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

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

• Emily Murray
• 100059361

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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)

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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

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DSM-IV-TR Criteria Contd.

• (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

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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)

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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

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The Current Debate

• Is anti-depressant medication always necessary
  when treating individuals who are suffering from
  major depression disorder?

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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)

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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)

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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)

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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 individuals synapses which
  decreases the nor epinephrine levels, which
  results in depression.

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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

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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

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Those Against, contd.

• 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

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Those Against, contd.

• 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)

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Graduate Work

• Dr. Peter Horvath
• Acadia University
• Personality and Depression
• Dr. Kate L. Harkness
• Queens 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.

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Question

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

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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).