Depression is one of the most talked-about and known mental illnesses. Its symptoms can range from persistent low moods, poor concentration, and increased anxiousness to finding it hard to complete basic tasks you were able to do before, such as getting out of bed. The symptoms and severity of depression vary from person to person; this is why many depression treatments have become available. An intervention that works for one may not work for another.
- We will start with a depression treatment overview, which will briefly introduce available depression treatments.
- We will then focus on the main depression treatments offered today; these include cognitive behavioural therapy and the antidepressant treatment of depression.
- To finish off, we will look at alternative depression treatments such as psychodynamic and interpersonal therapy.
Depression is a mental illness characterised by a persistent low mood, freepik.com/storyset.
Depression Treatment Overview
Let's take a look at a brief summary of the depression treatments that are available!
- Cognitive behavioural therapy – this intervention is widely accepted by cognitive psychologists, who argue that the illness should be treated via teaching coping strategies and helping client's overcome and change negative thoughts.
- Antidepressant treatment – biological psychologists tend to favour this depression treatment, as it works to block the reuptake of specific neurotransmitters.
- Psychodynamic therapy – psychodynamic psychologists consider this an effective depression treatment. The intervention aims to resolve unconscious conflicts that may be manifesting as depression symptoms.
- Interpersonal therapy – the intervention has psychodynamic origins. However, it takes more of a biopsychosocial approach to treat depression. The therapy considers and tries to overcome biological, social and psychological contributors to depression.
Cognitive Behavioural Therapy
Cognitive behavioural therapy is a common depression treatment with large degrees of success. The aim of the intervention is for therapists to help clients recognise maladaptive thoughts and form strategies to cope with potential stressors that contribute to depression symptoms, and teach them how to adjust maladaptive thoughts to adaptive thoughts.
Maladaptive thoughts refer to false beliefs and irrational thoughts that can contribute to the onset, maintenance, and relapse of mental illnesses such as depression.
Cognitive behavioural therapy is a structured programme that usually lasts between 8 – 12 weeks. The intervention is considered short-term and typically offers approximately 10 sessions. During the sessions, the client and therapist work together to try to combat cognitive factors that may be contributing to the individual's depression.
The standard framework of cognitive behavioural therapy, depression treatment used is:
- The client will discuss their issues with a therapist, during this the therapist will attempt to identify potential factors that may be contributing to their depression.
Some things that a therapist may try to identify are irrational beliefs and maladaptive thoughts, such as negative automatic thoughts. An example of an irrational belief of a depressed person is: “no matter how hard I try no one ever likes me.”
A negative automatic thought may be: “there’s no point in trying because I always fail."
- After the therapist has identified negative thoughts, the therapist will try to identify the emotions that they evoke, such as sadness or anxiety.
Depression and anxiety are mental illnesses that commonly occur together; this is known as co-morbidity.
- People who are depressed commonly are not aware that they have these automatic thoughts. Therefore, the therapist will attempt to point this out to them.
- Once the issues have been recognised the therapist will teach the individual coping strategies, changing maladaptive thoughts to adaptive thoughts and help clients rationalise irrational beliefs that they may hold.
Cognitive behavioural therapy is an intervention that is directed by the flow of the therapist, freepik.com/pch.vector.
Usually, depressed people are unable to cope with negative life events or stressors which cause their minds to spiral. The role of the therapist is to teach them how to deal with situations that evoke depression and its symptoms
A person's work may disappear from their computer. A depressed person is likely to attribute the event to a personal failure and ruminate over the issue, potentially spiralling into feelings of hopelessness, sadness, and possibly even guilt.
A therapist will ask the client to approach the problem in a different way, and avoid placing blame on themselves altogether whilst setting up fail safes to avoid situations like this in the future. They will work through the maladaptive thoughts and feelings and seek to encourage behaviours that establish routine and comfortability.
Although anyone would be frustrated in this situation, a person with depression may be more emotionally affected by a situation like this.
A therapist will also try to rationalise an individual's irrational beliefs. If an individual believes that there is something wrong with them and that’s why no one likes them, the therapist will point out this as untrue and may discuss the positive relationship the individual may have with their parents or some people that the client may have discussed earlier.
Evaluation of cognitive behavioural therapy
A systematic review that analysed 4335 adolescents revealed that 63% of participants were unlikely to develop depression when they were followed up (Oud et al., 2019). As the study was done on a relatively large sample, the results are generalisable.
The findings support that cognitive behavioural therapy is a relatively effective depression treatment. Another strength of the intervention is that it delivers quite fast results, which would be useful for people who are severely depressed that may need quick results.
However, a problem with the intervention is that it does not aim to understand or overcome the root of the problem. Some psychologists argue this is problematic as they suggest these underlying conflicts are what causes depression and if these underlying conflicts are not resolved then the mental illness will continue to exist.
Psychodynamic psychologists tend to hold this view.
Similarly, this programme is very rigid and structured therefore, the same structure is used for everyone. Therefore, the intervention does not consider individual differences; what works for one person may not work for another.
