Quick Write

After doing today’s reading (and based on what you already know), what is your opinion of antidepressants?

Why do you think that antidepressants seem to be becoming more popular?

PSYCHOLOGY 12 (2.14)

Antidepressants /The Effectiveness of Treatments for Depression

Goals

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

There are three main types of antidepressants 1. MAO inhibitors

2. Tricylics

3. SSRI’s

MAO Inhibitors

Discovered by accident.

Researchers were actually trying to create a treatment for tuberculosis.

An unintended side-effect was that patients seemed to be “happier”.

(Sandler, 1990)

What do MAO Inhibitors do? They slow down the body’s production of

monoamine oxidase (MAO)

This enzyme is related to the “breaking down” of neurotransmitters. Specifically, norepinephrine.

Stopping this break down leads to an increase in the activity of this neurotransmitter.

“Approximately half of the patients who take MAO inhibitors are helped by them” (Thase, Trivedi, & Rush, 1995).

The Dangers and Advances of MAO inhibitors 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.

Newer MAO inhibitors have been developed that affect norepinephrine levels without changing tyramine levels.

Tricyclics

Discovered by accident in the 1950’s.

Researchers were looking for a drug for schizophrenia.

The initial drug, imipramine, and related compounds are now called tricyclics “…because they all share a three-ring molecular structure”.

How do Tricyclics work?

By preventing the “reuptake” process.

How was this process described?

Are they effective?

Are Tricyclics effective?

They seem to be effective, but slow to take hold.

Studies seem to support that those taking tricyclics improve more than patients on placebos (APA, 1993).

Likewise, “…about 60-65% of those who take tricyclics are helped by them”.

What are the problems with Tricyclics? If the use of tricyclics is brought to

an abrupt halt, the chance of remission is about 50%

At the very least, they seem to require some level of “maintenance therapy”.

Some patients may be on the drugs for life.

Selective Serotonin Reuptake Inhibitors (SSRI’s) The “new generation” of antidepressant

medication.

EX: Zoloft, Prozac

Selective Serotonin Reuptake Inhibitors: Target the breakdown of serotonin specifically. In many cases, they are successful at increasing the activity of serotonin.

Are SSRI’s Successful?

Probably on the same level of tricyclics.

They are far more popular: The sale of Prozac is over 3 billion annually.

SSRI’s account for well over a third of global antidepressant sales.

The number of antidepressants prescribed nearly doubled between 1980-1987. This trend continues today.

They produce less of the unpleasant side effects of tricyclics.

But they have some side effects of their own.

How successful are antidepressants? Some researchers argue that antidepressants of

all kinds are not tremendously successful.

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”.

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.

Elkin et al. (1989)

Controlled outcome study commissioned by the National Institute of mental health.

28 clinicians and 280 patients (suffering from major depression) took part.

Depression was assessed based on the Hamilton Rating Scale of Depression.

Participants were randomly assigned treatment using an antidepressant (imipramine), cognitive-behavioral therapy, interpersonal therapy, or given a placebo pill and therapy sessions in combination.

The study was conducted as a double-blind design.

The participants were assessed at the beginning, after 16 weeks of treatment, and after 18 months.

Elkin et al. (1989) Results Just over 50% of patients recovered in each of

the therapy groups and the drug groups.

Only about 29% recovered in the placebo group.

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.

What can we take away from these results?

How do treatments for depression compare? 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.

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.

How do treatments for depression compare? 3. Depression as the result of marital problems seems to be just

as improved by couple therapy as other forms of therapy.

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)

5. Research seems to show that psychodynamic therapy is less effective than other therapies at all levels of depression.

6. Studies seem to show that a combination of both drug and psychotherapy is slightly more effective than either alone. (Frank et al., 2000).

7. Drugs and ECT seem to be equally effective for reducing depressive symptoms. ECT is definitely faster-acting.

So…which therapy is the best? How can we answer this question?

What questions should we ask as therapists when making this decision?