Depression On A Societal Scale

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  • The Diagnostic and Statistical Manual of Mental Disorders,  4th Edition (DSM-IV-TR) defines Major Depressive Disorder symptoms to include depressed mood, reduced interest in activities that used to be enjoyable, loss of energy, difficulty concentrating, paying attention or making decisions, and suicidal thoughts or intentions (American Psychiatric Association, 2000). Depression has grown over the past 30 years in America’s society, and depending on the research source, many claim that depression affects over 10% of this country’s population.
  • Reference: American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). Washington, D.C.: American Psychiatric Association.
  • Hundreds of antidepressants are available for consumers to use to mask the symptoms of depression, and many simply use these medications without psychotherapy in order to cope with the disorder. Researchers theorize many possible reasons for why depression has increased so dramatically over the past several decades, but none has come up with a single definitive answer. As more and more Americans are diagnosed daily with this disorder, pharmaceutical companies are working diligently to produce newer and more expensive drugs to treat the people affected. Insurance companies also earn their share of the profits from depressed beneficiaries. If a beneficiary chooses to attend therapy sessions, the insurance companies will limit the amount of sessions that the beneficiary can have depending on their diagnoses. Whether the set number of sessions are effective is not the insurance company’s problem; the burden then lies with the therapist and the patient to maximize each session before they run out of opportunities for treatment.
  • In the 50's and 60's anxiety was the overwhelming cause of many Americans. Then in the 70's, the depression epidemic began. Since then, "depression rather than anxiety has become the common term used to indicate the breadbasket of common psychic and somatic complaints associated with the stress condition" (Horwitz, 2010, p. 113). Horwitz and Wakefield (2007) claim that depression now dominates research in psychiatry, clinical practice, and treatment. To combat the onslaught of depression-related patients, physicians began to prescribe antidepressants to alleviate symptoms.
  • Only 33% of adult patients that are diagnosed with major depression are able to relieve the symptoms with one antidepressant prescription (Harvard Medical School, 2010). For the other 67% of people with major depression, several options are available. Some will choose to try another antidepressant all together, some will augment the first prescription with another drug, and some will augment the prescription with psychotherapy. When new drugs are added, side effects increase. New symptoms often emerge, such as nausea, headaches, anxiety, restlessness, and in some cases, suicidal thoughts, especially in children and adolescents (Ebmeier, Donaghey, & Steele, 2006).
  • One study used paroxetine, a common selective serotonin reuptake inhibitor (SSRI) along with a placebo drug with 718 depressed patients. The results indicated that those who only suffered from severe depressive symptoms were significantly improved by the use of paroxetine while those who display mild to moderate symptoms were unaffected by either placebo or the SSRI (Greenfield, 2010). The study also suggests that many antidepressants only affect those who are severely affected by depression, and those who are mildly or moderately affected often experience more side effects than actual relief of depressive symptoms (Greenfield, 2010). Although medication approaches may have the most extensive research support, they are only as effective as long as they are used  and not thereafter  (Paradise & Kirby, 2005).
  • To aid with the use of pharmacotherapy for the treatment of depression, a sequential approach is used. The sequential approach is "an intensive two-stage approach that derives from the awareness that one course of treatment in unlikely to provide a solution to all the symptoms of patients" (Fava & Tomba, 2010). That is, for those who have remitted from a major depressive disorder after only using antidepressants will now use psychotherapy along with pharmacotherapy to treat the depression. The problem that seems to keep coming up is that while it is documented that psychotherapy has a more lasting benefit compared to pharmacotherapy, pharmacotherapy is more readily available. Fava and Tomba (2010) suggests that by using the sequential approach, the prevention of relapse in depressed patients is the goal. Additionally, the use of the sequential approach should not have a timeline; rather it should be used as long as it is necessary so that targets are not predetermined, but rather dependent on the response of patients (Fava & Tomba, 2010).
  • One study suggests that while many patients will respond to one or more medications, "there is no evidence that any medications will reduce the risk of future depression once they are discontinued" (Paradise & Kirby, 2005). Another study suggests that the risk-benefit ratio to using medications to treat mild depression is too low (Ebmeier et al., 2006 ). Ebmeir et al. (2006) argue that in moderate to severe cases of depression, antidepressants are recommended in combination of some form of psychotherapy. Many different forms of psychotherapy exist such as cognitive behavioral therapy, interpersonal therapy, and psychodynamic therapy. All variations of these therapies are effective in treating depression and results are increased when coupled with antidepressants (Harvard Medical School, 2011).
  • A continuum of evidence claims that coupling pharmacotherapy and psychotherapy often leads to the best results when treating depression. Unfortunately, the people that prescribe antidepressants are not the ones who are conducting the psychotherapy. This could be where the problem stems from. It is possible to assume that while these two modalities continue to remain disconnected, that depressed patients will continue to struggle while attempting to find the right balance of therapy and medication in an effort to feel better. 

