Treatment of Depression

1. Treatment of Depression Psychology of Individual Differences

2. What is Depression? • Sad/flat mood • Loss of interest in usual hobbies. • Difficulty sleeping. • Shift in activity level. • Change in appetite (decrease or increase). • Feelings of worthlessness/guilt. • Thoughts of death/suicide • These symptoms must be persistent and last a minimum of 2 weeks.

3. Who suffers? • Anyone!!! • Only 1 in 3 people suffering from a mood disorder seeks help. • The risk of suicide is 30 times greater among people with depression than in the general population. • A study by the World Health Organization (WHO) and the Harvard School of Public Health reveals that by the year 2020 depression will be the single leading cause of death around the globe. • For youth between the ages of 15 and 24, suicide is now the third leading cause of death. For college students, it is the second leading cause.

4. Medical Model • Depression is inherited • McGuffin et al, 1996 • Harrington et al, 1993 • Wender et al, 1986 • Neurotransmitters • Bunney and Davis, 1965 • McNeal and Cimbolic, 1986

5. Treatments • The treatments used by the medical model are known as ‘somatic’ treatments, meaning ‘of the body’ • They aim to fix the part of the body which is ‘not working’ • There are three main types of anti-depressant, all of which affect the chemical balance of the brain.

6. Anti-Depressants • MAO-Inhibitors • Effective in approximately 50% of cases, but with severe side effects. Used only when other treatments have failed. • Tricyclic antidepressants • Prevent the re-absorption of serotonin and adrenaline, increasing the level in our system. However, Sommers-Flanagan et al (1996) found they were no more effective than a placebo.

7. Anti - Depressants • Selective Serotonin Re-uptake Inhibitors (SSRIs) • These include widely-used brands such as Prozac, and work in a similar way to tricyclics. • However, they only block serotonin reabsorption – not all neurotransmitters. • Joffe et al (1996) found they were more effective than placebos.

8. Evaluation of Anti-Depressants • Doesn’t work for all patients. • Side effects. • Nausea, diarrhea, anxiety insomnia, loss of libido (Hollander and McCarley, 1992; Jacobsen, 1992; Montgomery, 1995) • Can be quick acting to relieve the symptoms. • Cost free for the patients.

9. ECT • What can be used when drug treatments are ineffective? • Electro-Convulsive Therapy (ECT) is a controversial treatment mainly used as a ‘last resort’. • Comer (2002) found a 60-70% improvement rate, but Sackheim et al (2001) argued that many patients later relapsed.

10. ECT Process • A current of moderate intensity is passed through 2 electrodes attached to the patient’s head for about half a second. • This results in a 30-60 second convulsive seizure. • Usually this is repeated 6-10 times over a 2 week period. • Current patients are given an anaesthetic. Previously they were not which resulted in thrashing and injury.

11. Evaluation • Works for 70-80% of patients who have not responded to drugs (Janicak et al, 1985) • Works faster than some anti-depressants (Weiner, 1985) • Can cause memory impairment which can last for months (Squire 1977) • For more info on ECT check out the list of useful websites in the ‘Individual in the Social Context’ tab on the blog.

12. Revision essay question • Discuss the origins and treatment of depression according to the medical model. • To answer this task you should look at: • The approaches core beliefs. • What it believes causes depression. • How it attempts to treat depression. • Remember to evaluate each of these points. (What are its advantages and disadvantages?)

13. Cognitive- Behavioural Therapy • Teach clients to think more positively. • Eases the pain of hopelessness. • Client-centred – allows the client to make the changes for themselves. • Changing how you think (cognitive) in order to change what you do (behavioural)

14. Beck’s Cognitive Therapy (1976)

15. Beck’s Cognitive Therapy Process • Replace negative thoughts with positive ones. • Stage 1 Therapist & client agree on nature of problem & goals for therapy • Stage 2 Therapist challenges the client’s negative thoughts

16. Example • Situation: You've had a bad day, feel fed up, so go out shopping. As you walk down the road, someone you know walks by and, apparently, ignores you. • Thoughts: They ignored me – they must not like me. • Emotions: Rejected, sad. Feel sick, low energy. • Reaction: Go home and avoid them in the future.

