Depression, Addiction and Schizophrenia - Assignment Example

Part A. Questions about Disorders Depression is one of the most treated psychological complaints, as a component of disorders such as major depression or bipolar disorder. Discuss the utility of medical, pharmacological, and psychological treatments (Natalia’s presentation). Is there a danger of treating depression that may not be correctly diagnosed as such? Why? The medical approach to depression is valuable in improving the accuracy of diagnosing depression. It involves the use of medical tests for proper diagnosis and for ruling out other illnesses. Some of these medical tests are: (1) Complete blood cell count; (2) Thyroid-stimulating Hormone (TSH); (3) Liver function tests; (4) Blood alcohol level; (5) Dexamethasone suppression test (Cushing’s); and (6) Cosyntropin stimulation test (Addison’s) (Ivanovski, Major Depressive Disorder Presentation, slide 18). In the case study of Ivanovski (2014), it is important to rule out the following medical problems that can have the same symptoms as depression: (1) Infection (Lyme disease, HIV, encephalopathy, mononucleosis, and syphilis); (2) Inflammatory-rheumatic conditions (lupus); (3) Endocrinological disorder (Cushing syndrome, Addison disease, hypothyroidism, and hyperthyroidism); (4) Tumor; (5) Neurological disorder; and (6) Sleep apnea – polysomnography (Major Depressive Disorder Presentation, 2014, slide 17). For instance, my friend’s mother thought that she had depression because of weight loss and loss of energy and appetite, when, in reality, she had brain tumor (Desrocher, 2014b, Depression and Bipolar Disorders Presentation, slide 6). Fortunately, her doctor made the right diagnosis. The medical approach can accurately take out these related illnesses through conducting different medical tests that can result to a correct diagnosis for depression. Nevertheless, there is danger in treating depression that is not correctly diagnosed through the medical approach because it results to a pharmacological intervention and this intervention includes changing brain chemicals (Hickie & Scott, 2007, p.9). If the patient is diagnosed as having depression, when she has a neurological disorder, for instance, providing anti-depressant drugs may harm the patient’s health. This approach can subsequently result to worsened illnesses or even to actual depression, once the incorrect treatment creates further psychological, mental, and/or physiological changes. An example is when my aunt was incorrectly diagnosed as having depression, and the anti-depressant drugs had side effects of energy changes and suicidality on her (Ivanovski, Major Depressive Disorder Presentation, slide 24). Incorrect diagnosis of depression can have harmful consequences on patients. Depression must be correctly diagnosed to avoid inappropriate medications and therapies. Furthermore, the medical approach is also valuable in addressing medical illnesses that are related to depression. In Annie’s case, the noted drug treatment for her was Buspirone with a TCA or SSRI (Ivanovski, Major Depressive Disorder Presentation, slide 35). SSRIs stop the reabsorption of serotonin which can uplift the moods of depressed patients, while Buspirone can reduce anxiety (Ivanovski, Major Depressive Disorder Presentation, slide 35). My cousin who had depression took Citalopram which she said helped improve her mood, while Buspirone calmed her more during her “rough days,” as she would say. The medical approach provides drug treatments that can alleviate the symptoms of depression. The pharmacological approach is connected to the medical approach, and the former can be essential in treating the medical causes of depression. Some of the medical causes of depression are: (1) Low thyroid function; (2) Brain injuries and diseases (e.g. stroke, head injury, epilepsy, Parkinson’s disease); (3) Some forms of cancer; (4) Infectious diseases; (5) Blood vessel disease in the brain due to diabetes and/or hypertension; (6) Some steroid and hormonal treatments; (7) Chronic pain; and (8) Poor physical health due to smoking, obesity, lack of exercise (Hickie & Scott, 2007, p.6). Specific drugs can deal with these medical causes. Furthermore, Hickie (2005) observed that brain changes go along with untreated depression (as cited in Hickie & Scott, 2007, p.6). Frontal and subcortical brain changes are connected with the period of the untreated illness (Hickie & Scott, 2007, p.6). Medical research suggests that depression is connected with particular changes in the chemical message systems of the brain (serotonin, noradrenaline, dopamine) (Hickie & Scott, 2007, p.19). Antidepressant medication, by changing hormonal levels or returning them to normal levels, can rapidly alleviate the symptoms of depression, such as poor sleep, anxiety, tiredness, poor appetite, poor concentration, and agitation (Hickie & Scott, 2007, p.19). In Annie’s case, some possible pharmacological treatments are SSRIs (e.g., Citalopram [Celexa], Fluoxetine [Prozac], Paroxetine [Paxil]), SNRIs (e.g., venlafaxine [Effexor]; desvenlafaxine [Pristiq]), Atypical antidepressants (e.g., bupropion [Wellbutrin], mirtazapine [Remeron]), Monoamine oxidase inhibitors (e.g., isocarboxazid [Marplan]; phenelzine [Nardil]), or St. John’s Wort (Ivanovski, Major Depressive Disorder Presentation, 2014, slides 24-25). Though drug treatments can be effective in addressing hormonal changes and alleviating the symptoms of depression, some studies showed that SSRIs are not effective in treating many mild and moderate cases of depression (Ivanovski, Major Depressive Disorder Presentation, 2014, slides 26). If this is the case, a patient who receives SSRIs for treatment and do not experience benefits may be at risk for developing more severe depression. Thus, it is critical to prescribe the right medication for people with depression. Besides the pharmacological approach, psychological treatments tend to be popular and more acceptable to patients with depression because they do not involve drugs that may have side effects, or because they might see drugs as ineffective in dealing with their depression (Hickie & Scott, 2007, p.19). Depressed people often feel numbness and loss of concentration and energy, so they need to find sources of inspiration in becoming more positive-minded and to find pleasure in usual activities once more (Ivanovski, 2014, Major Depressive Disorder Presentation, 2014, slide 9). Psychological treatments are effective in helping people recover from depression and preventing its recurrence by helping people examine and change negative thoughts and feelings through therapies and activities that can inspire self-made changes in perspectives about life (Hickie & Scott, 2007, p.12). Each therapy provides an approach on modifying activities, feelings, and thoughts that can improve recovery and avert relapse, such as behavioral therapies that include stress management, sleep-wake cycle management, activity planning, and other activities that can compose problem-solving and cognitive therapy programs (Hickie & Scott, 2007, p.12). There are different kinds of psychological therapies that can help patients deal with depression. Cognitive behavioral therapies (CBT), for instance, can help patients determine and examine negative thought processes (Ivanovski, Major Depressive Disorder Presentation, 2014, slide 27). CBT teaches patients to oppose unhelpful schemas with balanced refutation (Socratic questioning) (Ivanovski, Major Depressive Disorder Presentation, 2014, slide 27). Another example is interpersonal psychotherapy. This therapy helped a friend of mine who had depression because she said she found extreme difficulty in maintaining close relationships. Interpersonal psychotherapy enhanced her communication and interpersonal skills that helped her improve how she saw herself and how she related with others (Ivanovski, Major Depressive Disorder Presentation, slide 31). These are examples of how psychological treatments provide tools and skills for patients to handle specific symptoms and feelings/behaviors that make them feel depressed. 2. What are the key centres of the brain involved in addictive behaviours? Do you think this pathway explains non-drug addictions (Rob’s presentation). There has been a move away from solely relying on medical means of treating addictions, toward more a holistic approach. What do you think has spurred this change and do you think these other modalities hold promise? The brain lists all pleasures in a similar manner, whether they come from drugs or other addictive behaviors. It has a reward pathway that involves the ventral tegmental area (VTA), the nucleus accumbens, and the prefrontal cortex (Caratun, 2014, Gaming Addiction Presentation, slide 5). A rewarding stimulus, such as food or water, sends information from the VTA to the nucleus accumbens and then to the prefrontal cortex. The brain has a specific signature for pleasure through the release of the neurotransmitter dopamine in the nucleus accumbens, which refers to a group of nerve cells lying beneath the cerebral cortex (Caratun, 2014, Gaming Addiction Presentation, slide 4). Dopamine release in the nucleus accumbens has been connected with pleasure for a long time that neuroscientists already call this part as the brains pleasure center (Harvard Health Publications, 2011). Abused drugs, for illustration, act on the pleasure center. They create a powerful production of dopamine in the nucleus accumbens. The chances that using the drug or doing a specific activity (i.e. Internet addition, gaming addiction, and the like) creates addiction that are connected with the speed that it results to dopamine release and the dependability of that release (Harvard Health Publications, 2011). Recent research further showed that dopamine both contributes to experiencing pleasure and influencing learning and memory, the latter effect being critical to liking something enough to be addicted to it (Caratun, 2014, Gaming Addiction Presentation, slide 6; Young, 2007, p.672). Internet addicts, for instance, learn that their Internet activities provide relief from anxiety and agitation in