Mood:
blueNow Playing: velvet revolver
Topic: School
Here's my 3rd draft of my English paper. It's basically finished. Too bad Kyle never had the opportunity to read it. :-/ Maybe it wouldn't have helped him anyway.
Lauren Grande
Professor Paoletti
ENG 112-400
22 November 2004
Double Therapy: A Lifesaving Treatment
Depression is a serious illness currently affecting millions of Americans, as well as over one hundred million others worldwide. Regrettably, it is often left untreated which results in tens of thousands of deaths due to suicide each year in the United States alone. There is hope, however: depression is a treatable condition, and with the right tools, it is possible for those suffering from this disease to find relief from their symptoms. There are three basic types of treatment for depression: psychotherapy (also known as talk therapy), electroconvulsive therapy (ECT), and medication. The two most common and widely accepted forms of treatment are psychotherapy and antidepressant medication. Lately, it seems that society has become increasingly dependent on drugs to make them content: people want instant happiness without resolving the true nature of their problems with psychotherapy. Nevertheless, antidepressants are effective and those who take them often feel better before those who opt for talk therapy treatment alone. Neither of these methods should be discounted for their efficiency, as antidepressants mend the mind, psychotherapy mends heart and soul. A combination approach of both psychotherapy and antidepressant therapy is the most effective treatment for adults experiencing major depressive disorder.
Many people will have some experience with a major depressive episode at some point in their lifetime. Either they will know a coworker, friend, or family member affected by this illness, or they will be affected by it themselves. Of the nineteen million cases of depression that occur annually in our country, it is estimated that as many as eighty to ninety percent can be effectively treated. Liora Nordenberg of the U.S. Food and Drug Administration cites the regrettable statistics of those who do not seek help: "However, two-thirds of the people suffering from depression don't get the help they need, according to NIMH. Many fail to identify their symptoms or attribute them to lack of sleep or a poor diet, the APA says, while others are just too fatigued or ashamed to seek help" (Nordenberg). If people are better educated about depression, perhaps they would be more likely to seek help, and not be ashamed for doing so.
There are three main types of depressive mood disorders: major depressive disorder, dysthymic disorder (dysthymia), and bipolar disorder (previously called manic depression). Major depressive disorder is characterized by one or more major depressive episodes lasting two weeks or more. This disorder also tends to be a recurrent illness and frequently occurs after a significant life event. Dysthymia is a constant low-grade depression which is not debilitating, but still affects the sufferer's life in a negative manner. Dr. Dennis Charney, M.D., Chief of Mood and Anxiety Disorder Research Program at NIMH and Dr. Charles Nemeroff, M.D., Ph.D., of Emory University School of Medicine define bipolar illness as "[M]ajor depression that alternates with periods of abnormally high mood in which a person feels energized, buoyant, and outgoing - sometimes to a pathological degree" (Charney and Nemeroff 85). A common theory of these disorders is that they are caused in some part by chemical imbalances in the brain. Dysthymia and bipolar are most frequently associated with these chemical imbalances, while major depressive disorder commonly arises after a negative life experience. Since major depressive disorder usually has both biological and external causes, the combination approach of medication and psychotherapy will be the most suitable method to utilize in its treatment.
Recent studies have suggested that antidepressant use for children and adolescents may be dangerous. Elizabeth Mechcatie, a reporter for Family Practice News, notes a public health advisory which was publicized by the Food and Drug Administration:
The FDA released the advisory to alert physicians to reports of suicidality in clinical studies of various antidepressants in pediatric patients with major depressive disorder (MDD). Although cases of suicidality "are not unexpected in patients with MDD, preliminary data suggest an excess of such reports" among patients who have been on some of those drugs compared with those on placebo, the advisory states. (Mechcatie)
Due to this declaration, it is not safe to assume that antidepressant usage should be recommended for those under the age of eighteen. We should instead focus on the way that these medications may help adults.
Society needs to recognize that depression is often a biologically based disease. As previously mentioned, it is believed that depression is caused by chemical imbalances in the brain. The National Alliance for the Mentally Ill identifies the neurotransmitters implicated in this condition:
Norepinephrine, serotonin, and dopamine are three neurotransmitters (chemical messengers that transmit electrical signals between brain cells) thought to be involved with major depression. Scientists believe that if there is a chemical imbalance in these neurotransmitters, then clinical states of depression result. Antidepressant medications work by increasing the availability of neurotransmitters or by changing the sensitivity of the receptors for these chemical messengers (Frank).
New clinical trials and studies regarding depression are being investigated continuously. As a result of this research, medications are being developed that are more effective at treating depression with reduced side effects.
Recent research has found that enduring stress can essentially reshape the brain. It is thought that stress may shrink the hippocampus (structure in limbic system of brain involved in memory formation) and also obstruct a process called neurogenesis (growth of new brain cells), causing depression. A hormone called corticotrophin-releasing hormone (CRH) stimulates the pituitary gland, which elicits a signal for release of glucocorticoids (stress hormones i.e. cortisol) from adrenal glands in the endocrine system. Constance Holden, a Mental Health Reporter and winner of a 2003 award from the National Mental Health Association (NMHA) elaborates on these findings, citing research performed by Dr. Charles Nemeroff:
Animal models, too, show that early stress, such as that induced by maternal deprivation, causes depression-like behavior [...] Such animals also hypersecrete CRH. "Many of the established neurobiological findings in depression may indeed be due to early life stress," when the young nervous system is still tender and impressionable, according to Nemeroff. His research has revealed that among adults who have been sunk in depression for 2 years or longer, 45% experienced abuse, neglect, or parental loss as children. (Holden 811)
These findings are exhilarating for those in the fields of psychiatry and psychology. This means that pharmaceutical companies will work to develop new drugs that will likely work by suppressing corticotrophin-releasing hormones. Nemeroff's figure of adults experiencing abuse, neglect, or parental loss gives support to why psychotherapy should play a role in treating depression.
