Depression Treatment

10 Key excerpts on "Depression Treatment"

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  eBook - ePub

  Depression And The Medically Ill

  An Integrated Approach

  • Gary Gary Rodin(Author)
  • 2017(Publication Date)
  • Routledge

    (Publisher)

  9

  Psychological Treatments

  Considering the wide array of factors that may contribute to depression in persons with a physical illness, an eclectic and integrative approach is needed in the selection of optimal and appropriate treatment. Such treatment may include practical physical interventions, and pharmacologic, psychological, and social treatments. Additional interventions that may relieve depression include optimizing the medical status of the patient, restructuring the social environment, assisting with occupational functioning, and identifying and eliminating depressogenic drugs that are not essential to the medical treatment. Even when a broad range of factors can be identified that contribute to or perpetuate depression in a medical patient, attention to one specific underlying factor may alleviate the mood disturbance. For example, when major depression is associated with hypothyroidism, the gradual institution of thyroid replacement medication not only takes precedence over other specific antidepressant treatments, but may, by itself, relieve the depression. In other cases, medical treatments should be instituted concurrently with psychological and biological therapies for depression.

  In the medical setting, the etiology of depression should usually be understood from multiple perspectives. Similarly, treatment selection often requires the consideration of diverse modalities. For the purpose of clarity, we have divided into separate chapters our discussion of biological and psychological treatments. However, this literary convenience should not be taken to imply that the use of one treatment modality in any way precludes the concurrent or sequential use of others. In this regard, although the efficacy of antidepressant medication for major depression has been substantiated in a variety of controlled studies (see Chapter 11

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  Major Depressive Disorder

  • (Author)
  • 2014(Publication Date)
  • Research World

    (Publisher)

  ________________________ WORLD TECHNOLOGIES ________________________ Chapter- 10 Management of Depression Depression , for the purposes of here, refers to the mental disorder known as major depressive disorder. This kind of depression is a recognized clinical condition and is becoming a common condition in developed countries, where up to 20% of the population is affected by this disorder at some stage of their lives. Patients are usually assessed and managed as outpatients, and only admitted to an inpatient mental health unit if they are considered to pose a risk to themselves or others. The three most commonly indicated treatments for depression are psychotherapy, psychiatric medication, and (in severe cases) electroconvulsive therapy. Psychiatric medication are the primary therapy for major depression. Psychotherapy is the treatment of choice in those under the age of 18, with medication offered only in conjunction with the former and generally not as a first line agent. Furthermore, pathology in the parents may need to be looked for and addressed in parallel. Psychotherapy There are a number of different psychotherapies for depression, which may be provided to individuals or groups. Psychotherapy can be delivered by a variety of mental health professionals, including psychotherapists, psychiatrists, psychologists, clinical social workers, counselors, and psychiatric nurses. With more complex and chronic forms of depression the most effective treatment is often considered to be a combination of medication and psychotherapy. As mentioned earlier, psychotherapy is the treatment of choice in people under 18. The most studied form of psychotherapy for depression is cognitive behavioral therapy (CBT), thought to work by teaching clients to learn a set of cognitive and behavioral skills, which they can employ on their own.

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  The Psychological Treatment of Depression

  • J. Mark G. Williams(Author)
  • 2013(Publication Date)
  • Routledge

    (Publisher)

  Chapter 4

  Psychological treatment of depression:Outcome studies

  Although theories about the aetiology, precipitation and maintenance of depression differ from each other, the treatment techniques predicted to be effective by the various models tend to converge. That is not to say that there are only a few methods used. On the contrary, I shall list over twenty techniques which have been applied, usually grouped in some multifaceted procedure, to clinically depressed patients. But each of these techniques could be argued to be affecting a subsystem of several of the psychological models outlined in Chapters Two and Three. In this chapter I should like to overview these procedures and the evidence for their effectiveness. In addition, I wish to discuss three other issues. First, the supposed commonality in procedures and in the factors mediating recovery. Second, the evidence for whether there exist any indications and contra-indications for the use of cognitive-behaviour therapy with depressed patients, or any evidence on which technique to use with which patient. Finally, the relationship of cognitive-behaviour therapy to pharmacotherapy will be discussed. In an early paper Whitehead (1979) outlined four general, though distinct, rationales from which cognitive and behavioural strategies were derived:

  1. That the depressive behaviour per se constitutes the disorder and can be modified by suitable manipulation of reinforcers.
  2. That depressive behaviour is a result of (or is maintained by) a reduced rate of positive reinforcement and that this reinforcement should be reinstated by a suitable manipulation.
  3. That depressed individuals fail to respond because they believe themselves to lack any control over their environment. Treatment should be directed towards demonstrating their capability for such control.

