situation. Such views often end up in making a person depressive (Baron, 2006). Negative views about oneself also cause depression. Depressive people often possess negative self-image and doubt their own abilities. They also tend to be highly sensitive to other people’s criticism. These people develop a habit of viewing things negatively, which further strengthens their negative beliefs. Distorted thinking make it difficult for such people to view things in the light of reality. As a result of which such people begin to view themselves as worthless and inappropriate for situations and fall into depression (Baron, 2006). Increased self-awareness is another cause of depression. Such people become introvert and often think about gaps between their present situation and future goals. Mostly people respond to such situations by adjusting their goals. However, depressive people torture themselves with self-criticism, which eventually takes them deep into depression (Baron, 2006). Types of Depression: Depressions are of different types. They are mentioned as follows: Clinical Depression: Clinical or major depression is a psychological term used to describe such people who experience symptoms related to depression. Although it is a psychological disorder but 80% of people are able to find relief once they begin the treatment (www.help-for-depression.co.uk). Dysthymia: It is a less serious type of depression but occurs for a long time. People who experience dysthymia have reported long lasting symptoms. The symptoms include sadness for 2 to 3 days, insomnia, and feelings of despair, negative thoughts and low confidence. Other physical symptoms include headaches, dizziness, laziness and problems related to digestive system. Appropriate medical help is essential before the disorder gets beyond control (www.help-for-depression.co.uk). Mood Swings: Mood swings are very commonly experienced by almost everyone. Occasionally a person feels depressed, tired and irritated. Although it is not bipolar disorder still the symptoms are almost the same. Up swings include increased excitement, irritability and strength. On the other hand, down swings include sleep disturbances, social aloofness, depression and laziness. Once again timely treatment is essential before the problem gets beyond control (www.help-for-depression.co.uk). Bipolar or Maniac Disorder: In this classification of depression, the patients feel extreme and prolonged swings in the mood. The ups in the mood are called mania and downs are called depression. In up swings of their mood, maniacs are euphoric, energetic and self-confidant. They love to gain attention of others by their outrageous stories. They do not accept criticism from others. When depressed, maniacs experience symptoms common to depression such as sleeplessness, pondering over death and negative thinking. If such mood swings continue for two weeks a person is then declared to be having bipolar disorder (Argyle, 1990). Cyclothemia: Cyclothemia is a less severe form of bipolar depression in which the mood swings from less severe form of mania to less severe form of depression. Cyclothemia is not as serious as bipolar disorder still it can affect the working, family and social life of the individual (www.help-for-depression.co.uk). Seasonal Affective Disorder: The people experience Seasonal Affective Disorder (SAD) usually in a fixed time of the year. In most cases people experience SAD during autumn or winter seasons. Although the reason for SAD is unknown it is believed by the psychologists that during winter the less hours of daylight disturbs the biological working of the body, which further disturbs the circadian rhythms of the body. The symptoms of SAD are similar to that of normal depression (www.help-for-depression.co.uk). Post Natal Depression: Approximately 10-15% of women experience depression within the first year of childbirth. It is called postnatal depression. Women feel curious, disturbed and tearful. They often find it difficult to make a bond with their babies. Psychologists attribute various psychological, biological and social reasons for the cause of postnatal depression (www.help-for-depression.co.uk). Treatment: Depression can be cured if the treatment is followed sincerely. There are a number of methods used by the psychiatrists for the treatment of mild to severe depression. Psychotherapies: A number of psychotherapies have been proven clinically effective for the treatment of depression. The most successful one, however, is the Cognitive Behavior Therapy. Beck’s Cognitive Behavior Therapy has been designed to change the distorted thoughts of the individual that causes depression. The distorted thoughts often produce depressing mood, which further increases the possibilities of more negative thoughts. Cognitive Behavior