The Most Effective Treatments for Depression - Literature review Example

 CHEMICAL INTERVENTION FOR DEPRESSION Introduction Depression is one of the most common forms of mental disorder. It has long time prevalence as high as 15%, and is linked with substantial morbidity as well as mortality, and inflicts a considerable burden in developing and also the developed countries. Based on the recent data, the unipolar major depression ranked the fifth leading cause of global disability, accounting for approximately 4% of the world’s entire burden of disease. Despite this, it is an obscure illness: people keep their depression secret; doctors choose not to recognize it; the cause is unknown; treatment is viewed with suspicion; and other conditions are given higher priority. (Baldwin & Birtwistle, 2002 p 5; par 1-3). The affective or ‘mood’ disorders are a group of related conditions including the depressive disorders, mania and hypomania, in which the primary disturbance is thought to be one of mood or affect. The separation of the anxiety disorders from the depressive disorders into distinct diagnostic groups is the subject of some controversy. It is one disorder (Ormel J, Tiemens B., 1997) with serious interpersonal, personal and societal consequences, which affect about 15% of the broad population and accounting for roughly 10% of consultations in primary care. The same investigation revealed that, women are twice as probable to suffer from depression rather than men and symptoms most likely increase with age. There are also available studies which suggest that, the incidence of depression exist in younger age groups, predominantly young men, which may be associated to the comparative rise in suicide rates. Clinical Manifestations of Depression According to Baldwin and Birtwistle (2002 p 5; par 4), it is never difficult to recognize depression, for as long as the right questions are raised in the correct manner. More assessment of distinguished cases need not be exceptionally time-consuming. In fact, doctors and patients can select from a range of effective as well as acceptable treatments and people can then get better. Doctors the key characteristics of the depressive disorders, Piccinelli (1998) said, include: reduced energy, low mood and loss of interest or enjoyment. Some other common symptoms reiterated by the World Health Organization (2002), include poor concentration, guilty thoughts, pessimism, reduced self-confidence, ideas of self-harm or suicide, altered appetite and disturbed sleep. Prevalence and Incidence Surveys of the general population in the UK reveal widespread negative public attitudes to depression. In a 1991 survey of the public conducted on behalf of the United Kingdom Defeat Depression Campaign5, only 16% believed people with depression should be treated with antidepressants, while 90% thought counseling should be used, which has disputed efficacy in the treatment of depression. In addition, the vast majority (78%) of the sampled general population believed that antidepressant drugs are ‘addictive’, probably confusing them with benzodiazepine anxiolytics. At a personal level depression causes significant psychologic distress, reduces quality of life and increases the mortality from cardiovascular disease, accidents and suicide, which is the cause of death in approximately 10% of patients with a severe recurrent depressive disorder. It can contribute to marital and family breakdown, and in depressed mothers may delay the development of their children. In addition there is a direct economic burden on society from health and social care costs, and indirectly through lost working days and the costs of premature mortality. Therapeutic Interventions of Depression There are many available therapies for depression and some include: 1. Use of Drug Therapy such as trycyclic antidepressants ( Monoamine oxidase inhibitors, Selective serotonin, Norepinephrine inhibitors); 2. Physical treatments like Electroconvulsive therapy (ECT) and light therapy; and 3. Psychologic Therapies such as Problem solving treatment, Interpersonal Therapy, Non-directive Counseling and Cognitive Behavior Therapy (Baldwin and Birtwistle 2002). Cognitive–behavior therapy (CBT) is considered as one of the most widely researched and widely used psychological treatments as far as depression is concerned. The said therapy is based on the premise that depressive moods are responsible for and maintained through illogical beliefs and a deformed attitude on the road to oneself, ones environment and the future. Cognitive–behavior therapy (CBT) CBT sessions are standardized, usually carried out in about 20 min. Patients are usually asked to perform definite tasks, like recording daily activities and their negative thoughts when they occur. Cognitive therapy is predominantly effective when complemented with antidepressant therapy, and has also been found effective in the prevention of relapse when administered in monthly ‘booster sessions’ subsequent to successful treatment with antidepressant drugs. Almost 60 years has passed since the first cognitive behavioural therapies by Albert Ellis’ and Aaron Beck’s emerged. It was in 1990 (Carroll & Onken, 2005, p. 1452) when the therapy been valuable and made available for the treatment of substance abuse and dependency. Cognitive behavioural therapy (CBT) is certainly a well-established type of treatment for a selection of presenting and underlying issues, as well