Depression Treatment Study

CH.17 - Treatment of Psychological Disorders

Drug vs. Psychological Treatments for Depression

  • Behavioral Activation

    • Definition: Clients are encouraged to increase rewarding behaviors to break the reinforcement spiral of depression.

    • Randomized Control Trial (RCT) Comparison:

    • Groups Compared: Behavioral Activation, Cognitive Behavioral Therapy (CBT), and Selective Serotonin Reuptake Inhibitors (SSRIs) such as Paxil.

    • Participants: 241 adults.

    • Duration: 16-week trial.

    • Outcomes for Severely Depressed Group:

    • Response Rates:

      • Behavioral Activation: 76% (Beck) / 60% (Hamilton)

      • Cognitive Therapy: 48% (Beck) / 40% (Hamilton)

      • Drug Treatment: 49% (Beck) / 40% (Hamilton)

    • Remission Rates:

      • Behavioral Activation: 52% (Beck) / 54% (Hamilton)

      • Cognitive Therapy: 40% (Beck) / 35% (Hamilton)

      • Drug Treatment: 42% (Beck) / 23% (Hamilton)

    • Conclusion:

    • Behavioral Activation showed the strongest outcomes overall for treating depression.

MAO Inhibitors (MAO)

  • Discussion on the use of MAO inhibitors in depression treatment (referencing authors such as Nardi).

Biological Approaches to Treatment

  • Drug Therapies

    • Definition: Psychopharmacology is the study of how drugs affect cognition, emotion, and behavior.

    • Drug Therapy: Most commonly used biological intervention in treating psychological disorders.

    • Usage Statistics: Over 200 million prescriptions per year for psychotropic drugs focusing on mood, thought, and behavior.

    • Market Context: Canada is the 2nd largest consumer of prescription psychotropic drugs per capita.

Major Categories of Psychotropic Drugs

  1. Anti-anxiety Drugs

    • Goal: Reduce anxiety while maintaining alertness and normal functioning.

    • Common Drugs:

      • Valium, Xanax, BuSpar.

    • Mechanism:

      • Most anti-anxiety drugs increase the activity of GABA (an inhibitory neurotransmitter), thus reducing neuronal activity in emotional arousal areas, resulting in a calming effect.

    • Drawbacks:

      • Potential psychological and physical dependence.

      • Withdrawal symptoms may include intense anxiety, nausea, and restlessness upon discontinuation.

      • Symptoms often return after stopping medication.

      • Buspirone (BuSpar):

      • Less addictive option; effective for generalized anxiety and PTSD with a slower onset of action.

      • Lower Abuse Potential:

        • Fewer side effects related to fatigue.

      • Mechanism:

        • Enhances postsynaptic GABA effect, slowing down excitatory nervous system activity.

  2. Antidepressant Drugs

    • Goal: Treat depression by increasing the activity of excitatory mood-related neurotransmitters, namely serotonin and norepinephrine.

    • Three Major Classes:

    1. Tricyclics (e.g., Elavil, Tofranil):

      • Function: Block the reuptake of serotonin and norepinephrine at the synapse, thus increasing their availability and stimulating postsynaptic neurons more effectively.

      • Side Effects:

        • Common side effects include constipation, blurred vision, dry mouth, and restlessness.

    2. MAO Inhibitors (MAOI) (e.g., Nardil, Parnate):

      • Function: Inhibit the enzyme monoamine oxidase, which typically breaks down neurotransmitters, leading to increased levels of norepinephrine and serotonin.

      • Risks:

        • Can cause dangerous spikes in blood pressure; severe reactions due to dietary restrictions related to aged cheese, cured meats, wine, and fermented foods.

        • Due to side effects, many patients abandon MAOIs.

    3. SSRIs (e.g., Prozac, Paxil, Lexapro, Zoloft, Celexa):

      • Function: Selectively inhibit the reabsorption of serotonin, resulting in increased serotonin levels in the synapse.

      • Benefits:

        • Generally exhibit fewer side effects than tricyclics.

        • Additionally effective for treating panic disorder, obsessive-compulsive behaviors, and social phobia.

      • Side Effects:

        • Insomnia, nervousness, sweating, and sexual dysfunction are notable side effects.

      • Suicide Risk:

        • Research findings are mixed regarding SSRIs and suicide; some meta-analyses suggest SSRIs may increase suicidal thoughts, while others focus on actual suicide rates instead of ideation.

        • Warning labels have been mandated on packaging due to these concerns.

Summary

  • The efficacy of behavioral activation in treating depression surpasses that of traditional drug treatments.

  • A detailed understanding of the various drug therapies available, including their mechanisms and potential side effects, informs both clinical practice and patient choice.