their lives, which is pleasurable, so learning this reinforces their belief that Internet and pleasure are connected (Young, 2007, p.672). Addiction feeds the pleasure center, although not in healthy ways, since they overload it. In a new theory in addiction, dopamine interrelates with another neurotransmitter, glutamate, to control the brains system of reward-related learning (Harvard Health Publications, 2011). This system has a critical function in sustaining life because it connects activities required for human survival (i.e. eating) with pleasure and reward (Harvard Health Publications, 2011). The reward circuit in the brain covers parts that are concerned with motivation and memory, including pleasure (Caratun, 2014, Gaming Addiction Presentation, slide 6). Addictive substances and behaviors arouse the same circuit, and subsequently, overwork it, thereby creating imbalances in wellbeing (Harvard Health Publications, 2011). Frequent exposure to an addictive substance or activities causes nerve cells in the nucleus accumbens and the prefrontal cortex (the region of the brain concerned in planning and executing tasks) to communicate in a manner that drives people to go after what they like (Caratun, 2014, Gaming Addiction Presentation, slide 5). The impact is motivating people to act on vigorously pursuing pleasure sources (Caratun, 2014, Gaming Addiction Presentation, slide 5). Throughout this time, the brain adapts where it makes the sought-after substance or activity less agreeable, so the addicted person wants to take the target product or behavior more than usual to gain the same level of dopamine release (Harvard Health Publications, 2011). This pathway is effective in explaining non-drug addictions because it shows that it is not just the substance that is the problem, but how people relate activities to feelings and thoughts of pleasure that influence the brain altogether, which, in turn, affects learning and memory (Desrocher, 2014a, slides 5-6). The pathway shows that dopamine can be affected by either brain-changing substances or by addictive behaviors. People then make connections that their activities or favored drugs make them feel pleasure, thereby becoming addicted to them. In addition, the presentation on Addictive Behaviours discusses the various causes of addiction that supports the brain pathway. Some of the causes of addiction are having an addictive personality, early childhood experiences (Fellitti, 2004), and biological sensitivity to drugs (i.e. such as having more reactive reward pathways) (Desrocher, 2014a, slide 21). Biology and having reasons for addiction because of personal problems and psychological/mental illnesses can result to addiction (Desrocher, 2014a, slide 21). Consequently, these feelings, thoughts, and interactions between substance chemicals and dopamine and glutamine, among others, can explain why people get addicted. At present, there is a move toward a holistic approach because of the rise of research on the interactions among the environment, genes, and behaviors, including addiction behaviors. Belsky et al. (2009) noted from their research that putative vulnerability genes may be serving as plasticity genes that make people more reactive than others to positive or negative life experiences (p.752). An example is a friend of mine, who after losing his girlfriend, became addicted to Internet games. He might have putative vulnerability genes because of this unhealthy reaction, since another friend, who had the same experience, did not develop addictions. Belsky et al.’s 2009 study provides important information on how the environment can create new behaviors that impact genetic expressions, which, in turn, affect how the brain works. This can help explain the pathways of addiction that happens when environmental problems and addictive behaviors interact with brain functions. Furthermore, Ernst et al. (2006) proposed that certain behaviors can result to adult neurogenesis or the growth of new neurons in the adult brain (p.84). Exercising, they learned, can reduce depression through adult neurogenesis. Their findings indicate that a holistic approach can be more effective, in the long-run, in dealing with addictions. These studies underscore the need to understand addiction, not just as a simple problem of people lacking self-control or will power, but also as a product of genetic and social variables and changes. Through these changes in thinking about human behaviors and illnesses, some authors offered new modalities. Instead of offering psychiatric services only, some health practitioners present a comprehensive approach merging medical, pharmacological, and psychological treatments. An illustration is a psychologist I know who uses medical tests, but focuses more on psychological treatments for treating addiction problems. He combines CBT with motivational therapy and support groups, depending on the specific personalities of clients and their other needs and variables that can affect the treatment process. I believe that support groups helped significantly in providing social