Describe about the Treatments for Depression for Psychotherapy?
Depression is a mental disorder which is characterized by persistent low mood along with low self-esteem and loss of interest in the normal activities which were earlier enjoyed as well. It is disables the patient and adversely affects the patient’s family, work, sleeping and eating habits and general health. It is common in people between ages of 20 and 30 with peak at 30 – 40 years. The depressed person perceives the world and the people completely differently. They begin to believe that their family and friends do not need them. To them, nothing seems comforting and pleasurable. They feel terrible and ashamed of themselves for snapping at people and not being able to accomplish anything, which leads to a low self-esteem. Society does not understand their state and think that these people have lost control over themselves and are maniac. They do not consider it to be a real illness and do not take it seriously.
Mild depression has symptoms that can be detected and affects the daily life activities. Interest in doing things which were previously enjoyed reduces, there is unusual irritability, the motivation to do work activities, household work and social activities decreases. Though the person will continue to function but it is not as a normal healthy person would do because of which mild depression is often remains undiagnosed. The symptoms are seen as to be too bad so people do not think they might be suffering from depression.
The treatment for mild depression comprises mainly of lifestyle changes like regular exercise, relaxation, sufficient and regular sleep are often sufficient. Natural therapies like St. John’s Wart may also be effective if the condition is diagnosed early.
The treatment modalities for more severe form of depression are
Physical treatment – It comprises of drug treatment and electroconvulsive therapy (ECT) and other Brain stimulation therapies.
Drugs used are
Tricyclic antidepressant (TCAs) e.g. amitriptyline, clomipramine, doxepin, nortriptyline and desipramine.
Monoamine oxidase inhibitor (MOIs) e.g. phenelzine, tranylcypromine.
Selective serotonin reuptake inhibitors (SSRIs) – It is the first line of treatment. e.g. fluoxetine, citalopram, fluvoxamine, paroxetine, sertraline.
Atypical antidepressants e.g. nefazodeone, bupropion, venlafaxine.
Psychological treatments – It includes
Cognitive behaviour therapy – It is based on the theory that the thoughts, behaviour and feelings are connected. Directly attempting to change the feeling is difficult, it aims at changing the thoughts and behaviours. The therapist and the patient establish a working relationship and work towards adding, removing and changing certain thoughts and behaviour to achieve a set goal. CBT is superior to placebos and not receiving any treatment options.
Interpersonal therapy – It a short, highly structured, manual based form of psychotherapy. The focus of IPT is to address the deficit in patient’s social sphere and help him to communicate better and raise his self-esteem to improve interpersonal relationships. IPT is as effective as CBT in general but in severe depression IPT is seen to be more effective.
Psychotherapy – Also known as talk therapy is sometimes used in severe depression patients along with CBT. It may only include the patients but it can include other people like family or the couple therapy. Group therapy involves people with similar condition.
Counselling
Self-help and alternative therapies include
Meditation
Relaxation and meditation techniques
Healthy nutrition
Avoidance of alcohol and drugs
Light therapy
Regular exercise
Bibliotherapy
Yoga
Acupuncture
The different types of psychotherapy are
Psychoanalysis and psychodynamic therapies – It involves working to change the problematic behaviour, feelings and thoughts by looking into the unconscious meaning and motivation for them. In psychoanalytical therapies, a close working relationship is established between the therapist and the patient aimed to make the patient more aware about themselves.
Behaviour therapy – It involves conditioning the behaviour of the patient, both normal and abnormal. E.g. Ivan Pavlov’s classical conditioning aimed at associated learning, Desensitizing used for phobias by repeated exposure, E.N. Thorndike’s operant conditioning that relies on reward and punishment for appropriate behaviour.
Cognitive therapy – It focuses on the thoughts of the patient rather than on their actions. It is based on the theory that by changing the thoughts, one can change how a person feels and acts.
Humanistic therapy – It relies on people’s capability to make rational choices and to grow to their maximum potential. There are three types of humanistic therapy which are influential – 1. Client centered therapy 2. Gestalt therapy 3. Existential therapy
Integrative or holistic therapy – It blends elements from different therapies and tailor it to meet the needs of the client.
Cognitive behaviour therapy is based on the idea that a person can make a permanent change in his behaviour by changing the way he thinks from negative thinking to positive thinking. It is a short term therapy and is goal-oriented. The therapist and the client identify the changes that have to be made and come up with the plan to do it. Cognitive psychotherapy is used for patients suffering from mild, moderate and sometimes in major depression as well. It is also used to treat anti-social behaviour, general stress, phobias, eating disorders, schizophrenia, sexual disorders, sleep disorders, substance abuse and attention deficit hyperactivity disorder.
