Running head: A Review of Three Treatment Protocols for Depression: 1

A Review of Three Treatment Protocols for Depression

Eleanor Wend HS 513 T301 Assignment 8.3 Bellevue University October 21, 2011

A Review of Three Treatment Protocols for Depression

Abstract This paper will review three treatment protocols for treating depression. The three protocols reviewed will be medication, psychotherapy and ECT: electroconvulsive Therapy. Keywords: Depression treatment, medication, psychotherapy, ECT

A Review of Three Treatment Protocols for Depression

Introduction Depression is the most commonly diagnosed mental illness in the world. 12% of women and 7% of men are affected by a depressive illness each year according to the NIMH web site statistics. At some point in their lives as this web site continues to report, as many as 20% of women will have at least one episode of depression and approximately 17% of adults will experience at least one major depressive episode in their lives. (NIMH, 2011) There is evidence from neuroscience, genetics, and clinical investigation demonstrating that depression is a disorder of the brain. Modern brain imaging technologies has revealed that in depression, neural circuits responsible for the regulation of moods, thinking, sleep, appetite, and behavior fail to function properly, and that critical neurotransmitters -- chemicals used by nerve cells to communicate -- are perhaps out of balance. Neuroendocrinology studies show that stressful life events may cause the onset of depressive episodes in both children and adults. Genetics research indicates that vulnerability to depression results from the influence of multiple genes acting together with environmental factors. Studies of brain chemistry, neuroimaging techniques and the mechanisms of action of antidepressant medications continue to develop new and better medical and psychotherapy treatments. (Psychcentral.com, 2011) (Johnson, Sheri L., 2009) The three most common treatments for depression are medication, psychotherapy and ECT electroconvulsive therapy. This paper will review these three treatment protocols and discuss which has the highest rate of success.

A Review of Three Treatment Protocols for Depression

Medication Treatment for Depression Medication has been used to treat depression since the 1950's. The antidepressants primarily work on brain chemicals called neurotransmitters, especially serotonin and norepinephrine. Other antidepressants work on the neurotransmitter dopamine. Scientists have found that these particular chemicals are involved in regulating mood, but they are unsure of the exact ways that they work. The latest information on medications for treating depression is available on the U.S. Food and Drug Administration (FDA) website at http://www.fda.gov. The following is an excerpt from a National Institute of Mental Health publication on depression and medications used in treatment:
Some of the newest and most popular antidepressants are selective serotonin reuptake inhibitors (SSRIs). Fluox(Prozac), sertraline (Zoloft), escitalopram (Lexapro), (Paxil), and citalopram (Celexa) are some of the most commonly prescribed SSRIs for depression. Most are available in generic versions. Serotonin and norepinephrine reuptake inhibitors (SNRIs) are similar to SSRIs and include (Effexor) and duloxetine (Cymbalta). SSRIs and SNRIs tend to have fewer side effects than older antidepressants, but they sometimes produce headaches, nausea, jitters, or insomnia when people first start to take them. These symptoms tend to fade with time. Some people also experience sexual problems with SSRIs or SNRIs, which may be helped by adjusting the dosage or switching to another medication. One popular antidepressant that works on dopamine is bupropion (Wellbutrin). Bupropion tends to have similar effects as SSRIs and SNRIs, but it is less likely to cause sexual side effects. However, it can increase a persons risk for seizures. Tricyclics

A Review of Three Treatment Protocols for Depression

Tricyclics are older antidepressants. Tricyclics are powerful, but they are not used as much today because their potential side effects are more serious. They may affect the heart in people with heart conditions. They sometimes cause dizziness, especially in older adults. They also may cause drowsiness, dry mouth, and weight gain. These side effects can usually be corrected by changing the dosage or switching to another medication. However, tricyclics may be especially dangerous if taken in overdose. Tricyclics include imipra-mine and nortriptyline. MAOIs Monoamine oxidase inhibitors (MAOIs) are the oldest class antidepressant medications. They can be especially effective in cases of atypical depression, such as when a person experiences increased appetite and the need for more sleep rather than decreased appetite and sleep. They also may help with anxious feelings or panic and other specific symptoms. However, people who take MAOIs must avoid certain foods and beverages (including cheese and red wine) that contain a substance called tyramine. Certain medications, including some types of birth control pills, prescription pain relievers, cold and allergy medications, and herbal supplements, also should be avoided while taking an MAOI. These substances can interact with MAOIs to cause dangerous increases in blood pressure. The development of a new MAOI skin patch may help reduce these risks. If you are taking an MAOI, your doctor should give you a complete list of foods, medicines, and substances to avoid.MAOIs can also react with SSRIs to produce a serious condition called serotonin syndrome, which can cause confusion, hallucinations, increased sweating, muscle stiffness, seizures, in blood pressure or heart rhythm, and other potentially life-threatening conditions. MAOIs should not be taken with SSRIs. (National Institute of Mental Health, 2011)

