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Different psychological approaches to treating depression - Part 1

Different psychological approaches to treating depression - Part 1

Depression is a serious mental illness that affects around one in ten of us at some point in our lives, and therefore it is important to have effective treatments available. This is particularly important as major depression, if left untreated, can lead to suicide.

     The biological approach assumes that depression can be explained by chemical imbalances, such as elevated or reduced levels of neurotransmitters such as serotonin and noradrenalin. As such, biological psychologists believe that depression should be treated by, for example, correcting the imbalances. Chemotherapy, also known as drug therapy, attempts to correct neurotransmitter activity in three different ways. SSRI’s (selective serotonin re-uptake inhibitors) prevent serotonin being reabsorbed in the synapse where it has been released, which leads to an increase in activity and thus, an elevation in mood. Tricyclics prevent the breakdown of both serotonin and noradrenalin in the synaptic cleft. MAOI’s (Monoamine oxidase inhibitors) also prevent the breakdown of serotonin. There has been numerous evidence to support the effectiveness of chemotherapy, such as Rockville’s research in 1993, wherein he found that after three months of treatment, fifty to sixty-five per cent of patients given antidepressants had significantly improved, compared with only twenty-five to thirty per cent of those given the placebo. However, this also suggests that there may be the expectation of the drug to work playing a small part in reducing symptoms, but that it is largely the drug affecting the neurotransmitter activity that has caused the improvements. Though, simply due to the fact that there are a wide number of antidepressants shows that there is not one treatment that is effective for everybody; essentially it is a matter of trial and error of the antidepressants that are available, which may in turn discourage a patient from continuing treatment, particularly in their depressed state. The fact that drug therapy takes a substantial amount of time to take effect, as illustrated by Rockville’s research taking three months, could also make patients unwilling to continue with treatment as they may feel they cannot be helped, and of course, they want to feel better instantly.

     A cognitive treatment for depression is cognitive behavioural therapy, or CBT. This treatment is based on the assumptions that mental illness is due to maladaptive thought processes, and also that behaviour is learned, and therefore, it can be unlearned. The aim of this therapy is to identify and consequently challenge patients’ negative schemas and thereby modify their behaviour. Patients keep a diary of events and how they felt, in order to establish triggers. Then, the therapist sets the patients challenges in order for them to disprove their beliefs themselves, as it is likely they may not believe what someone else tells them, due to their depression. For example, someone may believe they do not enjoy going out with friends, so they may be asked to go to the cinema with friends, and they would probably enjoy it without feeling too out of their comfort zone, and would therefore have disproved their negative belief. Wampold et al conducted a meta-analysis in 2000, and found that CBT did effectively treat depression. Another earlier meta-analysis by Dobson also showed that cognitive therapy is superior to no treatment or to placebo. However, in comparison with other treatments, CBT takes a while to become effective, and can be difficult initially due to the commitment it requires; if the patient does not willingly comply and actually have some desire to get better, or at least believe that they can, then it is hard for the treatment to work. A typical symptom of depression is lack of motivation, and a feeling of helplessness, so this is potentially an issue for many patients. 



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