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Depression: A Search for the Right Types of Treatment

Melencolia I (ca. 1514), by Albrecht Dürer.

Melencolia I (ca. 1514), by Albrecht Dürer.

Depression is a serious mental illness that affects all aspects of a person’s life, including the social, economic, and sexual properties of motivation and drive. A person with depression, whether with acute or chronic, is not able to live a life of happiness or satisfaction because of the chemical imbalances in the brain. These imbalances make the person feel hopelessness, anxiety, and even pain.

People with depression may become involved in recreational drug use, self-harm, or criminal activity, as well as other factors that weigh down a society. In a clinical setting, there exists a continuous search for effective methods of treatment for depression and the tailoring of those treatments to the specific individual. Various methods of treatment for clinical depression include medication, counseling services, and exercise regimes. However, what works best for one individual may not work well for another. Therefore, the specification of treatment to tailor ideally to a particular patient is what many scientists and researchers are studying to treat this mental illness. In this essay, clinical studies regarding depressed patients’ responses to medication, physical activity, and psychotherapy are analyzed and evaluated according to the understanding that depression is sometimes difficult to treat.

For doctors treating patients with depression, it is often difficult to find the right type of treatment that works well for the particular individual. Most commonly, general practitioners and psychiatrists will not hesitate to write a prescription for a selective serotonin reuptake inhibitor (SSRI) antidepressant with a good reputation in the pharmaceutical community, although this may not always be the best treatment for the patient (Shute, 2013). As Nancy Shute notes in the article “Could Brain Scans Reveal the Right Treatment for Depression?”, most safe drugs intended to treat depression require time (a few weeks/months) to begin working effectively, and then a staggering 60% of these patients never actually feel any changes in cognition (2013). Recently, however, scientists have begun testing new drugs that act more quickly and effectively than the standard SSRI medications. Such drugs include ketamine, riluzole, and scopolamine, which target the glutamate system in the brain where new neural connections are formed (Hamilton, 2012). Although at this time these drugs produce many unpleasant side effects, several drug companies are working on creating safe glutamate drugs to treat depression (Hamilton, 2012). However, medication is not always adequate for some patients battling depression. For those who do not feel comfortable with taking brain-altering medications, counseling therapy may be a less invasive treatment option to consider.

The most widely recommended form of treatment for any psychological disorder is counseling therapy. Society maintains the belief that if people simply talk about their problems, they will discover solutions. Psychotherapy works in this way. It is a form of counseling that aims to solve a patient’s unresolved issues through the discussion of past and present concerns of the patient’s life (Mulholland, 2010). Conducted by a mental health professional, psychotherapy is the process of evaluating a patient’s feelings and perceptions of his/her reality (Mulholland, 2010). For a patient battling depression, the psychotherapist will work with the patient to pinpoint the issues that produce feelings of hopelessness, lack of motivation, and anger. The psychotherapist will present the patient with discussion topics that are uncomfortable or scary to revisit. However, through discussion and evaluation, the patient is able to resolve the pressing issues in his/her life that cause displeasure. The goal of psychotherapy treatment is for the patient to ultimately acquire a good quality of life and mental wellbeing (Mulholland, 2010).

The 16th American president Abraham Lincoln suffered from "melancholy", a condition that now may be referred to as clinical depression.

The 16th American president Abraham Lincoln suffered from “melancholy”, a condition that now may be referred to as clinical depression.

A study conducted in the United States in 2014 suggests that psychotherapy can prevent a relapse in depression for patients after completing the initial round of therapy (Thompson, 2014). 241 participants, who had recently finished a round of psychotherapy but were likely to relapse in the coming months, were split into three groups (Thompson, 2014). The first group was given an antidepressant, the second received psychotherapy, and the third group was given a placebo pill (Thompson, 2014). Conducted by the Professor of Clinical Psychology at the University of Texas South Western Medical Centre in Dallas, the results indicate that the participants who received either the antidepressant or the psychotherapy sessions were only 18% likely to relapse, compared to the 33% for the placebo group (Thompson, 2014). Consequently, one may conclude that the use of psychotherapy as treatment for depression and prevention of relapse is as reliable as that of an antidepressant. These results suggest psychotherapy as an alternative form of treatment for patients who either feel uncomfortable ingesting mind-altering drugs or experience unpleasant side effects from such medication. An alternative treatment route, however, for those patients not able to afford the time or money that psychotherapy sessions require, includes good old fashioned exercise. Ancient Greek philosophy proposed the aphorism “a sound mind in a sound body”, suggesting that mental and physical health are interlinked. Based on current research and scientific study, it appears that the Greeks were actually on to something. As common knowledge, most people are aware that daily exercise produces an increase in endorphins (feel good hormones) in the brain. However, the benefits of physical activity on mental health go much farther than this.

Vincent van Gogh's 1890 painting Sorrowing old man ('At Eternity's Gate')

Vincent van Gogh’s 1890 painting
Sorrowing old man (‘At Eternity’s Gate’)

For example, in a psychological study carried out in 1981, researchers found that physical activity lead to “increased blood flow (in the brain), growth of nerve cells in the brain’s center of learning and memory, increased density of networks of nerve cells, and increased brain tissue volume” (Baily, 2014). From this research, scientists can infer that daily exercise is directly linked to improved cognitive functioning and an increase in positive mood. But could a daily exercise regime be used to treat depression? Many psychological studies support this claim. A study published in the “Archives of Internal Medicine” in 1999 split roughly 200 men and women up into three groups (Miller, 2013). One group was given an antidepressant by the name of Zoloft, another group partook in an aerobic exercise program, and the third group was instructed to do both (Miller, 2013). After 16 weeks, 60 to 70% of all groups were no longer diagnosed with major depression (Miller, 2013). From this study,experts can conclude that a certain amount of daily exercise for patients with depression will produce similar results to that of an antidepressant medication. Therefore, physical activity can be ruled as a cost efficient and natural way to treat depression.

Conclusions and Further Study

Although depression may appear as a destructive and difficult illness to treat, studies show that antidepressant medications, psychotherapy, and physical activity can greatly reduce the symptoms and prevent relapse. It is important for health care practitioners and pharmaceutical companies to provide various methods to treat depression because many people react differently and better to certain treatments. As of today, depression has become one of the most common diagnosable mental illnesses. Therefore, the search for new technologies and innovative treatment types for depression exists as an ongoing and continuous struggle that will inevitably yield powerful results.

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