Depression Treatment

Depression Treatment Overview

Let's take a look at a brief summary of the depression treatments that are available!

• Cognitive behavioural therapy – this intervention is widely accepted by cognitive psychologists, who argue that the illness should be treated via teaching coping strategies and helping client's overcome and change negative thoughts.
• Antidepressant treatment – biological psychologists tend to favour this depression treatment, as it works to block the reuptake of specific neurotransmitters.
• Psychodynamic therapy – psychodynamic psychologists consider this an effective depression treatment. The intervention aims to resolve unconscious conflicts that may be manifesting as depression symptoms.
• Interpersonal therapy – the intervention has psychodynamic origins. However, it takes more of a biopsychosocial approach to treat depression. The therapy considers and tries to overcome biological, social and psychological contributors to depression.

Cognitive Behavioural Therapy

Cognitive behavioural therapy is a common depression treatment with large degrees of success. The aim of the intervention is for therapists to help clients recognise maladaptive thoughts and form strategies to cope with potential stressors that contribute to depression symptoms, and teach them how to adjust maladaptive thoughts to adaptive thoughts.

Cognitive behavioural therapy is a structured programme that usually lasts between 8 – 12 weeks. The intervention is considered short-term and typically offers approximately 10 sessions. During the sessions, the client and therapist work together to try to combat cognitive factors that may be contributing to the individual's depression.

The standard framework of cognitive behavioural therapy, depression treatment used is:

• The client will discuss their issues with a therapist, during this the therapist will attempt to identify potential factors that may be contributing to their depression.

• After the therapist has identified negative thoughts, the therapist will try to identify the emotions that they evoke, such as sadness or anxiety.

• People who are depressed commonly are not aware that they have these automatic thoughts. Therefore, the therapist will attempt to point this out to them.
• Once the issues have been recognised the therapist will teach the individual coping strategies, changing maladaptive thoughts to adaptive thoughts and help clients rationalise irrational beliefs that they may hold.

Cognitive behavioural therapy is an intervention that is directed by the flow of the therapist, freepik.com/pch.vector.

Usually, depressed people are unable to cope with negative life events or stressors which cause their minds to spiral. The role of the therapist is to teach them how to deal with situations that evoke depression and its symptoms

A therapist will also try to rationalise an individual's irrational beliefs. If an individual believes that there is something wrong with them and that’s why no one likes them, the therapist will point out this as untrue and may discuss the positive relationship the individual may have with their parents or some people that the client may have discussed earlier.

Evaluation of cognitive behavioural therapy

A systematic review that analysed 4335 adolescents revealed that 63% of participants were unlikely to develop depression when they were followed up (Oud et al., 2019). As the study was done on a relatively large sample, the results are generalisable.

The findings support that cognitive behavioural therapy is a relatively effective depression treatment. Another strength of the intervention is that it delivers quite fast results, which would be useful for people who are severely depressed that may need quick results.

However, a problem with the intervention is that it does not aim to understand or overcome the root of the problem. Some psychologists argue this is problematic as they suggest these underlying conflicts are what causes depression and if these underlying conflicts are not resolved then the mental illness will continue to exist.

Similarly, this programme is very rigid and structured therefore, the same structure is used for everyone. Therefore, the intervention does not consider individual differences; what works for one person may not work for another.

Wiles study on the effectiveness of CBT

Wiles et al. carried out a study that compared treatment-resistant depression patients who only received antidepressants and patients who received CBT alongside antidepressants. The study recruited 469 participants across the UK, the chosen participants were identified as treatment-resistant (depressive symptoms had not improved after taking antidepressants for longer than six weeks).

Participants who received CBT along with the medication had between 12-18 sessions with a clinical CBT therapist. When the study came to a conclusion, 47 participants had dropped out of the study.

Beck's Depression Inventory was used to measure depressive scores before ad after the study, the inventory is a self-report measure which gives a score reflecting depression severity. The results revealed that 21.6% of the antidepressant-only condition reported a 50% reduction in depression symptoms and 41.6% reported this in the antidepressant and CBT group.

Antidepressant Treatment For Depression

Cognitive behavioural therapy is one of the steps taken as a depression treatment. If the intervention is not effective or the individual’s symptoms are too severe, then they are likely to be prescribed antidepressant medication.

Common antidepressant drugs that are prescribed are known as selective serotonin reuptake inhibitors (SSRIs). Low levels of the neurotransmitter, serotonin, have been linked to depression.

To help you understand how SSRIs work, let’s quickly go over how neurotransmitters may contribute to depression.

• Neurons use neurotransmitters to send messages and signals to the brain.
• When a neuron is “activated” they release neurotransmitters into the synapse.
• These move through the synapse and attach to a target receptor. Think of this as a lock and key, only a certain key will open a lock, and this is the same for neurotransmitters. The target receptor is attached to the post synaptic neuron next to the presynaptic neuron that initially sent the chemical message.
• Once the message has been relayed, the neurotransmitters that have not “locked” to receptors are 'cleaned up', this process is known as re-uptake.

Similar to a lock and key, only specific neurotransmitters can bind to specific receptors, freepik.com/eamesbot

The low abundance of serotonin in the synapses is what is thought as a cause of depression. SSRIs work by preventing the re-uptake of serotonin which leads to a higher abundance of serotonin in the synapse, which has been linked to less severe depression symptoms.

Evaluation of the antidepressant treatment of depression

Research by Ramsberg, Asseburg and Henriksson (2012) found that Escitalopram, a form of antidepressant that is classified as an SSRI, is one of the most effective antidepressant treatments in terms of the highest remission rates and most cost-effective.

The results indicate that some SSRIs are effective at lowering and preventing symptoms from re-occurring. As the drug treatment is cost-effective, it may be easily available for many to use.

However, similar to cognitive behavioural therapy, there are issues with this depression treatment. The intervention can be considered reductionist, as it only considers the biological factors that contribute to depression. To combat this problem, many healthcare practitioners often prescribe these medications and offer some forms of therapy alongside them. Moreover, similar to other interventions, it does not try to get rid of the root of the problem which may make relapse more likely.

Alternative Depression Treatments

Although cognitive behavioural therapy and antidepressant depression treatment are the most common depression treatments offered, there are alternative methods. Let’s briefly discuss psychodynamic therapy and interpersonal therapy as alternative depression treatment interventions.

Psychodynamic Therapy

The aim of this therapy is to uncover hidden unconscious memories or conflicts that may be repressed from childhood that may be contributing to the individual's depression.

The therapist's goal is to help the client resolve these unconscious conflicts, such as via free association or transference.

If the therapist says hate and the client responds father; then it suggests they have issues with their parent.

Transference occurs when the individual projects their feelings toward another onto the therapist. Most interventions such as cognitive behavioural therapy frown on this occurring. But psychodynamics believe that this allows the therapist to truly understand the client, and they can use this to direct and work through the issues that the two may be having.

Interpersonal Therapy

Interpersonal therapy takes the form of talk therapy. The basis of the intervention is that poor quality relationships contribute to depression. The intervention's goal is to help recognise and deal with problematic relationships the individuals may have or previously had.

Inventories have been established to identify such problems that assess past and current relationships.

The therapist may work with the individual and their spouse to help establish a better relationship. The individual is taught how to use the “healthy” relationship as a template for future relationships and to teach them how to direct their own future behaviour, e.g., not allow someone to manipulate them.