Drug Therapy

antidepressants

Just as with schizophrenia, depression is treatable with the use of drug treatment, from the biological approach. Drug treatment for depression tends to happen in the community: rarely are depressed people hospitalised, unless they are at risk of endangering themselves or others. Antidepressants are used to treat depression, and these drugs usually work by increasing the levels of serotonin in the brain, since some of the symptoms of depression come about due to low levels of serotonin (leading to low levels of noradrenaline). This is how the well-known drug Prozac works, although this is not to say this is strict proof that the monoamine hypothesis is correct, it does provide some sound evidence.

Such drugs used to treat depression are called SSRIs (selective serotonin reuptake inhibitors). The SSRIs include drugs like Prozac, and others such as Fluvoxamine and Citalopram, as well as some more modern and less-in-use atypical antidepressants (drugs which target individual monoamines, such as specifically noradrenaline).

Another group of drug used to treat depression is the MAOIs (monoamine oxidase inhibitors), which work to prevent the breakdown of the monoamines (serotonin, noradrenaline and dopamine), so in effect achieving the same results: increased levels of the monoamines in the brain.

As you would expect, no drug treatment comes without its potential side effects. Side effects of the SSRIs include nausea, insomnia, anxiety, dizziness, weight fluctuations, headaches, fatigue and blurred vision, and the MAOIs have more severe side effects and so are only used as a last resort if other drugs don’t work; similarly, another group of drugs, the tricyclic antidepressants, are a subtype of SSRIs which are nowadays outdated, and also have more severe side effects.

Treatment of depression with antidepressants has to be withdrawn gradually in order to avoid suffering withdrawal symptoms, which develop with what is known as ‘antidepressant discontinuation syndrome’ and involve crying spells, insomnia, aches and pains and muscle spasms.

Kuyken et al. (2008)
In this study, Kuyken et al. compared drug treatment and a form of cognitive-behavioural therapy, finding that a group version of CBT was at least as successful as drug therapy. They divided 123 people with depression into two groups: one continued with their medication, and the other had the psychotherapy (with the option to remain on or come off of their drug treatment). Over 8 weeks, the therapy group met and carried out group exercises, such as how to focus on the present and not the past. About 47% of the CBT participants had a relapse rate over the 15 months after the course had ended, whilst those who had drug therapy alone had a relapse rate of 60% and so it was thought that the person-centred therapy gave the patients skills for life that drug therapy could not. This study showed that whilst drug treatment for depression can be effective, it is not as effective as it could be without having another type of therapy used as well.

Evaluation

Strengths

  • Antidepressants can be used to boost mood so that other therapies, such as CBT, can take place: without drug therapy these other treatments cannot happen
  • Research is constantly undergoing to find more effective drugs with bigger success rates and fewer side effects (atypical antidepressants, for example, have far fewer side effects than the old tricyclic drugs)
  • Drugs are easy, quick and cheap to prescribe and are the favoured treatment for the NHS
  • The use of antidepressants is based on a scientific hypothesis, generally accepted by psychiatrists

Weaknesses

  • Although drugs are cheap and quick to prescribe and are readily available, it may be the case sometimes that doctors prescribe them over other treatments for their own convenience, rather than the good of the patient
  • Drugs are often criticised for only masking the problem, they do not cure the disorder
  • A common effect of discontinuation of drugs, especially with antidepressants, is withdrawal symptoms, which can prove troublesome and may need more drugs to treat the withdrawal symptoms, which is not ideal
  • Patients may forget to take their drugs or purposefully choose not to take them to avoid the side effects

ECT