as its central precept (Gabour & Ing, 1991, cited in Csiernik, 2003, p. 182) is that “individuals’ problems occur from their evaluations, beliefs, and interpretations concerning life events”. However, Dr. George Woody in a 2003 criticized CBT as individual and treatment for individuals with substance dependencies. Woody argued that psychotherapy ought to be used as a derivative treatment to drug counselling, and should not be a standalone treatment that may only be useful to small subpopulation of abusers (p. 525). Similar criticism was also presented in the NIDA manual, that cautioned against the use of CBT with simultaneous diagnosis of patients who are not stable, who do not practically have stable housing; those individuals who are not “medically stable and (NIDA, 1998, pp. 5-6) patients with any DSM-IV personality disorder. On the opposite of Dr. Woody, NIDA was more positive by stating that individuals who did not qualify the definition of a perfect candidate for CBT may still succeed in inpatient settings. On this ground, Ronen suggests that the clinicians must exercise flexibility and adaptability as they apply CBT techniques with patients who may not have cognitive skills which the original representation was designed for (p. 76). Regarding the second criticism, the author further encourages therapists to obtain on a more constructivist approach that would not “create the disagreeable belief in which clients should aspire to change as swiftly and as expansively as possible” (p. 77). Given that “constructivism put emphasis on accepting, living with, and disclosing oneself up to experiences” (p. 77), the clients can be assisted to accept their recent situation without the strains of a therapist who require immediate changes in their lifestyle. Ordinary adaptation to CBT practice will unlock the model up to a larger population of clients as well as with greater success. It will then also keep away from the temptation to execute any model, apart from its effectiveness and theoretically sound groundwork. CBT is best applied on an individual basis, in fact, comparative studies have proven that CBT has one and the same outcomes in both individual as well as group set ups (Marques & Formigoni, 2001; Sharp, Power, & Swanson, 2004). Probably, the individualized counseling approach depicts more of a practice ideal as compared to the realities of available evidence. For substance abuse in particular, the mainly common variations of CBT which have been proposed as treatments comprise skills training, motivational interviewing, contingency management therapies, and cognition-focused drug counseling (Carroll & Onken, pp. 1453-56). In 1998, the National Institute on Drug Abuse (NIDA) in US published a practitioner’s manual about cognitive behavioural treatment of addiction in cocaine (NIDA, 1998, p. 1). Interestingly, reasons for recommending CBT were definite to cocaine abuse. CBT is also principally conducted in the community-based outpatient settings and is flexible to adapt client’s therapeutic needs (Csiernik, 2003, p. 205). In many cases, including those which are not related to the substance dependency, this therapy have been shown effective in combination with other treatment options like self-help groups, pharmacotherapy, family and couples therapy, parenting skill training and vocational counseling (NIDA, 1998, p. 6). Addiction as one biopsychosocial phenomenon, CBT efficacy therapies with a number of adjunctive is promising because many clients may also need an emotional, social, or environmental intervention in order to ensure that the entire person is getting support. This way, the strength of this modality in reinforced since this is naturally not an attribute of treatments which emerged from the illness or moral models. Therefore, cognitive behavioral therapy is effective as well in a collaborative approach to treatment. Client and therapist have to mutually agree on treatment goals with consideration of the skills and knowledge of the professional as well as emphasis on the client’s problem(s) which is or to be identified. (NIDA, 1998, p. 23). Csiernik (2003, p. 182) suggests that, “the foremost step in CBT is to acquire a functional analysis of the patient’s behaviours related with drug use emphasizing on patterns of use and frequency.” Throughout a functional analysis, the individual and clinician work to recognize and explore the “feelings, thoughts, and circumstances” adjoining the substance use (NIDA, 1998, p. 2). Additionally, it is favorable later in treatment to “make out those circumstances or states in which the person still has difficulty in coping” (p. 2). It is helpful that the clinician should uphold a nonjudgmental stance at all times, given that chronic drug abuse is characteristically a coping mechanism for unsettled, underlying issues. In addition, if and when substance dependent individuals search for the intervention; they may be applying their drug of choice “as a single way of coping with a broad range of interpersonal as well as intrapersonal problems” (NIDA, p. 2). The premise behind skills training in CBT is that (1) the individual never learned effective coping strategies for life’s challenges, (2) once acquired coping strategies have now been lost, or (3) the individual’s ability to employ learned strategies is hindered by another underlying issue (NIDA, 1998, pp. 2-3). Skills training “places the client as active learner with the counselor as