A Critical Overview of the Current Depression Treatment Approaches - Coursework Example

A Critical Overview of the Current Depression Treatment Approaches

Introduction

Mental health, defined by World Health Organisation (WHO) as a state of well-being to function normally and cope with daily life situations, is one of the critical components of health (WHO, 2014). However, mental health problems remain a major health issue affecting a majority of people worldwide. The provision of mental health services similarly presents significant challenges in the healthcare delivery with persons living with severe mental illnesses dying much earlier than the general population (Mauer, 2009, p.4). This essay explores the current treatment approaches offered to individuals experiencing depression as a mental health issue. It gives a critical account of these approaches and their underpinning perspectives.

An overview of depression

Depression is a chronic mental health condition manifesting as tiredness, sadness, poor concentration, sleep problems, loss or diminished interest and low self-esteem (National Collaborating Centre for Mental Health UK, 2010). It has adverse impacts on health and well-being resulting in reduced ability to perform routine activities like going to work and coping with daily life stresses. Pompili (2010, p.234) noted that severe depression might even lead to self- destruction with high rates of suicide ideation and attempts witnessed in individuals with severe major depressive episodes. With early diagnosis and appropriate treatment interventions, the adverse impacts of depression on health can be prevented or mitigated. According to Dirmaier et al. (2012), the treatment approach to depression includes both pharmacological (psychotherapeutic with medications) and non-pharmacological based therapies. Even the effects of non-pharmacological treatments such as exercise and talk therapies are comparable with those of drug therapy, a combination of both is usually more beneficial, especially in severe depression.

Mental health and ill-health perspectives

The diagnosis, treatment, and monitoring of depression and other mental health disorders have been based on several perspectives relating to mental health and ill-health (Rogers and Pilgrim, 2014). It is imperative to note that most of these perspectives arise from models of care of different disciplines and they bear a lot of similarities and differences. Nonetheless, they all aim to achieve a single objective of alleviating mental health problems and improving the quality of life.

One such model of care that has been widely used in addressing mental health is the biomedical model that Deacon (2013) observed that emphasises on the pharmacological intervention for mental disorders. From this model, management of mental disorders is based on three perspectives including psychiatry, psychoanalysis, and psychology. Gabbard (2014) noted that psychiatry in clinical practice is mainly concerned with aetiology, diagnosis, treatment, and monitoring of mental health disorders to improve their understanding. This model acknowledges the significant role played by psychiatrists in designing the treatment plan that makes them indispensable in the care of individuals suffering from brain disorders like depression. However, its focus on the role of psychiatry at only the treatment stage has been dismissed by some psychiatrists, in part or whole, who have considered other fields including psychology, philosophy or sociology as an alternative approach (Rogers and Pilgrim, 2014). On the other hand, psychoanalysis similar to psychology focuses on the analytical factors contributing to mental health disorders hence improving their understanding (Dorpat and Miller, 2013). It disregards the concept of the continuum with its view that human beings are ill to some degree and achieving a 100% optimal physical, mental and emotional well-being is a farfetched idea. This position has sparked debate about the medical origin of psychoanalysis and its re-examination of life across various fields like psychiatry. Psychology that is a broad discipline offering insights into the ordinary and peculiar influences of life shares this similar belief (Dorpat and Miller, 2013; Seligman and Csikszentmihalyi, 2014). Its rise based on a theoretical logic of thoughtfulness about behaviour makes it a fundamentally objective subject that improves understanding of specific behaviours. This behaviourism hypothesis has restricted the domain of psychology leading to the inclusion of subjective component too into the clinical practice (Sternberg and Sternberg, 2016).

With the behaviourism becoming predominant in the academic discipline, the concept of distorted conditions including psychiatric and psychological disorders emerged (Buss, 2015). However, this behavioural emphasis would later decline during the 1970s and eventually replaced by cognitivism. Psychologists, therefore, began to emphasise on internal factors like an individual’s thoughts and experiences just like behaviours thus giving a hybrid of cognitive/psychological-behavioural approach to mental health problems. Later on, constructivist, systemic and psychoanalytical perspectives became increasingly and progressively incorporated into psychology practice though it remains unclear whether cognitivism was the driving factor of introducing cognitive therapy within clinical psychology during the 1980s or it only legitimised it. Based on these arguments, the effectiveness of biomedical model could not be ascertained and should be relooked to achieve better outcomes for mental illnesses like depression as well as consideration of alternative approaches if necessary.

Mental health issues can also be approached from statistical and ideal notions. According to Rogers and Pilgrim (2014), statistical notion holds a similar belief to sociology standards that common practices in a population are typical whereas rare ones are unordinary. For instance, a person’s talking style and speed could be considered typical or unusual whereby speech rate below and above the average may be regarded as discouragement and hypomania respectively by the psychiatrists. Conversely, ideal notion proposes two forms of thought; psychoanalysis and psychology. The analytical thought depicts ordinariness of an individual based on their cognizant qualities rather than the oblivious ones as opposed to the psychological one that depicts an individual perfection a satisfaction of all their human potentials of positive well-being (Rogers and Pilgrim, 2014). These notions are closely related to the perspectives of the biomedical model and therefore can be used together to improve management of depression and other brain illnesses.