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  When Someone You Love is Depressed

  • Xavier Amador, Laura Rosen(Authors)
  • 2016(Publication Date)
  • Free Press

    (Publisher)

  Interpersonal therapy works well for people who find that their depression leads to a life of isolation or for people who find their depression seriously hinders their ability to communicate with their loved ones. Behavioral therapy is based on the concept that we respond positively to positive reinforcement and negatively to negative reinforcement. A behavioral therapist assumes that since depressed people do not get enough positive reinforcement in their life, they should rearrange their actions to obtain more satisfaction and pleasure. Behavior therapy is based on behavior; instead of spending a lot of time talking about the history of the depression or the reasons behind it, focus is placed on coaching the patient to take actions that make her happier and to enhance her performance in social situations. Cognitive behavioral therapy is a form of behavioral treatment that targets depressive thoughts, or cognitions, that lead to increased depression. The theory behind cognitive behavioral therapy is that depression develops because of errors in thinking and unrealistic attitudes about oneself and the world. The three major errors in thinking are undervaluing oneself, a negative view of one’s current situation, and pessimism. Depression results from dissatisfaction with oneself, which comes from these errors in thinking. The cognitive behavioral therapist helps the patient to see that there is no evidence for her self-defeating beliefs. If the person’s beliefs and attitudes are changed, the depression will be lifted. Alternatively, other theories argue that the self-defeating beliefs arise as a consequence of the depression rather than causing the depression. Often the patient is asked to keep a journal of her feelings and thoughts so she can more readily identify what she is feeling and what she is saying to herself in specific situations

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  Depression

  Causes and Treatment

  • Aaron T. Beck, M.D., Brad A. Alford, Ph.D.(Authors)
  • 2014(Publication Date)
  • University of Pennsylvania Press

    (Publisher)

  19 suggested several guidelines for psychotherapeutic intervention, based on their review of depression-focused therapies. These psychotherapies include cognitive, interpersonal, and behavior therapy. Among their suggested guidelines are the following: (1) use a collaborative therapy relationship centered on the goal of developing new coping skills; (2) incorporate from other medical models examples of treating chronic disorders; (3) elicit feedback about what has failed to work in the past while remaining cautiously optimistic about the possibility of improvement; (4) establish stepwise, short-term goals with graded task assignments; (5) have frequent meetings with short sessions, if necessary; (6) use homework and rehearsal to develop skills; (7) meet with and involve significant others in order to enhance alliance and provide psychoeducation; (8) as short-term goals are reached, establish intermediate and long-term ones; and (9) keep the patient in therapy for 4–6 months following therapeutic response.

  Their review concluded that the depression-oriented psychotherapies are more effective than wait-list controls, that response rates are comparable to antidepressant meds in randomized clinical trials, that cognitive therapy may have more enduring effects long-term, and that treatment-resistant depression responds best to combined psychotherapy and pharmacotherapy.19

  Interpersonal Therapy (IPT) The two “pure-form” systems of psychotherapy that have been compared to pharmacotherapy in the treatment of depression include interpersonal psychotherapy and cognitive therapy.

  In discussing the development of depression in Chapter 13 , we advanced the idea of a “circular feedback model” between thoughts and emotions.21 In this model, an unpleasant life situation triggers schemas relevant to loss and negative expectancies. Such expectancies, in turn, become activated and stimulate affective structures that are responsible for the subjective feeling of depression. The affective structures further innervate the schemas to which they are connected, reinforcing the activity of such. Thus, the interaction schemas ↔ affective structures constitutes a reciprocal determinism in generating the depressive syndrome (Beck 1967).21

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  Clinical Handbook of Psychological Disorders

  A Step-by-Step Treatment Manual

  • David H. Barlow(Author)
  • 2021(Publication Date)
  • The Guilford Press

    (Publisher)

