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Evaluate the effectiveness of 3 (or more) different treatments of depression. The treatments examined can include drug therapy, dietary changes, cognitive behavioural therapy, and psychotherapy, or any othertreatment which has been scientifically evaluated.
Depression and Treatments
Depression is not only one of themost widespread and prevalent of the major psychiatric disorders but also oneof the most excessively researched mental illnesses. It has oftenfundamentally affects people’s well-being and quality of life. While a studydiscovered that of over 5.000 British residents approximately 5.9% of the malesand 4.2% of the females did suffer from depressive illnesses (based on DSM-IVcriteria) (Ohayon et al. 1999), the literature suggests that the depressioncourse differs from individual to individual, as does the effect of and theresponse to a treatment.
As 85% of currently depressedindividuals in primary care and 78% in psychiatric settings do endure relapsefrom depression after treatment (Coyne, Pepper, Flynn, 1999) it becomesself-evident to grasp and comprehend different techniques and methods to treatdepression and evaluate their strengths and weakness (Khan-Bourne & Brown,2003). Consequently this brief aims to review some of the current state ofresearch on three treatments which rely less on medication and excludepharamcotherapy. The treatments which will be critically evaluated areelectro-convulsive therapy, cognitive behaviour therapy, and acupuncturetreatment.
According to the DSM-VI, thesymptoms of depression fall into four different categories: cognitive (feelingsof low self-worth or unbecoming guilt), physical (forms of insomnia or loss ofappetite), emotional (enormous sorrowful feelings), and motivational (lack of motivationand aspiration). In other words, everyday feelings of sadness are not ascomprehensive, long-lasting and extreme as depression experienced as a mentaldisorder. Nonetheless, the term depression stands for an ample amount ofillnesses that are not comparable in terms of severity and time course since itranges in severity from mild irregular conditions of natural emotions todisorders of psychotic intensity (Hollon, Thase & Markowitz, 2002).
Murray and Lopez (1997) reportedthat although depression can be regarded as the top reason for people beingdisconnected from everyday healthy living worldwide the majority of individuals(approximately 80%) who suffer from depression never seek treatment, accordingto the National Institute of Mental Health (NIMH). As, however, the amount ofpeople experiencing depression has almost reached an epidemic status, and beingmentally ill is not stigmatised to such an extend by society, more and morepeople inform themselves and seek treatment (Hollon et al., 2002).
The goal of treating depressionshould be to reach both a thorough symptom and risk of relapse minimisation;and as a consequence, to improve significantly the patients’ quality of life.Ellis and collaborators (2003) noted that for a treatment to be generallysuccessful it must include and provide certain essential elements in thetreatment plan. Maximising the collaboration and identification between thepatient and the treatment in a therapeutic alliance which embraces thepatient’s social network is, for instance, only one of the necessary pillars ofan effective treatment. Gwosdow and Staff (2003) added that tailoring thetreatment uniquely to each patient, while paying attention such aspects as thesafety, tolerability and efficacy of required medicaments or the treatment areequally important factors which play a role in predicting the success rate of atreatment.
As a matter of fact there are manysuccessful approaches to tackle clinical depression effectively, whereas manyare backed up by scientific studies and evidence.
Electro-convulsive Therapy – ECT
Pharamcotherapy is by far not theonly way to alleviate or cure depression in people. In fact, the most effectiveantidepressant modality is electro-convulsive therapy according to Holden(2003). It is often used in acutely depressed patients as antidepressants takeusually more than three weeks to impact depression and is chosen over othermethods when pharmacotherapy fails to have an effect on a patient. ECT acts inso many ways on individuals that it is hard to disentangle the effects.Blocking effects of stress hormones, increasing serotonin levels or stimulatingneurogenesis in the brain are only a few of its positive effects while theinduction of seizures and the outbreak of epilepsy and severe personalitychanges are among some of its weaknesses.
Therefeore, ECT still remainscontroversial and receives public stigmatisation despite the fact that if ahealth care specialist administers ECT professionally, it does not bear higherrisk factors than surgical treatments that need general anaesthesia of thepatient.
