Treatments for Unipolar Depression

• Around half of the persons with unipolar depression receive treatment from a mental health professional each year

• Access to treatment differs among ethnic and racial groups

• Only 36 percent of depressed Hispanic Americans and 41 percent of depressed African Americans receive treatment, compared with 60 percent of depressed non-Hispanic white Americans

• Many other people in therapy experience depressed feelings as part of another disorder

• Much of the therapy being done today is for unipolar depression

• Variety of treatment approaches

Psychodynamic therapy

• Unipolar depression results from unconscious grief over real or symbolic losses, compounded by excessive dependence on other people

• Psychodynamic therapists seek to bring these issues into consciousness and work through them

• In the course of treatment, depressed clients will eventually gain awareness of the losses in their lives, become less dependent on others, and cope with losses more effectively

• Successful case reports

• Most successful with modestly or moderately depressed clients with a clear history of abuse

• Long-term therapy is only occasionally helpful in unipolar depression cases

• Depressed clients often are too passive and weary to participate fully

• Clients may become discouraged and end treatment too early

Cognitive-behavioral therapy

• Behavioral activation: The therapist works systematically to increase the number of constructive and pleasurable activities and events in a client’s life

• Most effective when combined with cognitive techniques

• Beck’s cognitive therapy: Used to guide clients to recognize and change negative cognitive processes

• Increases activities and elevates mood

• Challenges automatic thoughts

• Identifies negative thinking and biases

• Changes primary attitudes

• Depressed adults who receive these therapies improve much more than those who receive placebos or no treatment at all

• 50 to 60 percent show significant improvement in or elimination of their symptoms.

• Use mindfulness training and other techniques to help clients recognize negative cognitions simply as streams of thinking that flow through their minds, rather than as valuable guides for behavior and decisions

Sociocultural approaches: family-social treatments

• Interpersonal problems may lead to depression

• Interpersonal loss: encourage clients to explore their relationship with the lost person and express any feelings of anger they may discover

• Interpersonal role dispute: occur when two people have different expectations of their relationship

• **Interpersonal role transition:**develop the social supports and skills the new roles require
  **Interpersonal deficits:**teach social skills and assertiveness
  Useful for depression related to social conflicts or social role changes
  Studies suggest that IPT is as effective as cognitive therapy in treating
  depression

Biological approaches: antidepressant drugs

• In the 1950s, two kinds of drugs were found to reduce the symptoms of depression:

• These drugs have been joined in recent years by the second-generation antidepressants

• Approximately half of the patients who take these drugs are helped by them

• May cause a rise in blood pressure when combined with certain common foods

• Antidepressants fail to help at least 40% of clients with depression

• Publication bias may contribute to reported effectiveness rates of antidepressants (Kirsch; Turner et al.)

• With analyses of published and unpublished studies, the effectiveness rate for antidepressant drugs drops to approximately 50%

• Placebos bring improvement to 30-35%

Monoamine oxidase (MAO) inhibitors

• MAO: is an enzyme that breaks down serotonin, norepinephrine, epinephrine, and dopamine

• Work biochemically by slowing down the body's production of MAO

Tricyclics

• Act on neurotransmitter reuptake mechanisms of key neurons

• The reuptake process appears to be too efficient in some people,
  drawing in too much of the NT from the synapse

• Block an overly vigorous reuptake process and allow serotonin and norepinephrine to remain in the synapses longer

• Drugs must be taken for at least 10 days before such improvements take hold

• 50 to 60 percent of patients who take tricyclics are helped by them

• Relapse may occur if therapy is ended too quickly after recovery

• Can produce side effects

Brain stimulation

• Biological treatments that directly or indirectly stimulate certain areas of the brain

• Electroconvulsive therapy (ECT)

• Vagus nerve stimulation

• Transcranial magnetic stimulation

• Deep brain stimulation