Determinants of mental health and well-being

These perspectives explicitly point out that several factors influence mental health and well-being. For instance, psychiatrists, psychoanalysts, and psychologists evaluate most mental health problems in relation to individual biological or genetic, social, behavioural, and environmental factors. World Health Organization and Calouste Gulbenkian Foundation (2014, p.13) also noted that mental health and related common mental problems are associated with people’s surrounding socioeconomic and physical environments. Therefore, the widespread social inequalities have led to increased risk of many disorders and addressing this challenge requires appropriate interventions including structural, local and environment at the individual, community, and national levels.

Approaches to management of depression

Cognitive behavioural therapy (CBT)

Several interventions have been used in the treatment of depression and other mental disorders. However, cognitive behavioural therapy (CBT) is the common and most effective current psychological treatment of anxiety and moderate to severe depression (Royal College of Psychiatrists, 2009; Coull and Morris, 2011). CBT is a talking therapy that has an ability to influence a person’s thinking and behaviour, thus useful in managing depression (NHS Choices, 2016). The concept of interconnection between personal thoughts, feelings, physical sensations and actions with the vicious cycle of mental health disorders believed to arise from negative thoughts and feelings forms the basis of CBT in depressive symptoms. According to the Royal College of Psychiatrists (2009), it helps the patients to break this cycle of altered thinking, feeling and behaviour. Hofmann (2011) also acknowledged that CBT is based on the notion that the behavioural and emotional responses are strongly influenced by cognition, that is, thoughts.

Different from other forms of talking treatments, CBT focuses on and breaks the current problems and not the past into smaller parts to help an individual overcome their overwhelming challenges more positively (NHS Choices, 2016). It demonstrates a practical way how the negative patterns can be changed to improve the overall well-being on a daily basis. Jarrett (2015) noted that CBT has numerous advantages when used to treat depression. Some of these include its ease of standardisation, intuitiveness, and ability to deliver quick results in weeks as opposed to years needed for other therapies. Moreover, it is more acceptable to many people suffering from depression because it does not involve taking medications that affect the brain.

Effectiveness of CBT in treatment of depression

The effectiveness of CBT in managing depression is comparable to that of antidepressant medications for different types of depression such as selective serotonin uptake inhibitors (SSRIs) (Davidson, 2010, p.4). It has also been found that CBT is effective in the management of other mental and physical health problems such as obsessive-compulsive disorder (OCD), panic disorder, post-traumatic stress disorder (PSST) and sleep disorders as well. Dobson (1989) affirmed that the improvement in symptoms produced by CBT is greater than any other form of treatment or waiting list control and it has demonstrated an efficacy equivalent to pharmacotherapy for depression. It reduces relapse or recurrence of depression to a greater extent and therefore offers more benefits than antidepressant medication (Gabbard, Beck, and Holmes, 2007, p. 115). However, a combined therapy of CBT and medication has been found to be superior to a single treatment alone (Dirmaier et al., 2012). Ingram (2009) noted that this combination therapy produces superior outcomes during the phase of acute treatment in patients with more severe, recurrent or chronic forms of depression compared to when either medication or CBT was used alone (p. 174). The Royal College of Psychiatrists (2009) also noted that CBT should be used alongside antidepressants in severe depression and cannot be used as a quick fix thus limiting its use when quick recovery is desired. It considers a therapist as a personal trainer who can only advise and encourage the patient but cannot do for them. Therefore, it could be challenging for patients feeling low to concentrate and get motivated until they are given antidepressants to make them feel better.

CBT may also have a limited use on people with more complex mental health needs or learning difficulties owing to its structured nature (NHS Choices, 2016). Andrews (2010) noted that CBT is limited to only certain groups and should not be used for depression that is resistant to treatment as well as in individuals presenting with both depression and personality disorder. Moreover, the specific focus of CBT on only the current problems has been a subject of criticism. It is argued that this proposition fails to address the determinants or underlying causes of mental health conditions. Lastly, its focus on the individual's ability to change themselves including their thoughts, feelings, and behaviours often ignores the wider systems or family problems that also significantly affect the health and well-being of an individual (Andrews, 2010).

Biological approach

For these reasons, a more proactive approach including interventions targeting biological and other determinants have been adopted in the management of depression. For instance, biological approach to mental health problems has consistently dominated the provision of mental health services in the UK with a focus on its biological determinants since the establishment of psychiatry (Stacey, Felton, and Bonham, 2014). It is also called medical model or disease model and views mental health problems as a disease of the brain but whose assessment and treatment are the same to those of physical health. This process involves identification of a set of symptoms that are used to inform the diagnosis and plan treatment. Important to note, it is a process that is often led by a psychiatrist and hospital admission may be needed with medication of choice involving those that affect the central nervous system (CNS) through the action of specific neurotransmitters.

