Is Anti-Depressant Medication Always Necessary For Treating Major Depression Disorder?

1. Is Anti-Depressant Medication Always Necessary For Treating Major Depression Disorder?  Emily Murray 100059361

2. Depression Defined: • Depression is a normal reaction to grievous loss. However, when depression is excessive, disruptive, and recurring, it is classified as a psychiatric disorder (Pinel, 2003) • Depression as a disorder is sometimes characterized by symptoms such as persistent feelings of hopelessness, dejection, poor concentration, lack of energy, inability to sleep, and, sometimes, suicidal tendencies (Mash & Wolfe, 2005)

3. The Main Features of the DSM-IV-TR Diagnostic Criteria for Major Depressive Episode • Five or more of the following symptoms listed below be present during the same 2-week period and represent a change from previous functioning; at least one symptom is either (1) depressed mood or (2) loss of interest or pleasure (Mash & Wolfe, 2005): • (1) Depressed mood most of the day, nearly every day, as indicated by subjective account or observations by other • (2) Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by subjective account or observations by others) • (3) Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day • (4) Insomnia or hypersomnia nearly every day

4. DSM-IV-TR Criteria Cont’d. • (5) Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down) • (6) Fatigue or loss of energy nearly every day • (7) Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick) • (8) Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others) • (9) Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

5. Prevalence of the Disorder • Depression is now ten times more likely to occur in individuals than it was in 1960 (Paradise & Kirby, 2005) • It is estimated that as much as 10% of the population may suffer from this disorder and that it may be the most prevalent problem that is facing counselors today (Paradise & Kirby, 2005) • Research suggests that depression is the most common disorder experienced by people who see mental health practitioners and that from one third to more than 60% of mental health professions had reported a significant episode of depression within the previous year (Paradise & Kirby, 2005)

6. Different Therapies for Treating the Disorder • Paradise & Kirby (2005) identified the most widely used approaches to treating depression: • Psychodynamic therapy • Interpersonal psychotherapy • Cognitive behavior therapy • Marital and family therapy • Antidepressant medication therapy

7. The Current Debate • Is anti-depressant medication always necessary when treating individuals who are suffering from major depression disorder?

8. Background History to the Debate • The complexities of the debate between psychotherapy and psychopharmacology stem from a historical conflict between the advocates of the two approaches. The earliest advances in biological psychiatry challenged the unquestioned dominance of psychoanalysis, which provoked the both sides of the debate to trivialize, if not demonize each other. (Winston, Been, & Serby, 2005)

9. How Antidepressants Work: • The serotonin transporter is the molecular target of many antidepressants, and the gene (SLC6A4) encoding this protein has been associated with response to selective serotonin reuptake inhibitors (SSRIs) (Kraft, Slager, McGrath, & Hamilton, 2005) • There are four types of antidepressant drugs: • Monoamine Oxidase Inhibitors • Monoamine agonist that increases the levels of amines by inhibiting the activity of monoamine oxidase (MAO), the enzyme that has been found to break down monoamine neurotransmitters in the cytoplasm of the neuron (Pinel, 2003) • Tricyclic antidepressants • Block the reuptake of both serotonin and nor epinephrine, thus increasing their levels in the brain (Pinel, 2003)

10. How Antidepressants Work • Lithium • Therapeutic effects are thought to be mediated by its agonistic effects on serotonin function (Pinel, 2003) • Selective monoamine-reuptake inhibitors • Exert agonistic effects on serotonergic transmission by blocking the reuptake of serotonin from synapses (Pinel, 2003)

11. Those For Antidepressant Medication Therapy • Biological cause: That depression is due to biological factors • Mainly that there is an insufficient amount of serotonin in the individual’s synapses which decreases the nor epinephrine levels, which results in depression.

