Contrast biological and psychological treatment for MDD ERQ

Biological treatment

Refers to the use of medical or pharmacological interventions, most commonly SSRIs (Selective Serotonin Reuptake Inhibitors), which are believed to increase serotonin levels in the brain.

Reasons for biological treatment approach

The belief that malfunction of the brain, particularly neurotransmission, is the reason for depression. One hypothesis that addresses this is the monoamine hypothesis, that links depressive symptoms with disrupted or low serotonin levels. Hence, biological treatments often involve increasing the amount of serotonin available in the brain, which can be done through SSRIs that work through hindering the reuptake of serotonin by the presynaptic neuron.

Kroenke et al (2001) - Aim

To compare the efficacy of paroxetine, sertraline and flouxetine in treating MDD

Kroenke et al (2001) - participants

573 Americans aged 19-96 with a mean age of 46, mainly caucasian sample (83% Caucasian, 13% black, 3% other). They had all been referred to the study by their clinician if they were suitable for treatment by antidepressants.

Kroenke et al (2001) - Procedure

A baseline assessment of their depressive symptoms was done using Mental Component Summary Score, and were then randomly assigned to one of the three medications. Patients were reassessed using MCSS at intervals of 1, 3, 6 and 9 months, and provided self-report data on sleep, memory, etc to be used in conjuction with MCSS.

Kroenke et al. (2001) - Results

All participants improved from their baseline in terms of depressive symptoms from an average of 74% to 36% at 3 months and 26% after 9 months. Improvements in MCSS scores were fairly consistent, with participants improving by 15 and 17 points.

Kroenke et al. (2001) - Conclusion

SSRIs may be effective in treating MDD, and the three medications tested have similar efficacy.

Kroenke et al (2001) - Strengths

Reliability increased by triangulation of data, both more objective and subjective self report measures show overall effectiveness of medication.

External validity by large age range, shows how SSRIs can be universal in their effects and administration.

Kroenke et al (2001) - Limitations

No placebo trial, so unable to evaluate whether placebo effect is present (and hence if the SSRIs are the cause of symptom improvement). This decreases the validity of the experiment and henceforth the application of SSRIs as it is questionable if the side effects are worth it if it is not truly effective.

Strength for biological treatment

SSRIs are widely accessible, cost-effective, and fast-acting, allowing patients to manage their symptoms outside of hospital settings and regain autonomy. Unlike CBT, they don’t require a trained professional to administer directly, and are especially effective in severe cases of depression in improving symptoms.

Limitations for biological treatment

Reductionist, end up treating the symptoms rather than addressing the causes and other underlying problems. Many side effects, patients may not end up taking medication as perscribed. Placebo effect may be very strong and present, posing the question of if it is truly worth it considering all of the side effects.

Psychological treatment

Psychological treatments refer to non-invasive “talking” therapy approaches, with the most common form being cognitive behavioural therapy (CBT), where the patient works together with a trained professional to adress their cognitive distortions and irrational/harmful behaviours.

Reasons for psychological treatment

Aligns with Beck’s theory of the cognitive etiology of depression, where the patient’s maladaptive schemas, the cognitive triad and negative thoughts lead to the development of MDD. Hence, the CBT/psychological treatments work to address negative thoughts and behaviours and seeks to improve them by making the patient realise their irrationality. This can be done through presenting the patient with evidence that contradicts their thoughts, and restructuring their faulty cognition.

Clarke et al (1999) - Aim

To investigate the effectiveness of cognitive-behavioural therapy (CBT) in treating major depression in adolescents

Clarke et al - Participants

123 adolescents aged 16-19 diagnosed with major depressive disorder (MDD). 

Clarke et al - Procedure

• Participants were randomly assigned to one of three 8-week conditions:

  1. Adolescent group CBT (16 two-hour sessions)

  2. Adolescent group CBT + parent group (separate parent sessions)

  3. Control group on a waiting list

• After the 8-week intervention, participants who completed CBT were randomly reassigned for a 24-month follow-up to one of:

  • Booster sessions + assessments every 4 months

  • Assessments every 4 months only

  • Assessments every 12 months only

Clarke et al 1999 - Results

Both CBT groups had significantly higher recovery rates (66.7%) than the control group (48.1%).

Both CBT conditions (with or without parents) were equally effective.

Participants in CBT showed greater reduction in self-reported depression.

Recurrence rates over 2 years were lower than typically found in treated adult depression.

Booster sessions did not reduce relapse rates but accelerated recovery among those still depressed after treatment.

Clarke et al - Conclusions

CBT is an effective treatment for adolescent depression.

Adding parental sessions does not significantly improve outcomes.

Booster sessions may help with continued recovery but do not prevent relapse.

Early CBT intervention in adolescence may help reduce long-term recurrence compared to adult populations.

Clarke et al - Strengths

Longitudinal follow-up (24 months) provides data on long-term effects and relapse. Randomised control trial so bias reduced and high internal validity.

Clarke et al - Limitations

• Conducted mainly in Western clinical settings, limiting cross-cultural generalizability.

• Results may not generalize to adolescents with comorbid disorders or more severe depression.

Psychological treatment strengths

Allows for the patient to gain more authority over their own treatment and take it at their own pace, whereas drugs may cause changes that are overwhelming. Trained individuals are also needed for the treatment to continue, so patients are receiving reputable care.

Psychological treatment limitations

If the patient is not willing to improve/majorly depressed, CBT or psychological methods may be ineffective in improving symptoms. The emphasis on individual improvement and self-motivation may reduce effectiveness in collectivist cultures that don’t place values on this.