The treatment usually starts with theprocess of 6 to 12 electrically induced seizures spaced several days apart. ECTtreatments are spread over several days while the electrical current isutilised across the less dominant brain hemisphere (both uni- and bilaterally).ECT excites the compensatory central nervous system mechanisms which moderatethe neurotransmitter systems that are also affected by pharamcotherapeuticmedications. Confusion, which is the most natural first response to ECT isgenerally followed by transient amnesia after and for several months. Althoughresearch could not demonstrate permanent memory loss many patients complain andlament about this negative side of ECT.
However as it is very expensive and as it has possible impacts on cognition, memory and personality this method is only applied in severe cases of depression. Despite this fact only every second patient who did not benefit from medication will benefit from ECT, according to Prudic and collaborators 1996. A high relapse risk rate is another weakness of successful ECT while those who proved to be resistant against antidepressant are also more prone to suffer from relapse. Therefore, the ECT treatment is often extended and involves nowadays follow-up medication therapy that combines antidepressants and mood stabilizers (Sackeim et al., 2001). Individuals who suffer from depression post-recurrence despite having undergone this newly developed strategy may are asked to continue ECT treatment using a less powerful current and more distanced treatment days (Hollon et al., 2002).
Cognitive Behavioural Therapy – CBT
Beck (1991) canbe regarded as the pioneer and innovator of cognitive the therapy who developedthis kind of therapy in the early 1960s. It is theorized that individuals’sentiments and interpretations about certain life events have a fundamentalimpact on the individuals’ response to those events. In other words, depressedpatients are regarded as possessing inappropriate negative attitudes andnotions towards life events and their illness is thought to be due to theutilisation improper and incorrect information processing strategies.
Therefore, the aim of cognitive therapy is to allow patients to identify, assess and most importantly modify their maladaptive notions and to hinder the occurrence of negative automatic thoughts (NATs). Given that behavioural strategies are additionally used to enhance depressed patients’ conditions the treatment is termed cognitive behavioural therapy (CBT). Unlike what one might guess, CBT does not involve instilling unrealistic optimism into suffering individuals but seeks to help patients to assess themselves, their opportunities and abilities with more realistic measures. Previously held notions and sentiments have to be, as a consequence, constantly and continuously independently questioned by the depressed person so that he or she acquires a higher sense of mastery which gives him or her, in turn, more control and confidence over future life-events.
This approach seems quite effective as some studies have discovered that the relapse rate of mentally depressed people treated by this method is twice as low as the relapse rate of individuals treated with medications, according to Levine and Wetzel (1986). Hollon and colleagues (2001) demonstrated this more remarkable superiority of CBT over medication more recently and discovered that within a year after treatment 81% of individuals receiving medication relapsed whereas only 25% of patients treated by CBT relapsed. Unfortunately, there are not many studies that have extended the scope beyond relapse risk rate but Fava and colleagues (1998) maintained that CBT diminishes the risk of recurrence. Weaknesses of CBT include the fact that it is thought of having low cost-effectiveness compared to pharmacotherapy although Hollon (2002) interjects that this might be incorrect for long-term treatments where CBT is at least as cost-effective as pharmacotherapy.
CBT hasadditionally been extended to other cognitive therapies which include theso-called Mindfulness-based cognitive therapy which utilises and includes strategiesacceptance and meditation techniques (dialectic behaviour therapy) whichfacilitates patients keeping a safe mental distance form any depressiveruminations while targeting less the content than the process of pondering (Teasdale,Segal, & Williams,
1995). Teasdaleand collaborators succeeded in finding support for this method and estimatedthat due to its low relapse rate, increasing popularity and possibility toenjoy treatment in groups, this kind of treatment will play an even bigger rolein the near future.
In sum,cognitive based therapies seem to be successful in both minimising severedepression during treatment and diminishing its come-back risk aftertreatment. Additionally patients rarely suffer from any kinds of side-effectsand feel more enabled to control their illnesses themselves. Recently developedinterventions which are based on cognitive therapy appear, in addition to that,quite promising like the mindfulness-based cognitive therapy. The implicationswhich seem especially encouraging are ideas theorising that the interventionswhich effectively tackle relapse and recurrence could also diminish theworrying risk for initial onset in children and youths who have never encountereddepression.