17. Altered thinking • By altering this way of thinking the reaction (and therefore the behaviour) would be a lot different. • Thoughts: They look a bit distracted, I wonder if there is something wrong. • Emotions: Concern for the other person. • Action: Go home and phone them to see if they are ok.

18. Rational Emotive Behaviour Therapy (Ellis, 1957) • Like Beck’s Triad, Ellis believed that depression was a result of maladaptive thinking (self-defeating). • ABC model: • Activating events (the things that happen, eg getting fired) • Beliefs (how you interpret the event. This can be maladaptive, eg I am useless, or rational, eg My boss is an idiot) • Consequences (the behaviour as a result, eg become depressed or go out and find a new job) • This is what the current CBT is based on (as in the example above)

19. Success • Ellis, 1957 claimed 90% success rate with an average of 27 sessions. • Smith and Class, 1977 carried out a meta- analysis and found CBT to be most effective form of psychotherapy to treat depression (systematic desensitisation was first overall, CBT 2nd overall). • Ethical? Rosenhan and Eligman, 1989, criticised this method as being ‘judgemental’ and ‘aggressive’.

20. CBT Process • Sessions can be individual, in groups, or even via a self help book. • Individually can meet up with the therapist 5-20 times, weekly or fortnightly and from 30mins-hr. • Therapist asks questions about the past in order to determine why they think that way now and how they can change it in the here and now. • Clients decide their goals. • Work with the therapist to determine what they want to achieve from each session.

21. CBT Process contd. • Keep a diary between sessions to track progress and identify any thought patterns. • Work with the therapist to determine what is unhelpful and how to alter it in the future. • Homework between sessions is to actively attempt to change this way thinking.

22. Evaluation • Not a quick fix – takes time to train the client. • If the client is feeling low, it can be difficult to concentrate and get motivated. • To overcome anxiety, clients need to confront it. This may lead them to feel more anxious for a short time.

23. Evaluation • DeRubeiset al, 2005. Compared the effects of anti-depressants vs CBT. Found that CBT could be just as effective as AD but that its success was dependant on therapist experience and expertise. • Hollon, 2005 followed up DeRubeis study 12 months later and found that 31% CBT, 47% Drug therapy and 76% no treatment had relapsed. (CBT has longer lasting success) • David and Avellino, 2003, found that CBT was the most effective of the psychotherapies.

24. Revision Qstn • Discuss the origins and treatment of depression according to the Cognitive-Behavioural model. • To answer this task you should look at: • The approaches core beliefs. • What it believes causes depression. • How it attempts to treat depression. • Remember to evaluate each of these points. (What are its advantages and disadvantages?)

25. Psychodynamic Therapy • Psychodynamic Therapy sessions occur once a week for approx. 50mins. • Unlike CBT there is no agenda. It is open-ended and allows for ‘free association’. Also, the sessions can be longer term • the patient is encouraged to talk freely about whatever happens to be on his or her mind. As the patient does this, patterns of behaviour and feelings that stem from past experiences and unrecognized feelings become apparent. The focus is put then on those patterns so the patient can become more aware of how past experience and the unconscious mind are affecting his or her present life.

26. Sessions involve . . . • Discussion: • what's happening in their life at the moment - how they do things and the part they play in things going right or wrong for themselves; • what has happened in the past; • how the past can affect how they are feeling, thinking and behaving right now. • Understanding: • By understanding their own unconscious thoughts and feelings the patients can make better decisions.

27. Other psychodynamic approaches: • Dream analysis. • Free association. • These are used to unlock and give an insight into the unconscious mind in order to elicit understanding.

28. Evaluation • Task: • Read through the handout, highlighting all relevant evaluative studies. • Where possible, make notes on the aim, participants, method, results and conclusions.

29. Essay Question – Thursday 8th November • C4. Atypical Behaviour Describe one psychological approach which attempts to explain either depression or eating disorders. Explain this approach and its therapy for treating the same disorder. In your answer you may wish to include: • a definition of either depression or eating disorders; • a description of the chosen psychological approach and its therapy; • an evaluation of this approach and its therapy; • any relevant research evidence; • any other relevant points.