If medications treat the mind, then it is psychotherapy which treats the soul. There are several types of psychotherapy recognized as effective methods of treating depression. The National Alliance for the Mentally Ill (NAMI) identifies them as Cognitive-behavioral therapy (CBT) and Interpersonal therapy (IPT). According to NAMI, Cognitive-behavioral therapy "[H]elps to change the negative thinking and unsatisfying behavior associated with depression, while teaching people how to unlearn the behavioral patterns that contribute to their illness; Interpersonal therapy focuses on improving troubled personal relationships and on adapting to new life roles that may have been associated with a person's depression" (Frank). Both of these psychoanalysis methods achieve desirable results with regard to alleviating depression. It is through psychotherapy that the person afflicted by this illness truly begins to recover; they can explore their minds and discover the genuine reasons causing their depression. Medications can not do this; they must do it themselves.
There can be innumerable external contributing factors that may cause someone to lapse into depression. Charney and Nemeroff discuss these factors:
All types of depression usually arise from a combination of inborn vulnerabilities [...] and the interaction of those vulnerabilities, for better or worse, with life experiences, such as upbringing, education, culture, stress, or trauma. A particular case of depression may arise more from genetics, say, than upbringing, but no depression is all genetics, or all stress, or all upbringing. (Charney and Nemeroff 89)
These life experiences play a significant role in a depressive episode. It is because of these external factors that psychotherapy is imperative for treating depression.
Recent research has shown that antidepressants and psychotherapy are similarly effective for treating a major depressive disorder. Nicola Casacalenda, Christopher Perry, and Karl Looper, all psychiatrists with the Institute of Community and Family Psychiatry at Jewish General Hospital in Montreal, examined random controlled trials that evaluated medications and psychotherapy. The doctors found these results:
Tricyclic antidepressants, phenalzine and psychotherapy [...] were more effective at promoting remission than control conditions. There was no difference in remission between antidepressants and psychotherapy regimens. Antidepressants and psychotherapy may both be effective first-line treatments for outpatients with mild to moderate depression. (Casacalenda, Looper, and Perry 1186)
While some might argue that these findings could be a detriment to either drug companies or psychotherapists, it is in fact a benefit to both. Since both therapies have been found equally effective, the most successful depression treatment will be found when both sides agree to combine medication and psychoanalysis.
Many other professionals in the psychiatry and psychology fields agree that the combination approach to treating depression is ideal. Professor Raymond Lam, M.D., Head of the Division of Clinical Neuroscience, Department of Psychiatry at the University of British Columbia, corroborates on this idea:
We need to move away from simple comparisons of psychotherapy versus pharmacotherapy to consider combined therapy [...] there is preliminary evidence that combining antidepressant medications with psychotherapy may increase remission rates over monotherapy in severe depression and in chronic depression. (Lam 46)
The clinical trials cited in Lam's viewpoint are in progress and expected to be completed in March 2006 (McCullough). A combination approach of pharmacotherapy and psychotherapy has been endorsed by a myriad of professionals besides those already mentioned. Charney and Nemeroff feel that "The multiple roots of the condition [depression] mean that using multiple treatment approaches usually works best" (Charney and Nemeroff 89). All of these people are respected individuals within their fields and their ideas should be held in high esteem. Since both psychotherapy and pharmacotherapy have been found to treat depression effectively, using them in conjunction is logically the most efficient way to put a depressed person on the road to recovery. The medications will help the patient feel better in the beginning, and talk therapy will keep them in remission and sustain them through the years.
The Band-Aid approach to treating depression has gone on long enough. If we have the research and understanding to prove that antidepressant medication and therapy are the most effective means of treating depression, then that is what we must utilize. Those suffering from depression must move toward this choice and recognize its value. In treating major depressive disorder, we have to care for the whole person, and not just one part of them. If patients and doctors follow this advice, the rates of depression remission will rise and the number of suicides will fall. It is time for the medical community to embrace this strategy and save lives.
Works Cited
Casacalenda, Nicola, Karl Looper, and Christopher Perry. "Comparing Depression
Treatments." American Journal of Psychiatry. 160 (2003): 1186-1187.
Charney, Dennis, and Charles Nemeroff. The Peace of Mind Prescription: an
authoritative guide to finding the most effective treatment for anxiety and
depression. New York: Houghton Mifflin, 2004.
Frank, Ellen. "Major Depression." NAMI: National Alliance for the Mentally Ill - The
Nation's Voice on Mental Illness. May 2003. 13 November 2004
Holden, Constance. "Future Brightening for Depression Treatments." Science. 302.5646
(2003): 810-814.
Lam, Raymond. "Antidepressants and psychotherapy may be equally effective for promoting
remission in major depressive disorder." Evidence-Based Mental Health. 6.2 (2003): 45-
46.
McCullough, Ph.D., James P. "Research Evaluating the Value of Augmenting Medication with
Psychotherapy." National Institutes of Health. April 2003. 16 November 2004
Mechcatie, Elizabeth. "Antidepressants may boost suicide risk in Children: FDA
advisory." Family Practice News. 34.1 (2004): 78.
Nordenberg, Liora. "Dealing with the Depths of Depression." U.S. Food and Drug
Administration. August 1998. 12 November 2004
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at 4:36 PM EST