Alternative Medicine – Acupuncture
Especially the UK has experienced asignificant boom of complementary and alternative medicine (CAM) treatments ofmental disorders like depression. The statistics are speaking in favour of CAMsand are indicating extreme present and future potential of CAMs. As a matter offact, only 20% of the patients who received CAMs were dissatisfied with thereceived treatment while in total a quarter of the British population havestated to have already benefited from CAMs and over 90% of GPs (generalpractitioners) have already suggested the referral of a patient to CAMs(Hagelskamp et al. 2003).
Nevertheless, many limitationsexist that has not allowed CAMs yet to become more integrated into standardmedical interventions and practices. One of the major downsides of CAMs is thatmost of them lack clinical and scientific evidence and support whichdemonstrates their validated positive effects on disorders such as depression.However, therapists who are in favour of treatments like acupuncture which isused for alleviating pain and depressive symptoms in patients seek to gainhigher clinical acceptance in the near future by conducting more scientificstudies. In acupuncture treatment, the physiological functioning of the humanbody is sought to be altered and the energy balance is sought to be restored byinserting extremely fine needles alongside the energy meridians on the surfaceof the body.
Acupuncture has the benefit oflacking limitations of both counselling and medication as it does neither needoral administration nor motivation to self-reflect language, and as it,additionally, excludes frequently appearing side effects or potentialdependency. On the other hand, one of the weaknesses of this particular treatmentis that the there is no consent about the influence of the needles on body andmind, and while Chinese therapists regard the effect of acupuncture based onde-stagnation of unresolved stress and emotional conflicts, Western therapistsregard acupuncture as actively changing the neuropsychology of patients. Ernstand colleagues (1998) were among the first and few who sought to establishsound clinical evidence for acupuncture treatment.
Although their studies implicated that acupuncture significantly changed depressive patients conditions to the better, their research only utilised case studies and thus the reliability and validity of their study was questioned. Yang (1998) discovered that in contrast to medication acupuncture did reduce anxiety in patients and gave them more confidence in dealing with their disorder. More recently, Roeschke and collaborators (2000) investigated whether different types of acupuncture (e.g. sham, venum acupuncture) have different effects and discovered that there were no observable differences between different acupuncture treatments although all had significant effects on the patients well-being compared to a control group whose members did not receive acupuncture sessions.
This study led Roeschke and colleagues to imply that needling in general may be an effective countermeasure against depression. In sum, acupuncture does seem to successfully tackle depression and may possess both administrative and clinical advantages over pharmacological treatments. Nevertheless, as it is not yet sufficiently supported by research institutions, central government or health professionals it has not established and integrated itself among the mainstream health treatments of depression (Hagelskamp et al. 2003).
Not one but severaltypes of treatments exist which seem to be effectively intervening againstdepression. Each single one has both strengths and weaknesses – advantages anddisadvantages; thus none is universally accepted or successful. Usually,antidepressant medication based treatments have the most ample scientificsupport although on the downside they involve the risk of detrimental andnegative side effects. Additionally, there relapse and recurrence risk aftertreatment is remarkably high so the treatment has to be steadily continued.
ECT on the other hand represents the single most promising intervention for the most acute depressions, but since it impacts memory and cognition irrecoverably its advantages and disadvantages are well balanced and need to be considered before treatment. CBT seems to be a more appropriate counter-measure against depression for more mild types of depression (e.g. unipolar depression). Although it does neither bear negative side-effect nor involve high relapse risk factors its degree of success relies heavily on the competence of the responsible clinician.
Nevertheless, one fact which has to be considered is that despite the overwhelming amount of scientific studies assessing existing depression treatments over 50% of patients do not respond to any type of treatment yet and researchers and medical professionals have to date been unsuccessful in decreasing this staggering statistic. In conclusion no guide exists telling one what to do if acupuncture, CBT, ECT or pharmacology fails to have an impact on depressed individuals (Hollon et al. 2002).
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