Therapy focuses to break this circle of negative thoughts in order to bring the person out of depression (Baron, 2006). The role of the therapist is very important in understanding the nature of the patient’s thoughts. Working with the patient the therapist carefully turns his negative thoughts into positive ones. For example, if a person thinks of himself to be a total failure, the therapist can ask him to talk about such incidents in his life where he has achieved success. This technique can make the patient realize that he has not been a total failure, which in turn can bring a positive change in his mood (Baron, 2006). A number of studies have been carried out to prove the effectiveness of CBT over other psychotherapies. To confirm its efficacy 274 patients with symptoms of depression were treated with CBT for six months. Results showed that CBT improved the mood of the patients by minimizing the negative thoughts, their severity and duration. The patients also reported improvement in their work and social life. The study thus confirmed the efficacy of CBT for the treatment of depression (Proudfoot, 2004). Electroconvulsive Therapy: Electroconvulsive therapy is a procedure that involves the application of electrodes on the head region to cause a convulsion. The therapy is done under general anesthesia. Although this therapy is not widely used still in UK approximately 11,000 patients use it annually to treat depression. Approximately 8 out of 10 patients report positive effects after receiving therapy. They reported that they felt confident themselves again and realized the worthiness of life. However, the patients who received electroconvulsive therapy have reported some side effects, such as memory loss. To evaluate the efficacy of the therapy, an exhaustive review of the patient feedback was carried out. The feedback indicated that 80% of the patients believed that the electroconvulsive therapy was beneficial in the treatment of depression (Rose et al. 2003). Interpersonal Therapy: Interpersonal Therapies aims to focus on the client’s maladaptive interpersonal styles i.e. actions that forces other people to adopt a particular behavior towards the patient which in turn initiates his maladaptive behavior (Baron, 2006). IPT acts as a medium for understanding and curing people with depression. Research has shown that Interpersonal skills have been useful in treating the postnatal depression in women. Several randomized placebo controlled trials indicate that Interpersonal therapies when properly implemented play an important role in minimizing the symptoms of postnatal depression and four other types of depression. Research further indicates that there is some relationship between mother-child interaction and postnatal depression, although it is not the cause of depression (McGrath et al., 2003). Pharmacotherapy: A number of drugs have been proved effective in the treatment of depression. The most prominent ones being tricyclic anti depressants such as dothiepin, imipramine, amitryptyline. These medications are prescribed for the treatment of mild to severe depression. Their effectiveness can be noted after a period of two weeks. Some side effects have been reported with the above-mentioned medication. It is thus important to take doctor’s advice and avoid self-medication (www.help-for-depression.co.uk). Lithium carbonate acts as a mood stabilizer and is prescribed to the patients with bipolar disorder. Meta analysis suggests the efficacy of lithium for the treatment of depression. Lithium was clearly more effective for the treatment of bipolar mental disorders. Controlled studies for a period of 5 months to three years also indicated the efficacy of lithium when compared with placebo. Lithium has significantly showed 70% effectiveness in the treatment of bipolar disorders. The efficacy of lithium in the prophylaxis of unipolar depressive illness also cannot be ignored (Souza and Goodwin, 1991). The most commonly used drugs for depression are most commonly known as SSRIs (Selective Serotonin Reputake Inhibitors) and SNRIs. The most common anti depressant drugs are fluoxetine (Prozac) and Seroxat. They have the capability to stabilize the important chemical messengers in the brain (www.help-for-depression.co.uk). Phytomedicinal Treatment: Phytomedicinal treatment includes different plants that have been proved effective in the treatment of depression. Some are mentioned below: St. John’s Wort: St. John’s wort has proved to be as effective as any other anti depressant drug for the treatment of depression. A number of clinical trials have proved the efficacy of St. John’s wort. Some essential anti depressant chemicals such as hypericin, hyperforin and pseudohypericin are found in the plant, which help a patient in relieving depression. Clinical studies have proved that the plant is useful for the treatment of mid to severe depression (www.help-for-depression.co.uk). In a clinical trial 251 adult outpatients with severe major depression were treated with hypericum extract (St. John’s wort) and paroxetine. Patients were given measured doses of 900 mg/day of hypericum extract thrice a day or 20 mg of paroxetine once a day for six months. The results showed that in the treatment of mild to severe depression St. John’s wort was as good as paroxetine (Szegedi et al., 2005). 