  Sadly, the lack of information as well as the continued social stigma of psychiatric illness and treatment influence de- cision-making. Simultaneously, the decisions occur in an environment filled with social, political, and economic debate, and tension among policy makers, third-party payers, and clinicians, as well as among different types of practitioner guilds. (Jarrett, 1995, p. 435) When care is provided, it is frequently inadequate or minimally adequate (Wang et al., 2005), which can leave depressed individuals feeling frustrated, hopeless, or anxious (Mago, Fagiolini, Weiller, & Weiss, 2018). Evidenced-based treatments have not been widely ad- opted in clinical practice (Wiltsey Stirman et al., 2012), reflecting a public health crisis (Keller & Boland, 1998). The need for delivery of treatments with proven and rapid efficacy remains paramount. One of the major developments in the treatment of depression has been the emergence of cognitive therapy, which has expanded exponentially since A. T. Beck’s publication of a detailed treatment manual for depres- sion in 1979 (Beck, 1967, 1976; Beck, Rush, Shaw, & Emery, 1979). The work of Beck and his colleagues led to a paradigm shift within psychotherapy (Salkovskis, 1996). Due in part to Beck’s development of testable hypotheses and clinical protocols, cognitive therapy has received an enormous amount of professional attention (Hollon, 1998; McGinn & Young, 1996; Rehm, 1990). Of all the cognitive-behavioral treatment approaches to depression, Beck’s paradigm (Beck, 1967; Beck et al., 1979) has received the greatest amount of empiri- cal study, validation, and clinical application (Barlow & Hofmann, 1997; de Oliveira, 1998; Dobson, 2016; Dobson & Pusch, 1993; Hollon, 1998; Hollon, Thase, & Markowitz, 2002; Jarrett & Thase, 2010; Rehm, 1990; Roberts & Hartlage, 1996; Scott, 1996; Vittengl, Clark, Dunn, & Jarrett, 2007).

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  Depression

  Treatment Strategies and Management

  • Nestor Galvez-Jimenez, Thomas L. Schwartz, Timothy Petersen, Thomas L. Schwartz, Timothy Petersen(Authors)
  • 2009(Publication Date)
  • CRC Press

    (Publisher)

  CONCLUSIONS Over the past several decades, great strides have been made in our under-standing of which psychotherapies are most effective for treating depression. We now have two primary evidenced-based psychotherapies (CBT and IPT) that are increasingly being practiced by mental health professionals throughout the world. Despite this progress, a multitude of questions remains unanswered. These include how to best apply these treatments, whether some of the more recently developed treatments that represent significant paradigm shifts will prove efficacious in larger studies, how to best adapt our treatments to patients with significant comorbidities, what aspects of depression are important to consider in selecting treatments, and how evidence-based treatments can best be disseminated to frontline treatment settings. Answers to these questions will help shape the field for the coming decades. In parallel, we have many of the same questions and issues with regard to pharmacotherapy. There appears to be a pipeline dedicated to facilitating monoamine transmission and very few treatments that are “out of the box.” With available resources we must get better at providing safer, more aggressive treatment for the MDD patient. This may include early and better detection with rating scales and improved training, use of imaging and genetics, and finally rational polypharmacy to promote better effectiveness and tolerability. REFERENCES 1. Coelho HF, Canter PH, Ernst E. Mindfulness-based cognitive therapy: evaluating current evidence and informing future research. J Consult Clin Psychol 2007; 75 (6):1000–1005. 2. Hayes SC, Luoma JB, Bond FW, et al. Acceptance and commitment therapy: model, processes and outcomes. Behav Res Ther 2006; 44(1):1–25. 3. Brunstein-Klomek A, Zalsman G, Mufson L. Interpersonal psychotherapy for depressed adolescents (IPT-A). Isr J Psychiatry Relat Sci 2007; 44(1):40–46. 4. Ehrenreich JT, Goldstein CR, Wright LR, et al.

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  Treating Depression

  MCT, CBT, and Third Wave Therapies

  • Adrian Wells, Peter Fisher, Adrian Wells, Peter Fisher(Authors)
  • 2015(Publication Date)
  • Wiley-Blackwell

    (Publisher)

  Section 3 Treatments for Depression Introduction to Section 3: Case Study Implementing effective psychological treatment for depression requires considerable therapeutic skill and knowledge of the therapeutic model that underpins the treatment. The theoretical basis for each of the treat-ment approaches was described in Section 2. In the present section we have aimed to provide an in-depth understanding of how to deliver each treatment approach. To this end, the contributors were handed the description of a hypothetical patient with depression and were asked to show how they would assess, formulate, and treat this patient. By using the same case material we hope to illuminate the fundamen-tal differences that exist between the five treatments presented in this volume. Case Presentation Gail is a 48-year-old Caucasian woman, married, with two teenage daugh-ters who are doing well at school. She works part-time in the healthcare profession and was recently referred to the department of clinical psychol-ogy by her general physician, as she has been suffering from persistent depression and mild levels of anxiety. She has been on Paroxetine (30mg a day) for the past eight months, with little noticeable improvement in her mood. Treating Depression: MCT, CBT and Third Wave Therapies , First Edition. Edited by Adrian Wells and Peter L. Fisher. © 2016 John Wiley & Sons, Ltd. Published 2016 by John Wiley & Sons, Ltd. 266 Introduction to Section 3: Case Study Complaints and History At the pre-treatment screening interview Gail met the DSM-V diagnos-tic criteria for recurrent major depressive disorder (APA, 2013). The cur-rent episode had persisted for 16 months, prior to which she felt that her mood had been reasonable for approximately six months. Gail had experi-enced numerous episodes of depression in the past; she thought that the first episode had occurred when she was 19, during her second year at university.