Interpersonal psychotherapy is a time bound, psychodynamically informed psychotherapy, focused on interpersonal relationships with the goal of relieving the symptoms of the patient and improving interpersonal functioning. In interpersonal psychotherapy, the focus is on interpersonal relationship as the way to bring change in the patient. The aim of interpersonal psychotherapy is to help the patient improve the personal relationships they have with their friends, family and colleagues and also aims to change their expectations about them. It also aims to help the patient to improve their support system so that they can handle their current interpersonal problems in a better way (Stuart & Robertson, 2003).
Interpersonal psychotherapy is a strength based and not deficit based model of psychotherapy. The problem that is selected should always be focused on patient’s existing capacities and natural inclination and not explore any area with complicated interpersonal dilemma. The interpersonal psychotherapy avoids any highly contentious disputes that will threaten and destabilize the patient’s whole social support network. The interpersonal deficit category is generally avoided.
The type of drug used in the first line of physical treatment in depression are
Antidepressants – Antidepressant are used in many types of depression. Selective serotonin reuptake inhibitors (SSRIs), Tricyclics (TCAs) and Irreversible Monoamine Oxidase inhibitors (MAOIs) are the three main types of antidepressants.
Tranquillizers – Tranquillizers are of two main types – minor and major. Minor tranquillizers mainly benzodiazepines are addictive and are not used in depression. Major tranquillizers are used in patients with psychotic depression and melancholic depression when other medication do not work.
Mood stabilizers – These drugs are used in bipolar disorder. They are used to reduce the severity and frequency of mood swings.
Lithium is used to treat bipolar disorder for both acute mania and long term mood stabilization and prophylaxis. It is also useful in combating treatment resistant depression. Lithium has the unique properties of acting as both anti-suicidal and neuro-protective drug. It is relatively well tolerated by the body. Lithium has a favorable efficacy-tolerability balance. But despite all this, the use of lithium as mood stabilizer in practice is limited because there are concerns about its tolerability and long-term risks. There is a perception that with the use of lithium, the regular and reliable monitoring of plasma concentration is difficult.
A tranquillizer is a drug that acts on the central nervous system and is used to reduce anxiety, make the person calm and helps him to sleep. Tranquillizers are also called sleeping pills, sedatives, downers and depressants. Drugs which can be classified as tranquillizers are benzodiazepine, barbiturates, anti-depressant and anti-psychotic drugs. They are used in medical field for psychiatry and anesthesiology. But tranquillizers are highly addictive and have high potential for abuse. Tranquillizers can be divided into three types
Major tranquillizers – They are known as anti-psychotic drugs and are used to treat mental illness. They are often used in treatment of schizophrenia, delusional disorder, mania or some other condition in which psychosis is present. It is also used for mood disorders in absence of psychosis. It is a non-addictive drug and has very little potential for abuse. E.g. Phenothiazines, thioxanthenes, Butyrophenones, Piperazine compounds, piperidine compounds
Minor tranquillizers – They are classified as benzodiazepines. They are used in the treatment of anxiety, insomnia, seizures, muscle spasms and alcohol withdrawal. It has high potential for drug abuse and are highly addictive. They are known to produce euphoria when abused. People who get addictive to it have painful withdrawal symptoms. E. g Alprazolam, Diazepam, Lorazepam.
Others – It mainly includes barbiturates. They are used for their hypnotic and anti-anxiety effect. Recently benzodiazepines have replaced them because of less potential for drug abuse, less likeliness of lethal overdose and less severe drug side effects. E.g. amobarbital, phenobarbital and secobarbital.
References:
Treatments for depression, Black dog institute, reviewed from https://www.blackdoginstitute.org.au/docs/Treatmentsfordepression.pdf
Types of depression, reviewed from https://depressionet.org.au/what-is-depression/types/
Different approaches to psychotherapy, America psychological association, reviewed from https://www.apa.org/topics/therapy/psychotherapy-approaches.aspx
Robertson,M Rushton,P & C 2008, Interpersonal psychotherapy: An overview, Psychotherapy in Australia, Vol 14 No 3 Pg 46 – 54
Schwartz,H , Overview of IBPT, International society for interpersonal psychotherapy, reviewed from https://interpersonalpsychotherapy.org/ipt-brief-treatment/
Malhi,G Tanious,M Bargh,D Das,P & Berk,M, 2013, Safe and effective use of lithium, Australian presciber: an independent review, Vol 36, No 1
Tranquillizers, reviewed from https://www.treatment4addiction.com/drugs/barbiturates/tranquilizers/
What is depression, reviewed from https://www.allaboutdepression.com/gen_01.html
Lubow,C 2013, What its like inside a depressed person’s head, https://www.goodtherapy.org/blog/inside-head-depressed-person-0110134
Valdivia, I & Rossie, N, 2004, Brief treatment strategies for major depressive disorder: advice for the primary care clinician, Topics in advanced practice nursing eJournal
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