Stacey, Felton, and Bonham (2014) noted that improved understanding of the aetiology and pathophysiology of mental disorders could potentially lead to interventions that will prevent the onset or progression of the disease. To achieve this, a model that employs large but simple trial in a broad population determining incident cases as the primary outcomes could be useful. However, the current knowledge is not adequate to support research of this nature. Nonetheless, the well-understood processes of oxidative stress, inflammation, and apoptosis at the cellular level and their relationship with hormonal and genetic factors in disease could be further exploited in using biological approaches to address depression and mental health disorders.

Multidisciplinary care

Robinson and Cottrell (2005) noted that multi-disciplinary care by a team of health professionals from mental health and related disciplines such as psychiatry, psychology, social work, and nursing is required in addressing mental health problems for better outcomes. Therefore, management of depression requires teamwork and collaboration among various healthcare professionals as well as non-professionals who are part of primary health care. According to Mitchell et al. (2012), these multidisciplinary teams enable information and expertise sharing as well as the exchange of ideas that allows the provision of holistic care that meets all the patient’s needs. However, adequate coordination and clarity of roles and responsibilities among the team professionals during the planning and care processes are required for the success working of the teams and better outcomes as they encourage sound clinical decision-making (Nancarrow et al., 2013). More importantly, individual practitioners can learn to work in more challenging and complex situations through risk assessment development and management and listening to different perspectives in a multidisciplinary team. These collaborations involve not only the professionals but also the patients and their families as important members of the care process.

Collaboration with the service user

Lagan and Lindow (2004) observed that many mental health service users require support as this helps in minimisation of the potential risk of harm to themselves as well as others. It involves consideration of the individuals’ perspectives on their level of risk, triggers and coping strategies to avert or minimise these risks. To achieve this, a collaborative approach that involves the service users is necessary as it creates room for them to identify the areas that they feel pose risk but might have been overlooked by professionals such as the impact of medication or their disempowerment through the mental health system. Moreover, it allows them to participate in developing plans for addressing those areas. A collaborative risk assessment should be part of the therapeutic relationship between the patient and caregivers to ensure that these issues are discussed openly, and people feel supported to address and develop responses to the identified risks. However, Bracken et al. (2012, p.431) noted that a lot of sensitivity is required while discussing these potential risks and timing remains an important factor for consideration.

Collaboration with family and carers

Family and other people close to the service user should also be involved in the collaborative process of health care provision as they can easily observe any changes in the patient’s condition or behaviour. They also tend to be the most likely victims of the patient’s actions such as violent behaviour in case they arise. According to Bloomfield and Pegram (2015), an effective collaboration with the family and other carers should involve developing and reviewing of the management plans and reporting any concern that they observe to the health care team professionals. However, this process could be a complex issue within some families such as where antisocial behaviour is a norm and family situations contribute to risk –associated actions. In such a scenario, families might be unwilling to support the service user for fear that their beloved one is being set up to fail or they would later turn the blame on them.

In interdisciplinary care, recognising individual strengths and weaknesses of the team members and the available resources is an important step (Goodwin, 2013). This is particularly important during risk assessment to improve understanding of the potential risks and challenges that the team may come across. It includes knowing their abilities to understand and manage the risks as well as the resources including physical, emotional and social support that enable them to cope with daily life including distressing experiences. It also helps in identifying the risk trigger factors that is crucial in promoting greater understanding of the individual suffering from depression and their behaviour and supporting them during their recovery process.

Policy and legislation interventions

Mental health problems could also be addressed through policy and legislations. One such legislation is the Mental Health Act 2007 that recognises mental health and resilience as fundamental to achieving healthy life including physical health, relationships, education, training, and work (“Mental Health Act 2007”). As a result, Department of Health UK considers promoting and improve mental health for individuals and the population as a whole in the UK as everyone’s responsibility including individuals, families, employers, educators and communities. This initiative involves a range of stakeholders and partners like local and national government departments, organisations, care providers and users who work with the Department of Health on key six shared goals (Department of health, 2011). These include having more people with good mental health, having more mental health problems recovery, having more people with mental disorders having good physical health, having more people experiencing positive care and support, having fewer suffering avoidable harm and having fewer people experiencing stigma and discrimination. Through various policy and legislation interventions in managing depression, more people will experience improved mental health and fewer people will suffer from the harms of depression.

Conclusion

Addressing depression and other mental disorders requires effective strategies that take into consideration not only the treatment options but also the causes. Mental illnesses have varied determinants ranging from more salient factors like social factors to most likely unnoticeable ones like biological factors. CBT appears to be the most effective form of non-pharmacological based therapies to depression and remains as effective as pharmacological treatments. However, a more comprehensive approach involving biological considerations, multidisciplinary care and policy interventions should also be adopted in addressing depression owing to the complex nature of mental disorders. More importantly, these interventions should be evidence-based derived from appropriate health care models and perspectives.

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