Evaluate the use of biomedical, individual and group approaches to treatment
Evaluation of a biomedical treatment of depression
Drugs are nearly always part of the treatment for severe depression. The biomedical approach to the treatment of depression is under debate. The most common treatment for depression includes drugs. Anti-depressants may reduce depressive symptoms but they have side effects and do not cure patients. Studies indicate that the placebo effect could account for the effectiveness of medication.
Some researchers and psychiatrists now criticize the heavy use of medication on the grounds that it is not well known how it affects the brain long term (see Neale et al. 2001).
There is also increasing criticism of the role of pharmaceutical companies and their marketing of antidepressants, which has led to an increase in the prescription of SSRI.
Leuchter et al. (2002) Changes in brain function during treatment with placebo
· The study examined brain function in 51 patients with depression who received either a placebo or an active medication. An EEG was used to compare brain function in the two groups. The design was double-blind and ran over nine weeks. The study used two different SSRI, which were randomly allocated to the participants.
· Results showed a significant increase in activity in the prefrontal cortex nearly from the beginning in the trial in the placebo group. This pattern was different from the patients who were treated with the SSRI but patients in both groups got better. This indicates that medication is effective but placebo seems just as effective.
· The findings from the study are intriguing. The difference in activity in the brain indicates that the brain is perhaps able to heal itself since there was a positive effect in both groups. Believing they are being treated could be enough for some patients.
Kirsch et al. (2008) Meta-analysis of clinical trials
This meta-analysis used clinical trials of the six most used anti-depressants (including Prozac) approved between 1987 and 1999.
· The study analyzed all clinical trials of anti-depressants submitted to the FDA (US Food and Drug Administration).
· The results showed that the overall effect of new-generation anti-depressant medication (SSRI) was below the recommended criteria for clinical significance. This indicates that placebo may be just as effective.
· The highest effect of the medication was in the most severe cases of depression but the researchers speculate whether this is a real effect or due to a decrease in responsiveness to placebo rather than an increase in responsiveness to medication.
· According to the researchers, the placebo effect may account for any observed effect and they are very skeptical about the increasing use of anti- depressants on the basis of the results of the clinical trials.
Evaluation of an individual approach to the treatment of depression
Individual treatments are normally effective. Cognitive theories have been criticized for focusing too much on symptoms (distorted thinking patterns) rather than causes of depression.
The combination of behavioral techniques with cognitive restructuring in CBT seems to be effective, even in the absence of medication (Luty et al. 2007). Studies that combine medication with CBT have good results, see (Paykel et al. 1999).
Elkin et al. (1989) Controlled outcome study of treatment for depression.
· The study is one of the best controlled outcome studies in depression. It involved 280 patients diagnosed with major depression who were randomly assigned to either (1) an anti-depressant drug plus the normal clinical management, (2) a placebo plus the normal clinical management, (3) CBT or (4) IPT. The treatment ran for 16 weeks and the patients were assessed at the start, after six weeks, and after 18 months.
· The results showed a reduction of depressive symptoms of over 50% in the therapy groups and in the drug group. Only 29% recovered in the placebo group. There was no difference in the effectiveness of CBT, IPT or anti-depressant treatment. This indicates that psychotherapy might be an alternative in some cases.
· The recovery rate for therapy (psychological and drug) was only 50% in this study so neither of the treatments can guarantee recovery for all patients.
Evaluation of a group approach to treatment of depression
· Group therapy has been used to treat depression but it may not be appropriate as the only therapy and it should only be used when clients are positive about treatment in a group.
· Modern forms of group therapy include ideas from Buddhism and ideas from cognitive therapy. It seems to be a promising way to treat depression but it may be suitable only for clients who are not severely depressed.
McDermut et al. (2001) Meta-analysis on effectiveness of group therapy for depression
· The study was a meta-analysis based on 48 studies published between 1970 and 1998. The patients’ mean age was 44 years and 78% of patients were women. All but one study included a cognitive and/or behavioral treatment group.
· Results showed that 45 of the 48 studies reported that group psychotherapy was effective for reducing depressive symptoms. The overall results showed that group psychotherapy was more effective than no treatment around 19 weeks after the end of treatment. Nine studies showed that individual and group psychotherapy were equally effective.
· The conclusion was that there is sound empirical support that group therapy is effective for relieving depressive symptoms. Truax (2001) commented on the results saying that group therapy should only be used when clients are positive about treatment in a group. The meta-analysis did not include severely depressed and suicidal patients in the study so it is not possible to conclude anything in relation to this group.