Psychology 12 (2 14)

Quick Write,[object Object],After doing today’s reading (and based on what you already know), what is your opinion of antidepressants?,[object Object],Why do you think that antidepressants seem to be becoming more popular?,[object Object]

Psychology 12 (2.14),[object Object],Antidepressants /The Effectiveness of Treatments for Depression,[object Object]

Goals,[object Object],When you leave, you will be able to discuss antidepressants and assess the effectiveness of the various treatments for depression.,[object Object]

There are three main types of antidepressants,[object Object],1. MAO inhibitors,[object Object],2. Tricylics,[object Object],3. SSRI’s,[object Object]

MAO Inhibitors,[object Object],Discovered by accident. ,[object Object],Researchers were actually trying to create a treatment for tuberculosis.,[object Object],An unintended side-effect was that patients seemed to be “happier”.,[object Object],(Sandler, 1990),[object Object]

What do MAO Inhibitors do?,[object Object],They slow down the body’s production of monoamine oxidase(MAO),[object Object],This enzyme is related to the “breaking down” of neurotransmitters. Specifically, norepinephrine.,[object Object],Stopping this break down leads to an increase in the activity of this neurotransmitter.,[object Object],“Approximately half of the patients who take MAO inhibitors are helped by them” (Thase, Trivedi, & Rush, 1995).,[object Object]

The Dangers and Advances of MAO inhibitors,[object Object],Clinicians discovered that someone taking MAO inhibitors had to be very careful about their diet: Too much tyramine could lead to dangerous increases in blood pressure.,[object Object],Newer MAO inhibitors have been developed that affect norepinephrine levels without changing tyramine levels.,[object Object]

Tricyclics,[object Object],Discovered by accident in the 1950’s.,[object Object],Researchers were looking for a drug for schizophrenia.,[object Object],The initial drug, imipramine, and related compounds are now called tricyclics “…because they all share a three-ring molecular structure”.,[object Object]

How do Tricyclics work?,[object Object],By preventing the “reuptake” process.,[object Object],How was this process described?,[object Object]

Are they effective?,[object Object]

Are Tricyclics effective?,[object Object],They seem to be effective, but slow to take hold.,[object Object],Studies seem to support that those taking tricyclics improve more than patients on placebos (APA, 1993).,[object Object],Likewise, “…about 60-65% of those who take tricyclics are helped by them”.,[object Object]

What are the problems with Tricyclics?,[object Object],If the use of tricyclics is brought to an abrupt halt, the chance of remission is about 50%,[object Object],At the very least, they seem to require some level of “maintenance therapy”.,[object Object],Some patients may be on the drugs for life.,[object Object]

Selective Serotonin Reuptake Inhibitors (SSRI’s),[object Object],The “new generation” of antidepressant medication.,[object Object],EX: Zoloft, Prozac,[object Object],Selective Serotonin Reuptake Inhibitors: Target the breakdown of serotonin specifically. In many cases, they are successful at increasing the activity of serotonin. ,[object Object]

Are SSRI’s Successful?,[object Object],Probably on the same level of tricyclics.,[object Object],They are far more popular: The sale of Prozac is over 3 billion annually.,[object Object],SSRI’s account for well over a third of global antidepressant sales.,[object Object],The number of antidepressants prescribed nearly doubled between 1980-1987. This trend continues today.,[object Object],They produce less of the unpleasant side effects of tricyclics.,[object Object],But they have some side effects of their own.,[object Object]

How successful are antidepressants?,[object Object],Some researchers argue that antidepressants of all kinds are not tremendously successful.,[object Object],Kirsch and Sapirstein (1998) concluded that antidepressants were only 25% more effective than placebos, and “…no more effective than other kinds of drugs, such as tranquilizers”. ,[object Object],Likewise, Blumenthal et al., (1999) asserts that in many cases exercise was just as effective as SSRI’s in treating depression in an elderly group of participants.,[object Object]

Elkin et al. (1989),[object Object],Controlled outcome study commissioned by the National Institute of mental health.,[object Object],28 clinicians and 280 patients (suffering from major depression) took part.,[object Object],Depression was assessed based on the Hamilton Rating Scale of Depression.,[object Object],Participants were randomly assigned treatment using an antidepressant (imipramine), cognitive-behavioral therapy, interpersonal therapy, or given a placebo pill and therapy sessions in combination.,[object Object], The study was conducted as a double-blind design.,[object Object],The participants were assessed at the beginning, after 16 weeks of treatment, and after 18 months.,[object Object]

Elkin et al. (1989) Results,[object Object],Just over 50% of patients recovered in each of the therapy groups and the drug groups.,[object Object],Only about 29% recovered in the placebo group.,[object Object],The drug treatment produced results faster, but the study showed that there was no difference in the overall effectiveness of CBT, IPT, and drug treatments.,[object Object],What can we take away from these results?,[object Object]

How do treatments for depression compare?,[object Object],1. Some research seems to suggest that in certain cases, patients may respond better to one treatment over another. However, for the most part, the competing therapies seem to be equally effective at reducing symptoms.,[object Object],2. Cognitive and interpersonal therapies seem less likely to result in relapse. However, both drug therapy and psychotherapy seem to need “maintenance” to keep up mental health.,[object Object]

How do treatments for depression compare?,[object Object],3. Depression as the result of marital problems seems to be just as improved by couple therapy as other forms of therapy.,[object Object],4. While more effective than a placebo, behavioral therapy seems to be decidedly less effective than other types (especially in more severe cases of depression). (Emmelkamp, 1994),[object Object],5. Research seems to show that psychodynamic therapy is less effective than other therapies at all levels of depression.,[object Object],6. Studies seem to show that a combination of both drug and psychotherapy is slightly more effective than either alone. (Frank et al., 2000).,[object Object],7. Drugs and ECT seem to be equally effective for reducing depressive symptoms. ECT is definitely faster-acting.,[object Object]

So…which therapy is the best?,[object Object],How can we answer this question?,[object Object],What questions should we ask as therapists when making this decision?,[object Object]

Psychology 12 (2 14)

Psychology 12 (2 14)

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