teacher” (Csiernik, 2003, p. 182). The goal is to “strengthen and broaden the individual’s range of coping styles,” and the client is taught generalizable skills that can be applied to many of life’s challenging situations (NIDA, p. 3). Thus, one of the greatest features of CBT-focused skill training is that clients will learn and retain skills for their benefit well after treatment ceases (NIDA, p. 3). Rounsaville and Carroll presented five tasks which must be achieved in order for CBT to be flourishing for substance dependents (1992, cited in NIDA, 1998, pp. 3-4): Firstly, foster the drive for abstinence; Secondly, Teach coping skills, Next would be to change reinforcement contingencies, Fourth, is to foster management of throbbing affects, and finally to improve interpersonal functioning as well as enhance social supports. Every task represented is an important aspect of the addiction treatment when the concept is understood in a biopsychosocial framework. Common sense would speak that clients must learn to implement new skills subsequent to treatment particularly if they are expected to be persuaded into reusing drugs as a coping mechanism; on the other hand, if the client fails following treatment, it is unjust to blame the person if no acknowledgment is raised to his or her social environment. Improving social supports and interpersonal functioning elucidates the significance of understanding the patient’s social/environmental framework during addiction treatment. Besides, biologically focused intervention alone is destined to be unsuccessful if the client is detached to his or her same environment. One of the weaknesses of cognitive behavioural therapy, which was formerly mentioned, is that it is best fitted for a small, homogenous group of superior order thinkers. Aharanovich, Nunes, and Hasin (2003) carried out small but thorough study to examine the weight of impaired cognitive functioning to that of CBT-focused treatment outcomes. The authors purported to scrutinize whether the ineffectiveness of CBT in the company of some clients has relationship to demographics, insufficient motivation, or poor cognition (p. 209) and it came out that the participants in the low-cognition group were likely to drop out of the intervention program early, less likely to withdraw from using cocaine for the period of the 15-week treatment program (p. 209). Furthermore, they struggled with universal tests of cognition that suggests “difficulties in capacity to hold, focus, and sustain concentration (p. 209). The authors concluded that it is the differences and not the insufficient motivation or demographic factors can prevent persons with inferior cognition from succeeding with CBT apart from of the setting. One significant practice implication can be established from the above stated study; namely, that even while working with clients contained by an evidence-based framework, as well as even though clients’ circumstances may appear to be fitting with that modality, fundamental subtleties may put off them from succeeding. Therefore, failure is not unavoidably a result of the clinician’s insufficient competence, the client’s personal shortfall, or a need of support for the said treatment modality. This minimally speaks to a recurring subject matter in substance abuse treatment: the main concern of a thorough assessment and corresponding process with our clients down the treatment scale. With the contents of this conversation in mind, it can be said that Cognitive Behavior Therapy may be the best among behavioural psychotherapies which are intended for substance abuse treatment. The Research Society on Alcoholism in 2002, an international organization which is committed to discuss, conduct research, preventing, as well as treating alcoholism, came out with an idea that “Specific treatment is better as compare to the standard treatment” (p. 1650). Therefore, whether using CBT, a 12-step intervention program, motivational enhancement, dynamic psychotherapy, or family therapy, it resulted to the fact that the “effects on alcohol dependence” is much more favourable when compared to an unstructured, generalized counseling technique (p. 1653). Health care workers needs to understand substance addiction as a complex as well as interactive biopsychosocial phenomenon, thus, must ensure that the client’s unique experience is fitting with one or extra of the accessible treatment resources. Unfortunately, practitioners who lack knowledge o the concept of CBT are usually violating the rules about client-centeredness as well as deciding on a proper treatment according to the counselor’s or organization’s needs (Csiernik, 2003, p. 154). The client must be the ultimate determiner of her or his treatment goals as well as benchmarks of success. It must always be noted that, failure to recognize and treat depression will raise statistics of morbidity and mortality among elderly populations. It will also increase demands on relatives, social services and health services. When necessary, specific recommended antidepressant treatment is safe and effective even with comorbid physical illness. References Cited Aharanovich, E., Nunes, E., & Hasin, D. (2003). Cognitive impairment, retention, and abstinence among cocaine users in cognitive-behavioral treatment. Drug and Alcohol Dependence, 71, 207-211. Alcoholism: Clinical and Experimental Researcher, 27(10), 1645-1656. 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