sources of support and motivation for people with addictions. These different modalities are promising because they can analyze and address various aspects of human thinking, emotions, and functioning. In addition, these modalities are effective because they are targeting different aspects of addiction. For example, some addicts are also depressed, so pharmacological and psychological treatments can help in addressing this effect of their addiction (Caratun, 2014, Gaming Addiction Presentation, slide 29). Lastly, these modalities can help increase interest in and implementation of new, patient-centered therapies and activities, which may be more effective than relying on one-size-fits-all modality only. Psychological treatments, for example, can have different methods and activities that can be customized for every patient and their specific circumstances (Caratun, 2014, Gaming Addiction Presentation, slide 31). Hence, new modalities can truly improve how practitioners see addiction and how it can be resolved. 3. What is the neurology of the positive and negative symptoms associated with schizophrenia? Why are the positive symptoms more likely to be targeted for assessment and treatment? What are some obstacles to treatment and what patient characteristics may be related to these obstacles? Reference both presentations in your answer (Angela and Priyanjali). The positive symptoms of schizophrenia are delusions, hallucinations, disorganized thinking (speech), and grossly disorganized or abnormal motor behavior (including catatonia) (Desrocher, Schizophrenia Presentation, 2014, slide 8; Pagano, Schizophrenia Presentation, 2014, slide 3). Dopaminergic mesolimbic hyperactivity seems to be implicated in these positive symptoms (Pagano, Schizophrenia Presentation, 2014, slide 3). The negative symptoms of schizophrenia are associated with disruptions in normal emotions and behaviors, and they refer to “flat affect,” lack of pleasure in everyday life, inability to start and sustain planned activities, and speaking little, even when being persuaded to interact with others (Pagano, Schizophrenia Presentation, 2014, slide 3). Positive symptoms are more likely to be targeted for assessment and treatment because they are more responsive to treatment using antipsychotic agents, while negative symptoms are not well-understood and difficult to treat (Pagano, Schizophrenia Presentation, 2014, slides 3-4). In addition, positive symptoms are more obvious than negative symptoms, thereby making it easier to assess and treat them than the latter (Mithal, Schizophrenia Presentation, 2014, slide 7). Moreover, positive symptoms can be explained by different models that seek to describe the neurology of schizophrenia. The Dopamine Hypothesis notes that schizophrenia is caused by overactivity of dopaminergic synapses (Pagano, Schizophrenia Presentation, 2014, slide 10). Overactivity happens through the mesolimbic pathway, including the ventral tegmental area of RF to the nucleus accumbens and amygdale (Pagano, Schizophrenia Presentation, 2014, slide 3). Increased dopamine activity can come from the excessive stimulation of striatal dopamine D2 receptors (Laruelle, Kageles, & Abi-Darham, 2003, as cited in Mithal, Schizophrenia Presentation, 2014, slide 17), or deficit in glutamate activity through the blocking of NMDA sites (Godd & Coyle, 2001, as cited in Mithal, Schizophrenia Presentation, 2014, slide 17). The Dopamine Hypothesis explains that a pathway that has glutamate neurons, which runs from the prefrontal cortex to the ventral tegmental area, regulates the dopamine release in the mesolimbic pathway (Desrocher, Schizophrenia Presentation, 2014, slide 10). A low level of glutamate in the frontal lobe could lower the basal release of dopamine in the mesolimbic pathway (Desrocher, Schizophrenia Presentation, 2014, slide 10; National Institute of Mental Health, 2009, p.7). Basal release is the spontaneous release of neurotransmitter which is frequently happening in the nervous system, whatever the environmental stimuli might be. Low basal release can cause dopamine receptors in the mesolimbic pathway to become too sensitive and overreact to environmental stimuli, thereby leading to delusions, for example (Desrocher, Schizophrenia Presentation, 2014, slide 10). There are not enough studies to prove this, but the model shows how more evidence can be accumulated in assessing the positive symptoms of schizophrenia. Another theory comes from the Southwales study which can help also understand the negative symptoms of schizophrenia (Weickert, 2011, as cited in Mithal, Schizophrenia Presentation, 2014, slide 17). The study observed that the ventral striatum lights up in response to rewards and is linked to decision making, and this is completely unresponsive in people with schizophrenia (Mithal, Schizophrenia Presentation, 2014, slide 17). People with schizophrenia do not know the difference between expected and unexpected rewards and thus, they fail to conduct effective decision making (Mithal, Schizophrenia Presentation, 2014, slide 17). The negative symptom