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  eBook - ePub

  Depression

  • Constance Hammen, Ed Watkins(Authors)
  • 2018(Publication Date)
  • Routledge

    (Publisher)

  Nonetheless, there is good evidence for the hypothesis that CBT teaches a new set of skills that help individuals to deal with negative thoughts when they do arise (Barber and DeRubeis, 1989). First, the specific and concrete techniques taught during therapy, including setting an agenda, structuring the session, asking for specific examples and adherence to cognitive methods such as labelling cognitive errors and examining evidence, predicted subsequent symptom reduction when assessed early in CBT treatment (DeRubeis and Feeley, 1990; Feeley, DeRubeis and Gelfand, 1999; Strunk, Brotman and DeRubeis, 2010). However, neither the therapeutic alliance nor more abstract approaches, such as exploring the meaning of thoughts, predicted improvement.

  Second, as noted in Chapter 5 , patients who recovered through pharmacotherapy showed greater increases in dysfunctional attitudes following a negative mood induction than those who recovered through CBT, with such ‘cognitive reactivity’ predicting relapse over the next 18 months (Segal et al., 2006). The association between depressive symptoms and negative cognition post-treatment was weaker for patients who received CBT (in addition to pharmacotherapy) than for patients who did not receive additional CBT, suggesting that CBT teaches skills that weaken the link between negative mood and negative thinking (Beevers and Miller, 2005). Change in patient’s learning of coping skills was negatively correlated with their cognitive reactivity (Strunk, Adler and Hollars, 2013).

  How to improve psychological treatments for depression?

  Understanding how treatment works

  Related to not knowing the active mechanisms of therapy, we also don’t know the active ingredients of psychological treatments. Treatments like CBT are complex interventions consisting of many elements (therapist factors, specific techniques, organising principles, modes of delivery). We still don’t know which ingredients are active in causing improvement, inert or potentially unhelpful, leading to a call for more research into how CBT and other effective treatments work (Holmes, Craske and Graybiel, 2014). One approach is the use of innovative trial designs, such as factorial designs, which enable a robust examination of the active components within therapy, by manipulating different treatment components (Watkins et al., 2016). This will enable us to parse out the most effective elements within therapy to systematically build briefer and more potent therapy, as well as to separate specific from nonspecific treatment effects.

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  eBook - ePub

  Treating Depression

  MCT, CBT, and Third Wave Therapies

  • Adrian Wells, Peter Fisher, Adrian Wells, Peter Fisher(Authors)
  • 2015(Publication Date)
  • Wiley-Blackwell

    (Publisher)

  Section 3 Treatments for Depression Passage contains an image

  Introduction to Section 3: Case Study

  Implementing effective psychological treatment for depression requires considerable therapeutic skill and knowledge of the therapeutic model that underpins the treatment. The theoretical basis for each of the treatment approaches was described in Section 2. In the present section we have aimed to provide an in-depth understanding of how to deliver each treatment approach. To this end, the contributors were handed the description of a hypothetical patient with depression and were asked to show how they would assess, formulate, and treat this patient. By using the same case material we hope to illuminate the fundamental differences that exist between the five treatments presented in this volume.

  Case Presentation

  Gail is a 48-year-old Caucasian woman, married, with two teenage daughters who are doing well at school. She works part-time in the healthcare profession and was recently referred to the department of clinical psychology by her general physician, as she has been suffering from persistent depression and mild levels of anxiety. She has been on Paroxetine (30mg a day) for the past eight months, with little noticeable improvement in her mood.

  Complaints and History

  At the pre-treatment screening interview Gail met the DSM-V diagnostic criteria for recurrent major depressive disorder (APA, 2013). The current episode had persisted for 16 months, prior to which she felt that her mood had been reasonable for approximately six months. Gail had experienced numerous episodes of depression in the past; she thought that the first episode had occurred when she was 19, during her second year at university. She felt that her life had been plagued by depression, approximately twenty of the last thirty years of her life having been affected by significant episodes of low mood. There was a time in her early thirties when she felt genuinely content for three to four continuous years. This was the longest depression-free period in Gail's adult life that she could recall. More typically she would experience episodes of depression for six to nine months, then she would have an improved mood for a period of a few months before returning to the ‘misery and despair that depression brings’.

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