Treatment: Depression

• Examine biomedical, individual and group approaches to treatment
• Evaluate the use of biomedical, individual and group approaches to the treatment of one disorder
• Discuss the use of eclectic approaches in treatment
• Discuss the relationship between etiology and therapeutic approach in relation to one disorder

1. Biological:
- Janowsky et al suggested that depression may stem from an imbalance in neurotransmitters. He gave participants a drug that decreased noradrenaline in their body, and found that participants became profoundly depressed within minutes of having taken the drug. The fact that depression can be artificially induced by certain drugs suggest that some cases of depression might stem from a disturbance in neurotransmission.
- Teutung et al analysed and compared urine samples from depressed and non-depressed patients. He found that depressed people's urine had lower levels of noradrenaline and serotonin compared to non-depressed patients, and concluded that depressed people have lower levels of certain neurotransmitters. 

Biomedical:

The biomedical approach is based on the assumption that if the problem is caused by biological malfunctioning, drugs can be used to restore the biological system. Since depression involves imbalances in neurotransmitters (typically low levels of serotonin/adrenaline), then drugs can be used to elevate a depressed mood. Most common groups of drugs are known as SSRIs - selective serotonin reuptake inhibitors - which increases the level of serotonin.

Studies For:
- Bernstein et al found that antidepressant drugs are an effective way to treat depression in the short run, significantly helping 60-80% of people.
- Kirsch and Sapirstein analysed the results from 19 studies, covering over 2318 patients who had been treated with SSRIs, and found that antidepressants were 25% more effective than a placebo.
- Cujipers et al found that medication was more effective in psychotherapy in improving symptoms, but that the best results were found in studies that used a combination of drugs and medication.

Studies Against:
- Blumenthal et al found that exercise was just as effective as SSRIs in treating depression in an elderly group of patients
- Leuchter and Witte found that depressive patients receiving drug treatments improved just as well as those receiving a placebo. Researchers argue that the brain does not respond to the same way to placebos and drugs, but people's mental health improved even when on a placebo, indicating that there are other ways to improve from depression other than antidepressants, which may have side effects.

Evaluation:
Generally, antidepressant drugs are an effective way to treat depression, but only in the short term. Just relying on drugs will not cure depression, as well as they have side effects, such as sexual problems, insomnia, and dry mouth. It is also argued that drugs do not target the problem, but just address the symptoms. It is therefore important for patients to use a combination of both drugs and therapy - drug itself is unlikely to make the disorder disappear permanently.

2. Cognitive:

- Beck et al suggested that cognitive distortion theory of depression, which are ways in which our mind convinces us of something that isn't true. He proposed that a person's cognitive vulnerability to depression is based on negative schemas, which are activated by stressful events. This gives the person a pessimistic attitude about themselves, the world and the future, making it very difficult for the person to see anything positive in life.

- Wessman and Beck assessed the thought processes of depressed people to establish if they were using negative schemas. Thought processes were assessed by using the dysfunctional attitude scale (DAS). Participants were asked to fill in a questionnaire by ticking whether they agreed or disagreed with a set of statements. They found that depressed people were more likely to make negative assessments than non-depressed people. 

- Alloy et al followed a sample of young Americans in their 20s for 6 years. Their thinking style was tested and they were placed in the "positive thinking group" and the "negative thinking group" according to their ways of thinking. After 6 years, they found that only 1% of those in the positive thinking group developed depression compared to 17% of those in the negative thinking group. The results indicate that there may be a link between negative cognitions and depression.

Individual Approach

The individual approach to depression is aimed to deal with distorted cognitions. Cognitive-Behaviourial therapy is an example of individual therapy, and it consists of identifying the negative thoughts assumed to underlie depression as well as helping the person to understand the connection between their negative thoughts and their emotional state.

Studies For:
- Rush et al found that CBT is an effective way of treating patients
- Dobson also found that cognitive therapy is more effective than drugs or a placebo
- Riggs et al studied effectiveness of CBT in combination with either a placebo or an SSRI. The researchers concluded that treatment with drugs and CBT is effective but that treatment with a placebo and CBT is almost as effective. This shows that CBT is effective.
- Nemereoff et al found that CBT in combination with drugs was the most effective in treating depression

Evaluation:

Cognitive therapies are cost-effective because they do not usually involve prolonged treatment. They are effective in treating the cause of the problem. No side effects have been found.

3. Group Approaches
Group approaches are for those that find it difficult to share with a therapist, and may be more encouraged to open up in discussions when they are surrounded with others that are going through a similar phase.

Studies For
- Hyun et al randomly assigned depressed adolescents to group CBT or a group receiving no treatment. They found group CBT to be extremely effective at relieving symptoms of depression, compared to the group receiving no treatment.
- Siporin reviewed 74 studies comparing individual and group treatment. Group treatment was found to be as effective as individual treatment in 75% in the studies, and more effective in the remaining 25%. In no case was individual therapy found to be more effective than group therapy.

Evaluation
Group approaches are effective, but dissatisfaction with the group or any of its members may lead to drop out and this will affect the effectiveness. Many factors need to be considered: confidentiality and privacy, must not be exclusion or group cohesion, conformity etc. Other people may not be comfortable in sharing. Studies have shown that group therapy is highly effective, and more effective than individual therapy.