of schizophrenia of inability to start and continue activities can be partially explained through this study. This theory shows that that schizophrenia is a complex, under-researched illness that deserves further study, especially in understanding the neurology of its negative symptoms. After discussing its positive and negative symptoms, some of the obstacles to treatment of schizophrenia are its side effects, patient disempowerment, patient choices, and painful administration (Pagano, Schizophrenia Presentation, 2014, slide 33). Pharmacological treatments, like any other drugs, have its side effects. Clozapine, for instance, has a side of effect of weight gain and carried 1% risk of fatal agranulocytosis (Pagano, Schizophrenia Presentation, 2014, slides 29, 31), while Aripiprazole or Ziprasidone can have cardiac arrest effects, particularly if patients have heart problems or have high risks for heart attacks (Pagano, Schizophrenia Presentation, 2014, slide 31). A patient from another clinical study showed that she did not want to take any drugs because she felt that they made her fatter and number. Her doctor had a hard time offering her drug treatment because of her aversion to drugs. Aside from side effects, patient disempowerment is also an issue. Those who already experience psychosis may be well deep into their delusions that it is hard for them to make decisions, so health care practitioners and/or family members are making treatment decisions for them (Pagano, Schizophrenia Presentation, 2014, slide 33). An instance is a case learned from volunteering at a clinic. The patient was diagnosed with schizophrenia. She had delusions that everyone was out to kill her. She resisted speaking with her family and doctors and she had become completely socially withdrawn. Her family decided that she was not sane enough to make healthcare decisions, so they made these decisions for her. They ordered a pharmacological treatment that was forced on her. Once, I saw one of the painful administrations of the drugs and I felt the patient’s helplessness. Disempowerment may result to further feelings of loss of control over life and reality that many patients with schizophrenia feel. Besides patient disempowerment, patient characteristics that may be connected to these obstacles are personal circumstances and negative feelings and/or attitudes toward therapy and practitioners and full belief in delusions (Pagano, Schizophrenia Presentation, 2014, slide 39). Some patients who live alone or have high IQ may resist treatment because of lack of support and superiority feelings (Hawton et al., 2005, p.13). A case study noted from a volunteer experience supports this connection among aloneness, IQ, and resistance to treatment. The patient was a single woman, 33 years old, and pursuing her PhD in Mathematics. She lived alone and had high IQ. She did not want any treatment because she said nobody cared and she could heal herself because she was smart enough to do so. Definitely, not all who have the same circumstances as her would behave similarly, but she did show how individual conditions can contribute to the problem of not accessing immediate treatment. Another obstacle is having negative attitudes toward treatment and therapies (Lines & Mulder, 2005, p.6). A number of patients do not get treatment because they do not think they are ill and they fear the stigma connected to treating mental illnesses (Lines & Mulder, 2005, p.6). My friend who was diagnosed with schizophrenia denied any mental illness. She hated it when people said she was sick because she stressed that she was sane and perfectly normal. It took a long time before she accessed the treatment she needed because her family did not want to force her to go to a doctor if she was not ready for it. She is an example of someone who could not receive immediate treatment because she did not want to accept that she had a mental illness already. Aside patient beliefs, complete belief in the delusions can lead to patients to psychosis. Some clinical case studies personally seen showed patients who were already far out into their delusions and had become somewhat violent enough to not access the needed treatments. It is, hence, important to work with patients before they fully believe in their own delusions (Aviv, 2010, p.36). These are only some of the different obstacles for treating schizophrenia. Part B. General Questions About the Course: Answer ONE of the following questions. You may use lecture notes, presentations, and readings to support your opinions. Outside sources are welcome, but not necessary. Limit of 5 pages for your answer. (1 essay out of 25 points) 4. In terms of treatment, how do you feel about prescribing drugs for treatment? When do you think these are called for? Use examples to illustrate. When would psychological interventions be useful? Use examples from the presentations to discuss the modes of treatment that make sense for two disorders: depression and addiction. I actually do not think that drugs are critical to the treatment of depression and addiction, unless, patients