Wiles study on the effectiveness of CBT
Wiles et al. carried out a study that compared treatment-resistant depression patients who only received antidepressants and patients who received CBT alongside antidepressants. The study recruited 469 participants across the UK, the chosen participants were identified as treatment-resistant (depressive symptoms had not improved after taking antidepressants for longer than six weeks).
Participants who received CBT along with the medication had between 12-18 sessions with a clinical CBT therapist. When the study came to a conclusion, 47 participants had dropped out of the study.
Beck's Depression Inventory was used to measure depressive scores before ad after the study, the inventory is a self-report measure which gives a score reflecting depression severity. The results revealed that 21.6% of the antidepressant-only condition reported a 50% reduction in depression symptoms and 41.6% reported this in the antidepressant and CBT group.
The results suggest that a holistic approach (multiple interventions) is better for improving a patient's depression.
Antidepressant Treatment For Depression
Cognitive behavioural therapy is one of the steps taken as a depression treatment. If the intervention is not effective or the individual’s symptoms are too severe, then they are likely to be prescribed antidepressant medication.
Common antidepressant drugs that are prescribed are known as selective serotonin reuptake inhibitors (SSRIs). Low levels of the neurotransmitter, serotonin, have been linked to depression.
Neurotransmitters are chemical messengers within the brain.
To help you understand how SSRIs work, let’s quickly go over how neurotransmitters may contribute to depression.
- Neurons use neurotransmitters to send messages and signals to the brain.
- When a neuron is “activated” they release neurotransmitters into the synapse.
- These move through the synapse and attach to a target receptor. Think of this as a lock and key, only a certain key will open a lock, and this is the same for neurotransmitters. The target receptor is attached to the post synaptic neuron next to the presynaptic neuron that initially sent the chemical message.
- Once the message has been relayed, the neurotransmitters that have not “locked” to receptors are 'cleaned up', this process is known as re-uptake.
Similar to a lock and key, only specific neurotransmitters can bind to specific receptors, freepik.com/eamesbot
The low abundance of serotonin in the synapses is what is thought as a cause of depression. SSRIs work by preventing the re-uptake of serotonin which leads to a higher abundance of serotonin in the synapse, which has been linked to less severe depression symptoms.
Evaluation of the antidepressant treatment of depression
Research by Ramsberg, Asseburg and Henriksson (2012) found that Escitalopram, a form of antidepressant that is classified as an SSRI, is one of the most effective antidepressant treatments in terms of the highest remission rates and most cost-effective.
The results indicate that some SSRIs are effective at lowering and preventing symptoms from re-occurring. As the drug treatment is cost-effective, it may be easily available for many to use.
However, similar to cognitive behavioural therapy, there are issues with this depression treatment. The intervention can be considered reductionist, as it only considers the biological factors that contribute to depression. To combat this problem, many healthcare practitioners often prescribe these medications and offer some forms of therapy alongside them. Moreover, similar to other interventions, it does not try to get rid of the root of the problem which may make relapse more likely.
Alternative Depression Treatments
Although cognitive behavioural therapy and antidepressant depression treatment are the most common depression treatments offered, there are alternative methods. Let’s briefly discuss psychodynamic therapy and interpersonal therapy as alternative depression treatment interventions.
Psychodynamic Therapy
The aim of this therapy is to uncover hidden unconscious memories or conflicts that may be repressed from childhood that may be contributing to the individual's depression.
Someone may have been abused by an ex-partner of their parents and repressed the memories, causing them to forget it happened.
The therapist's goal is to help the client resolve these unconscious conflicts, such as via free association or transference.
Free association is used to help a client recognise hidden thoughts, feelings, and memories. The technique involves the therapist saying a random word and without thinking the client has to respond with the first word that comes to their mind.
If the therapist says hate and the client responds father; then it suggests they have issues with their parent.
The therapist will be less apparent with the words that they use.
Transference occurs when the individual projects their feelings toward another onto the therapist. Most interventions such as cognitive behavioural therapy frown on this occurring. But psychodynamics believe that this allows the therapist to truly understand the client, and they can use this to direct and work through the issues that the two may be having.
Interpersonal Therapy
Interpersonal therapy takes the form of talk therapy. The basis of the intervention is that poor quality relationships contribute to depression. The intervention's goal is to help recognise and deal with problematic relationships the individuals may have or previously had.
Inventories have been established to identify such problems that assess past and current relationships.
You can probably see the psychodynamic origins here!
The therapist may work with the individual and their spouse to help establish a better relationship. The individual is taught how to use the “healthy” relationship as a template for future relationships and to teach them how to direct their own future behaviour, e.g., not allow someone to manipulate them.
Depression Treatment - Key Takeaways
- Cognitive behavioural therapy
- Antidepressant depressant treatment such as SSRIs block the reuptak of serotonin to increase serotonin levels, which has been linked to decreasing depressive symptoms.
- Wiles et al. established that a holistic rather than reductionist approach is better to treat depression, e.g., the use of multiple intervention techniques that target different factors that may contribute to depression.
- Psychodynamic therapy uses techniques such as free association and transference to uncover and solve unconscious conflicts/ memories that may be causing depression.
- Interpersonal therapy aims to improve the individual's relationships with those close to them as a way to treat their depression.
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