Treatments for Unipolar Depression (Edexcel A-Level Psychology): Revision Notes

Treatments for Unipolar Depression

Biological treatments: drug therapy

Antidepressant medications represent the most widely used intervention for unipolar depression. These drugs have been developed and refined over time to target specific neurotransmitters in the brain. They are prescribed to alleviate the symptoms of depression quickly and help prevent relapse.

Mechanism of action

Antidepressants function by increasing the availability of noradrenalin and serotonin in the brain. These medications are typically used alongside other therapeutic approaches that address the underlying causes of the disorder.

Antidepressants are classified as agonists because they enhance the activity of noradrenaline and serotonin. They achieve this through two main mechanisms:

• Blocking the reuptake of neurotransmitters at the transporter cells
• Preventing the enzyme that breaks down neurotransmitters in the synapse

Both mechanisms result in neurotransmitters remaining in the synapse for extended periods, thereby increasing activity along the affected neural pathways.

Selective serotonin reuptake inhibitors (SSRIs)

Doctors typically prescribe SSRIs as the first-line medication for depression. These drugs are considered safer and generally produce fewer adverse side effects compared to older antidepressant classes. SSRIs are also less likely to cause serious harm if taken in overdose.

SSRIs, such as fluoxetine, work by blocking the reuptake of serotonin at the transporter cells. This mechanism ensures that serotonin remains in the synapse for longer, producing a more sustained therapeutic effect.

Serotonin and norepinephrine reuptake inhibitors (SNRIs)

SNRIs were developed to operate similarly to SSRIs but with a dual action—blocking the reuptake of both serotonin and norepinephrine. However, research has not demonstrated that SNRIs are more effective than SSRIs. For some individuals, SNRIs may be the preferred option due to better safety profiles and improved tolerance. Duloxetine is an example of an SNRI medication.

Tricyclic antidepressants

Tricyclic antidepressants, such as imipramine, block the reuptake of both serotonin and noradrenaline, causing them to remain in the synapse longer and produce a stronger effect. These medications are older and tend to cause more severe side effects and more serious consequences if taken in overdose compared to newer antidepressants.

Monoamine oxidase inhibitors (MAOIs)

MAOIs, such as tranylcypromine, may be prescribed as a last-resort treatment when other medications have failed. This is because they can produce serious side effects. MAOIs work by inhibiting the enzymes that break down amine neurotransmitters in the synapse, making them available for longer periods.

Additional medications

Other medications may be combined with an antidepressant to enhance its effects. For example, two antidepressants may be prescribed together, or medications such as mood stabilisers or antipsychotics may be added. Anti-anxiety and stimulant medications might also be included for short-term use.

Evaluation of drug therapy

Effectiveness in symptom relief

Drugs can alleviate the symptoms of depression but do not address the underlying cause. For this reason, they are often combined with other forms of therapy. However, they do provide most people with relief from debilitating symptoms, enabling them to access and benefit from other types of therapy, such as cognitive behavioural therapy (CBT).

Antidepressants can reduce the symptoms of depression relatively quickly. The Royal College of Psychiatrists reported that 50 to 65 per cent of people treated with antidepressants showed improvement compared to only 25 to 30 per cent of those treated with a placebo.

ECT is particularly appropriate when there is an immediate threat of harm, as antidepressants can take several weeks to reduce symptoms.

Side effects

Common side effects may make antidepressants unpalatable for some patients. These include nausea, insomnia, blurred vision, dizziness and sexual dysfunction. These side effects should diminish over time if the patient continues with the drug.

Duration of treatment

The minimum recommended prescription is usually six months, but research has shown that a short course of CBT is highly effective as a first-line treatment for mild to moderate depression. However, resourcing issues might lead to an over-reliance on drug treatments.

Research evidence on necessity

Drug trials are expensive and often funded by pharmaceutical companies with a vested interest in proving that expensive drugs are effective treatments. Some critics argue that prescribing drugs does little to treat the disorder.

The benefits of medication are therefore not conclusive.

Ethical considerations

Critics argue that drug treatment is being overused as an easy way to treat people with problems and that those people would be better off with an alternative therapy. Alternative approaches might help people take control and treat the underlying cause of their issues rather than becoming dependent on a chemical solution.

Psychological treatment: cognitive behavioural therapy for depression

Cognitive behavioural therapy (CBT) is the first-line psychological treatment for depression and anxiety disorders, especially for those with mild to moderate symptom severity. The therapy is designed to achieve quick and lasting results, with treatment consisting of weekly or fortnightly sessions lasting about an hour for a period of around three months (although this depends on the nature of the depression).

The CBT model

CBT is an active and directive therapy, first developed by Aaron Beck in 1967. The focus is very much on the 'here and now' of the client's life. Consistent with cognitive theory, it aims to challenge the irrational beliefs that may be at the root of the depression. The therapy combines aspects of behavioural therapy with cognitive restructuring and problem solving. It can be delivered as one-to-one therapy, group therapy or more recently as computerised therapy (iCBT).

How CBT works

The therapist helps the client recognise faulty cognitions that the client uses to process information about the world and encourages them to challenge these cognitions.

Mood monitoring and homework

Clients are encouraged to keep a daily mood diary and complete exercises (homework) outside the therapy sessions. They then reflect and report back on their effectiveness. Typically, the course of treatment will start with an education phase, where the client learns about the relationships between thoughts, emotions and actions.

Thought catching

Clients can be taught techniques such as thought catching, where they analyse events that have happened and map the emotional response that follows the thought associated with the event. This allows the therapist to help the client challenge the thoughts triggered by the event.

Behavioural activation

The behavioural aspect of the therapy involves hypothesis testing using a behavioural activation plan. The client is set work to do outside therapy that aims at changing the experiences they are having and therefore challenging their negative beliefs about themselves.

Evaluation of CBT

Evidence-based therapy

CBT is an evidence-based therapy, meaning that it has been widely tested with empirical evidence. This has led to it being widely recommended by various agencies across the world, for example, the National Institute for Health and Care Excellence in the UK.

Ethical advantages

This therapy does not carry side effects, so it could be regarded as more ethical than drug treatment if it works just as well. Early studies, such as those by Elkin et al. (1989), found that CBT was marginally less effective than active drug treatment with clinical management, but as it is less invasive it might be more preferable to drugs.

Individual differences in effectiveness

Embling (2002) also found that CBT was an effective treatment and was able to isolate certain personality variables that appeared to impact the outcome of therapy, specifically perfectionism and sociotrophy. This indicates that a 'one size fits all' approach to therapy is inadvisable, as certain types of therapy work better for certain types of people. CBT is most useful for those with good communication skills who are capable of flexible thought.

Potential limitations

A negative point is that this therapeutic view essentially blames the person for their disorder because it is their thoughts that cause it. This could have ethical implications for how the person feels about themselves. However, CBT aims to give people the tools to enable them to deal with the disorder themselves rather than passively take drugs for extended periods.

However, some have argued that it is too simplistic to deal with complex issues and that a better approach would be to use more psychoanalytic techniques to investigate the root cause of the disorder.