prefer them and believe in their efficacy, and unless patients show brain damage problems and acute physiological symptoms that cannot be addressed through psychological treatments and neurogenesis. Some patients do not believe in psychological treatments, a sentiment which is a huge obstacle to using the former, so they might prefer drugs for their treatment. Then again, drugs alone will not work, because pharmacological treatments and psychological therapies tend to be better combined for the treatment of depression, for instance (Ivanovski, Major Depressive Disorder Presentation, slide 32). Apart from patient preference, prescribing drugs are also important for brain damage problems and acute physiological symptoms. Brain damage as cause of depression can also require particular drugs for treatment. Also, physical symptoms that are no longer tolerable or acute entail drug prescription too. SNRIs, for instance, can work for high-pain syndromes though they also have the same side effects as SSRIs (Ivanovski, Major Depressive Disorder Presentation, slide 24). These are some of the instances where drug prescriptions may be necessary. Despite the need for drug prescriptions in treating the symptoms of depression and addiction, I have reasons on why I prefer psychological treatments. These are my reasons for supporting psychological treatments as frequently as possible, depending on client characteristics and preference and other contextual factors. First, pharmacological treatment is not necessarily effective for all patients. Ivanovski reported that SSRIs are no better than placebo for most (mild and moderate) cases of depression, though some people with severe depression benefit (Major Depressive Disorder Presentation, slide 26). Previously unpublished FDA data reviewed (Kirsch et al., 2008; Khan et al., 2002, as cited in Ivanovski, Major Depressive Disorder Presentation, slide 26) and meta-analysis of 6 RCTs with placebo controls showed low effectiveness for SSRIs, since Cohen d effect size for difference between medication and placebo was less than 0.20 (Fournier et al., 2010 as cited in Ivanovski, Major Depressive Disorder Presentation, slide 26). The positive effects of these drugs may also be due to therapies that accompany them which may result to neurogenesis or actual changes in patients’ ideas, feelings, and behaviors (Ivanovski, Major Depressive Disorder Presentation, slide 26). Moreover, for addiction, there are no currently accepted drug therapies (Caratun, 2014, Gaming Addiction Presentation, slide 5). Psychological treatments are preferred because they can improve how patients understand their addictions and how they can choose their own pathways to resolving them (Caratun, 2014, Gaming Addiction Presentation, slide 36). Because of these varying effectiveness levels of drug treatment, I prefer psychological treatments, especially when symptoms of depression and addiction are still on their onset, or even when at their worse, as long as practitioners can persuade patients to try psychological approaches. Depression, for instance, can have symptoms that can be treated through psychological treatment. My experiences in depression commonly showed the effectiveness of different psychological treatments, such as CBT and interpersonal psychotherapy. I believe that even the physical symptoms of depression, such as depressed mood, loss of energy, and recurrent thoughts of suicide, can be resolved through psychological treatment approaches. An example is a friend with depression, who, with CBT and interpersonal psychotherapy, improved her desire to meet and communicate with others, which uplifted her spirits and helped her find interest in her life once more. This is only one of the cases, where I saw the effectiveness of well-monitored and patient-centered psychological treatments. Thus, these treatments may be better than drug prescriptions or may work effectively even without them. Second, several holistic approaches can already combine cognitive and psychological therapies that can produce lasting psychological and physical health improvements and critical analysis of the causes of illnesses. Psychological treatments are useful if patients can still be persuaded to try them and if healthcare professionals are dedicated in helping find different strategies and tactics that may be different for every patient. Ernst et al. (2006) showed that exercise has an anti-depressant effect through the adult neurogenesis hypothesis. Exercise can be used to treat depression, although it must be combined with other activities and therapies for a more comprehensive impact on depression’s symptoms. For example, a relative who had depression found exercise and engaging in art helpful in treating her depression. Walking for an hour 4 times a day and painting nearly every day alleviated her feelings of lack of energy and motivation in life. Three years after her treatment, she shows continued improvement in her thinking and behaviors that helped her relapse to depression. She is an example of the lasting effects of psychological