12. Research Findings Supporting the Use of Antidepressant Medication Therapy • As noted by Paradise & Kirby (2005), reasons to use antidepressant medication as a form of therapy for depression include: • their clear effectiveness to treat the disorder • how the drugs provide a measure of protection against relapse as long as the user continues to take the medication as was prescribed • An approximate fifty percent response rate to the medication • Psychodynamic therapy lacks the adequate empirical evidence of its efficacy • Its results are just slightly better than those of placebo medications • According to Kraft, Slager, McGrath, & Hamilton (2005) selective serotonin reuptake inhibitors (SSRIs) are effective medications for MDD and are the most widely prescribed antidepressants worldwide

13. Those Against Antidepressant Medication Therapy • Believe that there are other ways to treat depression and that depression is not always caused by biological factors • Past research has found that: • Interpersonal psychotherapy has demonstrated its effectiveness as a treatment for major depression. In comparison studies it has shown it is as effective as medication approaches (Paradise & Kirby, 2005). • The overall effectiveness of psychotherapy with depressed children and adolescents has been supported in at least three recent meta-analytic reviews (Michael, Huelsman, & Crowley, 2005) • Winston, Been & Serby (2005) attested that all practitioners need to recognize and acknowledge those cases that do not progress in therapy and may respond well to drugs as well as those patients who may improve through a “talking cure” without the use of psychotropics

14. Those Against, cont’d. • Most clinicians recognize that many patients require both drug treatment and psychotherapy as in the studies reviewed by Winston, Been & Serby (2005) where it appears to indicate that a combined approach of medication and psychotherapy is most advantageous for severe, recurrent depression; chronic depression; and depression in the elderly. For other types of depression, combination treatment may not be better at reducing depressive symptoms but may have a broader effect, particularly on social adjustment

15. Those Against, cont’d. • Ethical issue • The downside to medication: • Discontinued use does not protect one against relapse (Paradise & Kirby, 2005) • Motivation, bad side effects, cost, and so on, all contribute to negative outcomes over time (Paradise & Kirby, 2005) • Side effects for these medications include insomnia, nausea, vomiting, tremors, and memory impairment, to name just a few (Paradise & Kirby, 2005)

16. Graduate Work • Dr. Peter Horvath • Acadia University • Personality and Depression • Dr. Kate L. Harkness • Queen’s University • Etiology and pathology of major depression in adolescents and adults. • Dr. Peter Mcleod • Acadia University • Depression, Anxiety, Stress, & Coping; The Psychology of Control • Dr. David Zuroff • McGill University • Relations between personality, especially dependency and self-criticism, and psychopathology, especially depression.

17. Question • Do you believe that medication should be used to treat individuals with depression?

18. References Kraft, J.B., Slager, S.L., McGrath, P.J., & Hamilton, S.P. (2005). Sequence analysis of the serotonin transporter and associations with antidepressant response. Biol Psychiatry, 58, 374-381. Mash, E.J., & Wolfe, D.A. (2005). Mood Disorders. In E.J. Mash & D.A. Wolfe, Abnormal Child Psychology (3rd ed., pp. 224-225). Toronto: Thomson Wadsworth. Michael, K.D., Heulsman, T.J., & Crowley, S.L. (2005). Interventions for child and adolescent depression: do professional therapists produce better results? Journal of Child and Family Studies, 14(2), 223-236. Pinel, J.P.J. (2003). Affective Disorders: Depression and Mania. In J.P.J. Pinel, Biopsychology (5th ed., pp. 468-469). The United States of America: Allyn and Bacon. Paradise, L.V., & Kirby, P.C. (2005). The Treatment and Prevention of Depression: Implications for Counseling and Counselor Training. Journal of Counseling and Development, 83, 116-119. Winston, A., Been, H., & Serby, M. (2005). Psychotherapy and psychopharmacology: different universes or an integrated future? Journal of Psychology Integration, 15(2), 213-223. http://hawthorne.mfriends.org/faculty/Biology/cmb-2000/cmb-kd/Biochemical Causes.htm (Retrieved on October 15, 2005).