A Review of Three Treatment Protocols for Depression

Psychotherapy Treatment for Depression Psychotherapy has been a treatment for depression since its origins in the late 19th century when depression was referred to as 'melancholia'. The most utilized psychotherapy approaches for treating depression are cognitive-behavioral and interpersonal therapy. CBT helps people with depression restructure negative thought patterns. Doing so helps people interpret their environment and interactions with others in a positive and realistic way. It may also help you recognize things that may be contributing to the depression and help you change behaviors that may be making the depression worse. IPT helps people understand and work through troubled relationships that may cause their depression or make it worse. For mild to moderate depression, psychotherapy may be the best option. However, for severe depression or for certain people, psychotherapy may not be enough. For many patients including teens, a combination of medication and psychotherapy may be the most effective approach to treating major depression and reducing the chances of it coming back. Another study looking at depression treatment among older adults found that people who responded to initial treatment of medication and IPT were less likely to have recurring depression if they continued their combination treatment for at least 2 years. (NIMH, 2011) Electro-convulsive Therapy ECT treatment for depression This is the most controversial treatment for depression but can be very successful when other methods fail.

A Review of Three Treatment Protocols for Depression

The following is an excerpt from the NIMH publication on depression on the use of ECT as a treatment protocol:
For cases in which medication and/or psychotherapy does not help relieve a person's treatment-resistant depression, electroconvulsive therapy (ECT) may be useful. ECT, formerly known as "shock therapy," once had a bad reputation. But in recent years, it has greatly improved and can provide relief for people with severe depression who have not been able to feel better with other treatments. Before ECT begins, a patient is put under brief anesthesia and given a muscle relaxant. He or she sleeps through the treatment and does not consciously feel the electrical impulses. Within 1 hour after the treatment session, which takes only a few minutes, the patient is awake and alert. A person typically will undergo ECT several times a week, and often will need to take an antidepressant or other medication along with the ECT treatments. Although some people will need only a few courses of ECT, others may need maintenance ECT usually once a week at first, then gradually decreasing to monthly treatments. Ongoing NIMH-supported ECT research is aimed at developing personalized maintenance ECT schedules. ECT may cause some side effects, including confusion, disorientation, and memory loss. Usually these side effects are short-term, but sometimes they can linger. Newer methods of administering the treatment have reduced the memory loss and other cognitive difficulties associated with ECT. Research has found that after 1 year of ECT treatments, most patients showed no adverse cognitive effects.32 Nevertheless, patients always provide informed consent before receiving ECT, ensuring that they understand the potential benefits and risks of the treatment. Other more recently introduced types of brain stimulation therapies used to treat severe depression include vagus nerve stimulation (VNS), and repetitive transcranial magnetic stimulation (rTMS). These methods are not yet commonly used, but research has suggested that they show promise.

(NIMH, 2011) The most significant thing I learned from this research Medications seem to have the most immediate effect on treating depression but seem to vary greatly from individual to individual. They also seem to have a variety of mild to serious side

A Review of Three Treatment Protocols for Depression

effects. Additionally they may require more than one medication for example in the case of sleep disturbance when another medication may be needed to sleep. The most effective seems to be a combination of medication and psychotherapy for long term results since the individual may be at risk for recurrent episodes once they have had one round. Conclusion In conclusion the three treatment protocols for depression: medication, psychotherapy and ECT all have a role to play in helping alleviate the symptoms of the most common mental illness diagnosis. While medication may have the fastest results with approximately 80% of those diagnosed with depression experiencing some relief, it also has variable side effects ranging from mild to serious ones such as seizures and high blood pressure. A combination of medication and psychotherapy will often produce the most lasting results and reduce the re-occurrence of the depressive episodes. ECT has proven to be the most effective alternative with treatment-resistant patients.

A Review of Three Treatment Protocols for Depression

References Francis, Allen et al., Task Force. (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, D.C.: American Psychiatric Association.

Johnson, Sheri J. et al. (2009). Mood Disorders: Biological Bases. In Blaney, Paul H. & Millon, Theodore (Eds.), Oxford Textbook of Psychopathology (2d ed., pp. 198-218). New York: Oxford University Press.

National Institute of Mental Health. (2011) Depression. Retrieved October 24, 2011 from
http://www.nimh.nih.gov/health/publications/depression/how-is-depression-diagnosed-and-treated.shtml

Netherton, Sandra D., Holmes, Deborah & Walker, Eugene C. (Eds.). (1999). Child and Adolescent Psychological Disorders: A Comprehensive Textbook. New York. Oxford University Press. Psychcentral. n.d. Depression Research. Retrieved October 24, 2011 from
http://psychcentral.com/disorders/depressionresearch.htm