treatments that are holistic in understanding her needs and concerns that lead to depression. Moreover, CBT can also be effective in dealing with addiction. CBT is a recognizable treatment based on the principle that thoughts determine feelings (Young, 2007, p.673). CBT teaches patients to monitor their thoughts and identify those that generate addictive feelings and actions while they learn new coping skills and ways to avoid a relapse (Young, 2007, p.673). A friend who was addicted to online games improved his self-control when it comes to these games. He said that, through CBT, he realized how his addiction made him irritable and less able to concentrate at school and work. Psychological treatment equips people with knowledge and skills that they can use with or without medication in handling feelings and behaviors that start or reinforce depression or addiction. CBT is also helpful in treating depression. Cognitive therapy is frequently used in association with medication or following treatment of an acute episode of depression (Hickie & Scott, 2007, p.17). Therapy can entail keeping a diary of thoughts and feelings that can assist people in recognizing and undercutting negative thoughts (Hickie & Scott, 2007, p.17). CBT for Annie involved psychoeducation in session, followed by using the Mood/thought tracking (app) and Bibliotherapy and interpersonal therapy (Ivanovski, Major Depressive Disorder Presentation, slide 38). These therapies and activities helped Annie improve her coping skills and interpersonal skills. These studies underscore that if emotions and behaviors can have an impact on genetics and brain functions and changes, they can also be used to analyze the cause of psychological illnesses and to find lasting solutions that are in form of activities and therapies that can empower patients in resolving their own illnesses. Lastly, psychological treatment can unmask underlying psychological issues that may be the foundation of depression and addiction, such as traumatic childhood experiences (Felitti, 2003). These therapies are not about finding immediate short-term solutions, but uncovering the unconscious causes of addiction and depression. My aunt who suffered from depression found out that she was depressed because she never got over the fact that her father left them when she was younger. Since then, she felt that she was not good enough to be loved and respected. CBT explored her childhood experiences, and upon knowing them, she dealt with them instead of burying them in her subconscious. The more that patients understand the cause of their addiction and depression, the more that they can work with practitioners in finding different sets of activities and skills to help them healthily deal with these causes. Psychological treatment can also result changes in genetics or the brain, so they can have the same effect as drugs (Belsky et al., 2009). Developing new thought patterns and habits can increase dopamine naturally, as patients learn to connect new coping mechanisms and experiences with pleasure and actually trigger the pleasure center of the brain. Psychological treatments can prove how powerful thoughts and behaviors are in changing imbalances in the brain. I believe that, in many circumstances, these treatments are more effective, reliable and safe that drugs in treating depression and addiction. References Aviv, R. (2010). Which way madness lies: Can psychosis be prevented? Harper’s Magazine, 35-46. Belsky, J., Jonassaint, C., Pluess, M., Stanton, M.,Brummett, B., &Williams, R. (2009). Vulnerability genes or plasticity genes? Molecular Psychiatry, 14, 746–754. Caratun, R. (2014). Gaming (Internet) addiction case study [PowerPoint slides]. Desrocher, M.E. (2014a). Addictive behaviours [PowerPoint slides]. ___________. (2014b). Depression and bipolar disorders [PowerPoint slides]. ___________. (2014c). Schizophrenia [PowerPoint slides]. Ernst, C., Olson, A.K., Pinel, J.P.J., Lam, R.W., & Christie, B.R. (2006). Antidepressant effects of exercise: Evidence for an adult-neurogenesis hypothesis? Journal of Psychiatry and Neuroscience, 31(2), 84-92. Felitti, V.J. (2003). The origins of addiction: Evidence from the adverse childhood experiences study. Praxis der Kinderpsychologie und Kinderpsychiatrie,52, 1-13. Harvard Health Publications. (2011). How addiction hijacks the brain. Retrieved from http://www.health.harvard.edu/newsletters/Harvard_Mental_Health_Letter/2011/July/how-addiction-hijacks-the-brain Hawton, K., Sutton, L., Haw, C., Sinclair, J., & Deeks, J.J. (2005). Schizophrenia and suicide: Systematic review of risk factors. British Journal of Psychiatry, 187, 9-20. Hickie, I., & Scott, E. (2007). Understanding depression. NSW: Educational Health Solutions, Brain & Mind Research Institute. Ivanovski, N. (2014). Major depressive disorder: A case study. PowerPoint Presentation. Lines, E., & Mulder, S. (2005). What can communities do? A community action guide to early psychosis intervention strategies. Canadian Mental Health Association. Mithal, P. (2014). 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