Are Psychopharmaca Superior to Psychotherapy in the Treatment of Depression?

Title: Are psychopharmaca superior to psychotherapy in the treatment of depression?

Introduction

Concerning the treatment of depression, the figures are of such proportions that details can never be over-looked or neglected. Consider the following. Depressive disorders are amongst the most frequent psychiatric diseases in the Western World, with prevalence numbers between 9% and 18%. According to a 1997 survey (Jindal & Thase, 2003) of the most common reasons for patient visits to family physicians in the United States, depression and anxiety ranked 11th and 17th respectively. The seriousness of this disorder, besides prevalence but in terms of affect, cannot be overstated. Beck (1967) identified five cardinal symptoms of depression: (1) a sad and apathetic mood, (2) feelings of worthlessness and hopelessness, (3) a desire to withdraw from other people, (4) sleeplessness and a loss of appetite and sexual desire, and (5) change in activity level, to either lethargy or agitation. Depression is potentially fatal since most patients think about suicide, about 50% try to commit suicide and up to 15% of patients with sever depression die from suicide

(Jindal & Thase, 2003).

The 20th century saw the development of Electroconvulsive therapy in the 1930's, and the development of antidepressant medication the the 1950's as attempts to affect depression directly on a neurobiological level. Today's two prominent forms of treatment are psychopharmaca (with TCA's and SSRI's in the forefront), and psychotherapy (with a form of Cognitive Therapy usually being recommended). The knowledge of the true efficacy of these two dimensions of treatment is of vital importance now, and in the future, where a combination of treatments may be opted for.

Antidepressants

The first step in the development of antidepressant medication was taken with the investigation of the ill side effects of the antihypertensive drug Reserpine, in the 1950ґs. Though relieving high blood pressure, patients were found to be severely depressed. This drug reduced the availability of dopamine and norepinephrine, which led to the assumption that dopamine and norepinephrine were reduced during depression, and that they acted as agents that affected the development of a depressive condition. Indeed, with the gained understanding of the Monoamine neurotransmitter system, this led to the Monoamine Hypothesis of Depression(MHD). It states that an abnormality in one or more of the three main central nervous system monoamine neurotransmitter systems (norepinephrine, dopamine, and serotonin) underlies depression. The development of such abnormality may be due to:

1. a genetic predisposition

2. an acquired central nervous system change as consequence of interaction with the psychosocial environment.

The importance of the MHD has been such that it has remained influential for nearly 4 decades; one might say, giving rise to three generations of effective antidepressant medication. The first generation, developed in the 1950's were the MAOIs (monoamine oxidase inhibitors). The second generation, the TCAs (Tricyclic antidepressants) were found to be more effective than MAOIs for most patients. About two thirds of depressed patients experience significant relief by taking one or another drug. Unfortunately both drugs produce unwanted side effects, from dizziness and drowsiness to rapid heartbeat and more serious effects specific to other medical conditions. The latest generation of antidepressants, the SSRIs (selective serotonin re-uptake inhibitors) produce fewer side effects by far (much less dizziness, drowsiness, sweating, and rapid heartbeat than tricyclics), and have rapidly risen in popularity.

Psychotherapy

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