Treatments for depression

Biological – chemical and drugs

There are four types of antidepressants commonly used:

1. Atypical antidepressants – these target neurotransmitters alone or along with serotonin. Common side effects are fatigue, nausea, weight gain.
2. Irycyclic antidepressants – these inhibit the brain’s reuptake of serotonin and norepinephrine. They take about 2 weeks to provide relief and are known to have the most side effects and can lead to overdoses.
3. Selective serotonergic re-uptake inhibitors (SSRIs) – these are commonly prescribes and have fewer side effects. Even though, they have been associated with extreme violence and suicide, Rucci et al (2011) found that suicidal thoughts took longer to emerge with people on SSRIs compared to people on psychotherapy.
4. Monoamine oxidase inhibitors (MAOIs) – these inhibit the actions of monoamine oxidase, which breaks down neurotransmitters, therefore there are higher levels of serotonin and noradrenaline. However, these are seen as the least effective.

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Biological – Electro convulsive therapy 

Nordenskjold et al (2013) tested the effectiveness of ECT with drug therapy compared to drug therapy alone. There were 56 participants and the relapse rate within a year of completion was measured. It was found that 32% relapsed after ETC and drug therapy, compared to 61% with drugs alone.

Dierckx et al (2012) did a meta-analysis on whether response to ECT varies between bipolar and unipolar patients. In total there were 1000 participants from 6 different studies. It was found that the remission rate with bipolar patients was 53% and 51% for unipolar patients. This is encouraging as both showed similar efficacy rates.

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Cognitive restructuring 

BECK’S COGNITIVE THERAPY (1979) 

1. The therapist explains the rational and purpose of the therapy.
2. Clients are taught how to monitor automatic negative thoughts/schemas.
3. Clients are taught to use behavioural techniques to monitor the thoughts.
4. Both the therapist and client explore how the thoughts are responded to by the patient.
5. The dysfunctional beliefs are identified and/or challanged.
6. The therapy ends with the client having ‘cognitive tools’ to repeat the process on their own. 

Hans and Hiller (2013) found that outpatient CBT was effective and maintained the results for at least 6 months.

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Rational Emotive behaviour therapy (REBT)

ELLIS (1962) developed a cognitive theory based on the idea that all individuals have strict, irrational and rigid beliefs that result in unhealthy thinking patterns and mental disorders. It follows the ABC model:

• Activating event – the fact, event or behaviour.
• Belifs – about the fact, event or behaviour.
• Cognitive response – the reaction to the fact, event or behaviour.

The therapy encourages patients to recognise such belies and replace them with logical, flexible patterns after a period of self-analysis.

Sava et al (2008) found that there aren’t very significant differences in the results of the Beck’s depression Inventory Score between REBT, CBT and prozac conditions. However, the two cognitive therapies were preferred because they are cheaper.