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Psychology, depression, abnormal psychology
Biological treatment
Antidepressants are based on the assumption that depression is at least partially caused by an imbalance of chemicals in the brain called neurotransmitters. This is known as the serotonin hypothesis. The main goal of antidepressants in to provide symptom relief by restoring the proper balance of neurotransmitters by decreasing or increasing neurotransmitter’s effects. This can be done by blocking receptor cells so that more of the neurotransmitter is available in the synapse, the junction between brain cells. They can also mimic neurotransmitters so that a greater signal is passed through the brain. Antidepressants commonly affect dopamine, serotonin, or noradrenaline. The most common antidepressants are Selective Serotonin Reuptake Inhibitors (SSRIs), which black serotonin receptors in brain cells. The most common SSRI is fluoxetine, which is sold as Prozac in the U.S.
T.A.D.S (2004-2007) —> Aim
The ‘Treatment of Adolescents with Depression Study’ study was conducted to examine the short-term and long-term effectiveness of drug treatment and psychotherapy for treatment of depression in adolescents.
T.A.D.S (2004-2007) —> Method
It was a longitudinal study employing randomised controlled trials running for 36 weeks involving 439 participants aged 12-17 diagnosed with (MDD). The study involved 3 stages. In the first stage (acute treatment) lasting 12 weeks, participants were randomly assigned to 1 of 4 conditions: fluoxetine alone, CBT alone, combination of fluoxetine and CBT, and placebo. In the second stage (consolidation treatment) lasting 6 more weeks, participants in the placebo group were informed they were being treated with the placebo and were given the choice of the other 3 treatment conditions. They were then withdrawn from the study. Lastly, the third stage of the experiment (continuation treatment) lasted 18 weeks and assessed the long-term effectiveness of the treatments based on response rates, which was determined by percentage of participants that showed a 50% or more decrease in scores in a standardised depression scale.
T.A.D.S (2004-2007) —> Findings
The results showed that at the end of stage 1, the combination treatment had the best response rate (71%), followed by fluoxetine alone (61%), CBT alone (44%), and placebo (35%). At the end of stage 2, these response rates were 85% (combined), 69% ( fluoxetine), and 65% (CBT), and the end of stage 3, the response rates for both fluoxetine and CBT alone increased to 81% with the combined treatment response rate remaining the same (85%).
T.A.D.S (2004-2007) —> Use
This study supports antidepressants as a treatment of depression as it showed that they were more effective than the placebo and were more effective than CBT in the short term.
T.A.D.S (2004-2007) —> Strengths
Large sample size and age group
Longitudinal
T.A.D.S (2004-2007) —> Limitations
Only U.S. participants
Ethical issues involving the control
Cipriani et al (2018) —> Aim
To update and expand on previous work to compare and rank antidepressants for the acute treatment of adults with only MDD.
Cipriani et al (2018) —> Method
They did a systematic review and meta analysis of placebo controlled head to head trials of 21 antidepressants used to treat both sexes. Studies were used from the beginning of online data bases on January 8th 2016 to 2018. In the end 522 trials are assessed with 116, 477 participants.
Cipriani et al (2018) —> Findings
All antidepressants were more effective than the placebo. In the head to head trials some antidepressants, like agomeletine, were more effective while some, like fluoxetine, were less effective.
Cipriani et al (2018) —> Use
This supports the use of antidepressants as all 21 were more effective than the control. It also suggests that while fluorine is popular, it could be replaced as it is not very effective. Additionally it brings the question of how different the TADS study would have been if they used agomeletine instead of fluoxetine.
Cipriani et al (2018) —> Strengths
Huge sample with both sexes
All studies were double blind
Cipriani et al (2018) —> Limitations
Some antidepressants, like fluoxetine, have had many studies look into then while others have very little data on them, meaning that the effectiveness of some might not be reliably shown here.
Evaluation of antidepressants
Strengths:
Alleviates symtoms
More effective than a placebo
Reduces hospital inpatients
Rapid effects
Cheap and easy access
Very useful for the short term
Limitations:
Negative side effects
Discontinuation syndrome
Might not dress the root of the problem
Serotonin hypothesis was disproven
Reductionist to only look at biology.