5- HTP (Hydroxtryptophan): 5-HTP is an amino acid, which passes into the brain and is converted into serotonin. Another cause of depression is the low serotonin level. Many anti depressants such as Prozac, Paxil, Luvox and Zoloft increase the serotonin level and reduce the depression symptoms. Normally a dose of 50-300 mg of 5-HTP per day helps in relieving depression after a couple of weeks (www.help-for-depression.co.uk). Bibliotherapy: Bibliotherapy is a new method that has been adopted by the doctors of the treatment of mild to severe depression. The new method has been chalked out of the growing concerns among the doctors that too many depressed patients are either treated with medicines or remain untreated. Under the new program of “bibliotherapy” the doctors prescribe books and other reading material to the patients that help them in understanding their own situation. In the United Kingdom, bibliotherapy has been used for the treatment of thousands of patients. The self-help books are discussed with the patients and their applicability is also understood. Psychologists have notices a significant improvement in the symptoms of depression due to bibliotherapy. Research has shown that bibliotherapy does play a major role in reducing the symptoms of depression. In a randomized controlled trial 525 individuals with severe symptoms of depression were advised to study two internet websites that provided information on depression and way to cure it. Detailed information on Cognitive Behavior Therapy and psycho education was provided to the participants through the websites. The participants reported a change in their abnormal thoughts, symptoms of depression and lifestyle. It was concluded that psycho education received through printed material is effective in minimizing the symptoms of depression (Christensen et al., 2004). Conclusion: In conclusion, depression is a growing concern for the psychiatrists as the number of patients is increasing everyday. Depression is curable no matter how dangerous the symptoms are. The only thing that the patient needs to understand is the proper and timely treatment. Medication, psychotherapies and self-help have been proved scientifically effective for the treatment of depression. It is very important to consult a doctor for medical advice before the disorder becomes unbearable. References Argyle, Michael. (1990). “Social Behavior and Mental Disorder”, The Psychology of Interpersonal Behavior, Fourth edition, Penguin Books, UK. Pg. 218-220. Bosely, Sarah. (April 28, 2006). “Depression is UK’s biggest health problem, government told”, The Guardian, Retrieved on November 18, 2006 from http://politics.guardian.co.uk/economics/story/0,,1763419,00.html Baron, Robert A. (2006), “Mood Disorders: The Downs and Ups of Life”, Chapter 14 Mental Disorders: Their Nature and Causes, Psychology, Fifth edition, Pearson Education Inc. London, UK. Pg. 549-551. Christensen, Helen., Griffiths, Kathleen M., Jorm, Anthony F., (2004). “Delivering interventions For Depression by using the Internet: randomized controlled trial”, The British Journal of Psychiatry, 187, 456-461. McGrath, P.J. Elgar, F.J., Johnston, C., Dozois, D.J.A., Reyno, S. (2003). “Treating Maternal Depression?”, The British Journal of Psychiatry, 183: Pg. 461-462. Proudfoot, Judith. (2004). “Clinical efficacy of Computerized Cognitive Behavior Therapy for Anxiety and Depression in primary care: randomized control trial”, The British Journal Of Psychiatry, 185. Pg. 46-54. Rose, Diana. Fleischmann, Pete. Wykes, Til. Leese, Morven. Bindman, Jonathan. (June 21, 2003).“Patients perspectives on electroconvulsive therapy: systematic review”, British Medical Journal, 326: Pg.1363-1367. Souza FG, Goodwin GM. (1991). “Lithium Treatment And Prophylaxis In Unipolar Depression: A Meta-Analysis”. British Journal of Psychiatry, 158. Pg. 666-675. Szegedi, A., Kohnen, A., Daniel, A., Kieser, M. (March 5, 2005), “Acute treatment of moderate to severe depression with hypericum extract WS 5570 (St Johns wort): randomised controlled double blind non-inferiority trial versus paroxetine.” British Medical Journal, 330: pg: 503-506. “What is Depression” (n.d.), Help For Depression. Retrieved on November 18, 2006 from http://www.help-for-depression.co.uk/ Read More