Transcript

  • 1. Akash Mansingh
    Argosy University
    Depression on a Societal Scale:Medication vs. Therapy
  • 2. Symptoms include:
    Depressed mood
    Reduced interest in activities that used to be enjoyable
    Loss of energy
    Difficulty concentrating, paying attention, or making decisions
    Suicidal thoughts or intentions
    Depression has consistently grown over the past 30 years
    Some researchers claim that depression affects up to 10% of the U.S. population
    Major Depression Defined…
  • 3. Many different severities of depression exist:
    Mild, Moderate, Severe
    With or without psychotic features
    With catatonic features
    With meloncholic features
    With atypical features
    With postpartum onset
    Depression continued…
  • 4. Hundreds of antidepressants are currently available
    Many who suffer from depression turn to medications
    Society places an emphasis on a “quick fix” by using medications to treat depression
    Pharmaceutical companies are working around the clock to invent better and more effective medications before their patent for their previous medication runs out
    Medications…
  • 5. 1950’s – 1960’s anxiety reigned supreme in the mental health field
    1970’s – current: Depression epidemic began
    “Depression rather than anxiety has become the common term used to indicate the breadbasket of common psychic and somatic complaints associated with the stress condition" (Horwitz, 2010, p. 113)
    Depression now dominates research in psychiatry, clinical practice, and treatment (Horwitz & Wakefield, 2007).
    Anxiety Turned Inwards = Depression
  • 6. By the year 2000, antidepressants led all drug sales in the U.S. (Mojtabai, 2008)
    Only 33% of adult patients diagnosed with depression relieve the symptoms with medication alone (Harvard Medical School, 2010)
    Those unaffected by medication use will often try another type of antidepressant
    Some patients will try psychotherapy when drugs fail to work
    Depression Trends
  • 7. A study compared paroxetine ( a common SSRI) with a placebo drug
    718 depressed patients were studied
    Results indicated that those who were only severely depressed improved by using paroxetine (Greenfield, 2000)
    Mild and moderately depressed patients were unaffected by the SSRI or placebo (Greenfield, 2000)
    Although medication approaches may have the most extensive research support, they are only as effective as long as they are used (Paradise & Kirby, 2005).
    One study suggests…
  • 8. An intensive two-stage approach that derives from the awareness that one course of treatment in unlikely to provide a solution to all the symptoms of patients" (Fava & Tomba, 2010)
    Example: Those who have remitted from a major depressive disorder after only using antidepressants will now use psychotherapy along with pharmacotherapy to treat the depression
    Should not have a timeline
    Should be used as long as it is necessary, not insurance dependant
    The Sequential Approach
  • 9. There is no evidence that any medications will reduce the risk of future depression once they are discontinued" (Paradise & Kirby, 2005).
    The risk-benefit ratio to using medications to treat mild depression is too low (Ebmeier, Donaghey, Steele, 2006 ).  
    In moderate to severe cases of depression, antidepressants are recommended in combination of some form of psychotherapy (Ebmeier, Donaghey, Steele, 2006 ).  
    Medication vs. Psychotherapy
  • 10. “Specific forms of psychotherapy are more effective than medication when patients are interviewed about outcomes and that these psychotherapies tend to generate lower rates of relapse than pharmacological treatments alone" (Puterbaugh, 2006, p. 373).
    In many cases, the people that prescribe antidepressants are not the ones who are conducting the psychotherapy
    It is possible to assume that while these two modalities continue to remain disconnected, that depressed patients will continue to struggle while attempting to find the right balance of therapy and medication in an effort to feel better.
    Medication vs. Psychotherapy continued…
  • 11. American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). Washington, D.C.: AmericanPsychiatric Association.
    Ebmeier, K. P., Donaghey, C., & Steele, J. (2006). Recent developments and current controversies in depression. The Lancet, 367(9505), 153-167.
    Fava, G. A., & Tomba, E. (2010). New modalities of assessment and treatment planning in depression: The sequential approach. CNS Drugs, 24 (6), 453-465.
    Greenfield, R. H. (2010). Good only when it's bad: Drugs for depression. Journal of Alternative Medicine Alert, 303, 47-53.
    Harvard Medical School. (2010). Augmentation strategies for depression. Harvard Mental Health Letter, 27 (6).
    Harvard Medical School. (2011, May). Women and depression. Harvard Mental Health Letter, 27(11), pp. 1-3.
    Horwitz, A. V. (2010). How an age of anxiety became an age of depression. The Milbank Quarterly, 88 (1), 112-138.
    Horwitz, A., & Wakefield, J. (2007). The Loss of Sadness: How Psychiatry Transformed Normal Misery into Depressive Disorder. New York: Oxford University Press.
    Mojtabai, R. (2008). Increase in antidepressant medication in the US adult population between 1990 and 2003. Pyschotherapyand Psychosomatics, 77, 83-92.
    Paradise, L. V., & Kirby, P. (2005). The treatment and prevention of depression: Implications for counseling and counselor training. Journal of Counseling & Development, 83, 116-119.
    Puterbaugh, D. T. (2006). Communication counseling as part of a treatment plan for depression. Journal of Counseling and Development, 84, 373-380.
    References