Treatment and Management MAD

Biological Treatments (Pharmacological Approaches)

Anti-depressant Drugs

Anti-depressants are commonly known as biochemical treatments for depressive disorders. They affect neurotransmitter levels in the brain and include various classes:

Tricyclics

• Mechanism: Increase levels of serotonin and norepinephrine by preventing their reabsorption.

• Efficacy: Effective compared to other anti-depressants but with more side effects.

• Side effects: Drowsiness, nausea, blurred vision, weight gain.

• Usage: Primarily when other treatments fail.

Monoamine Oxidase Inhibitors (MAOIs)

• Mechanism: Block monoamine oxidase, preventing breakdown of norepinephrine, serotonin, and dopamine.

• Efficacy: Reserved for resistant depression due to interactions with other medications.

• Side effects: Dry mouth, hypertension, nausea, headaches.

Selective Serotonin Reuptake Inhibitors (SSRIs)

• Mechanism: Block the reabsorption of serotonin in the brain, increasing serotonin availability at the synapse.

• Efficacy: Improve mood and reduce anxiety in depressive disorder patients.

• Side effects: Fewer than tricyclics and MAOIs; improve quality of life.

Supporting Studies for Biological Treatments

Katagiri et al. (2013)

• Aim: Test efficacy and safety of OLANZAPINE for bipolar disorder.

• Procedure: Double-blind study with 156 patients (104 on OLANZAPINE, 52 on placebo).

• Findings: Greater symptom improvement in OLANZAPINE group, but associated with weight gain and increased cholesterol.

• Conclusion: OLANZAPINE is effective but has significant side effects.

Malhi et al. (2013)

• Conclusion: Noted Lithium's efficacy in stabilizing manic moods, although limited for depression with unique anti-suicidal properties.

Rucci et al. (2011)

• Aim: Compare the impact of SSRIs and psychotherapy on suicidal thoughts.

• Finding: SSRIs may delay the onset of suicidal thoughts in major depression.

Evaluations of Biological Treatments

Strengths

• Effective: Proven to reduce symptoms in many patients.

• Fast-acting: Noticeable improvements often within weeks.

• Accessible: Widely available and can be prescribed by various healthcare professionals.

Weaknesses

• Side effects: Common side effects can reduce adherence.

• Not a cure: Do not address underlying psychological causes.

• Dependency risks: Prolonged use can lead to withdrawal symptoms and reduced effectiveness.

Psychological Treatments

Cognitive Restructuring (CBT)

• Mechanism: Focused on challenging and changing irrational thoughts.

• Process: Involves monitoring negative thoughts, identifying dysfunctional beliefs, and reframing thought processes.

Supporting Study: Wiles et al. (2013)

• Aim: Assess efficacy of cognitive restructuring in treatment-resistant depression.

• Procedure: Randomised allocation of 469 depressive patients to CBT or usual care.

• Findings: CBT group showed 3X more response in symptom reduction.

Evaluation of Cognitive Treatments

Strengths

• Supported by research, e.g., March et al. (2007) found CBT equally effective as antidepressants.

• Effective across various disorders including anxiety and PTSD.

Weaknesses

• Requires high motivation, limiting its effectiveness in severely depressed patients.

• Time-consuming with a slow progression in therapy.

Rational Emotive Behaviour Therapy (REBT)

• Mechanism: Based on stoic principles; targets irrational beliefs through the ABC model.

• Process: Therapists challenge beliefs to reshape negative thinking patterns.

Supporting Study: Lyons and Woods (1991)

• Aim: Review effectiveness of REBT.

• Findings: Significant improvements in patients receiving REBT compared to controls.

Electroconvulsive Therapy (ECT)

• Description: A biological treatment involving electrical stimulation to induce brain changes.

• Study: Nordenskold et al. (2013)

  • Aim: Effectiveness of ECT combined with drug therapy.

  • Findings: Only 32% relapsed in ECT + drug group compared to 61% in drug-only group.

Issues and Debates

Individual vs. Situational Factors

Treatment effectiveness varies; some respond better to pharmacological methods while others benefit from CBT, influenced by situational factors like socio-economic conditions.

Nature vs. Nurture

• Biological treatments emphasize genetic predispositions, while cognitive approaches focus on learned behaviors and experience, highlighting the complexities in understanding mood disorders.

Conclusion

Both pharmacological and psychological methods play crucial roles in treating mood affective disorders, with varying efficacy and challenges associated with each. A combined approach may often yield the best results in managing these complex conditions.