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Is Anti-Depressant Medication
Always Necessary For
Treating Major Depression
Disorder?
Emily Murray
100059361
Depression Defined:
Depression is a normal reaction to grievous loss.
However, when depression is excessive, disruptive,
and recurring, it is classified as a psychiatric disorder
(Pinel, 2003)
 Depression as a disorder is sometimes characterized
by symptoms such as persistent feelings of
hopelessness, dejection, poor concentration, lack of
energy, inability to sleep, and, sometimes, suicidal
tendencies (Mash & Wolfe, 2005)

The Main Features of the DSM-IV-TR
Diagnostic Criteria for Major
Depressive Episode

Five or more of the following symptoms listed below
be present during the same 2-week period and
represent a change from previous functioning; at
least one symptom is either (1) depressed mood or
(2) loss of interest or pleasure (Mash & Wolfe, 2005):

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(1) Depressed mood most of the day, nearly every day, as
indicated by subjective account or observations by other
(2) Markedly diminished interest or pleasure in all, or
almost all, activities most of the day, nearly every day (as
indicated by subjective account or observations by others)
(3) Significant weight loss when not dieting or weight
gain, or decrease or increase in appetite nearly every day
(4) Insomnia or hypersomnia nearly every day
DSM-IV-TR Criteria Cont’d.

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(5) Psychomotor agitation or retardation nearly every
day (observable by others, not merely subjective feelings
of restlessness or being slowed down)
(6) Fatigue or loss of energy nearly every day
(7) Feelings of worthlessness or excessive or inappropriate
guilt (which may be delusional) nearly every day (not
merely self-reproach or guilt about being sick)
(8) Diminished ability to think or concentrate, or
indecisiveness, nearly every day (either by subjective
account or as observed by others)
(9) Recurrent thoughts of death (not just fear of dying),
recurrent suicidal ideation without a specific plan, or a
suicide attempt or a specific plan for committing suicide
Prevalence of the Disorder



Depression is now ten times more likely to occur in individuals
than it was in 1960 (Paradise & Kirby, 2005)
It is estimated that as much as 10% of the population may
suffer from this disorder and that it may be the most
prevalent problem that is facing counselors today (Paradise
& Kirby, 2005)
Research suggests that depression is the most common
disorder experienced by people who see mental health
practitioners and that from one third to more than 60% of
mental health professions had reported a significant episode
of depression within the previous year (Paradise & Kirby,
2005)
Different Therapies for Treating the
Disorder
 Paradise
& Kirby (2005) identified the most
widely used approaches to treating
depression:




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Psychodynamic therapy
Interpersonal psychotherapy
Cognitive behavior therapy
Marital and family therapy
Antidepressant medication therapy
The Current Debate
 Is
anti-depressant medication always
necessary when treating individuals who are
suffering from major depression disorder?
Background History to the Debate
 The
complexities of the debate between
psychotherapy and psychopharmacology
stem from a historical conflict between the
advocates of the two approaches. The earliest
advances in biological psychiatry challenged
the unquestioned dominance of
psychoanalysis, which provoked the both sides
of the debate to trivialize, if not demonize
each other. (Winston, Been, & Serby, 2005)
How Antidepressants Work:
The serotonin transporter is the molecular target of
many antidepressants, and the gene (SLC6A4)
encoding this protein has been associated with
response to selective serotonin reuptake inhibitors
(SSRIs) (Kraft, Slager, McGrath, & Hamilton, 2005)
 There are four types of antidepressant drugs:


Monoamine Oxidase Inhibitors
• Monoamine agonist that increases the levels of amines by
inhibiting the activity of monoamine oxidase (MAO), the enzyme
that has been found to break down monoamine
neurotransmitters in the cytoplasm of the neuron (Pinel, 2003)

Tricyclic antidepressants
• Block the reuptake of both serotonin and nor epinephrine, thus
increasing their levels in the brain (Pinel, 2003)
How Antidepressants Work

Lithium
• Therapeutic effects are thought to be mediated by its
agonistic effects on serotonin function (Pinel, 2003)

Selective monoamine-reuptake inhibitors
• Exert agonistic effects on serotonergic transmission by
blocking the reuptake of serotonin from synapses
(Pinel, 2003)
Those For Antidepressant Medication
Therapy

Biological cause: That depression is due to biological
factors
 Mainly that there is an insufficient amount of
serotonin in the individual’s synapses which
decreases the nor epinephrine levels, which results
in depression.
Research Findings Supporting the Use
of Antidepressant Medication Therapy
•
As noted by Paradise & Kirby (2005), reasons to use antidepressant
medication as a form of therapy for depression include:
•
•
•
•
their clear effectiveness to treat the disorder
how the drugs provide a measure of protection against relapse as long as the
user continues to take the medication as was prescribed
An approximate fifty percent response rate to the medication
Psychodynamic therapy lacks the adequate empirical evidence of its efficacy
• Its results are just slightly better than those of placebo medications

According to Kraft, Slager, McGrath, & Hamilton (2005) selective
serotonin reuptake inhibitors (SSRIs) are effective medications for MDD
and are the most widely prescribed antidepressants worldwide
Those Against Antidepressant
Medication Therapy


Believe that there are other ways to treat depression and
that depression is not always caused by biological factors
Past research has found that:

Interpersonal psychotherapy has demonstrated its
effectiveness as a treatment for major depression. In
comparison studies it has shown it is as effective as
medication approaches (Paradise & Kirby, 2005).
 The overall effectiveness of psychotherapy with depressed
children and adolescents has been supported in at least
three recent meta-analytic reviews (Michael, Huelsman,
& Crowley, 2005)
 Winston, Been & Serby (2005) attested that all
practitioners need to recognize and acknowledge those
cases that do not progress in therapy and may respond
well to drugs as well as those patients who may improve
through a “talking cure” without the use of psychotropics
Those Against, cont’d.

Most clinicians recognize that many patients
require both drug treatment and psychotherapy
as in the studies reviewed by Winston, Been &
Serby (2005) where it appears to indicate that a
combined approach of medication and
psychotherapy is most advantageous for severe,
recurrent depression; chronic depression; and
depression in the elderly. For other types of
depression, combination treatment may not be
better at reducing depressive symptoms but may
have a broader effect, particularly on social
adjustment
Those Against, cont’d.


Ethical issue
The downside to medication:

Discontinued use does not protect one against relapse (Paradise &
Kirby, 2005)

Motivation, bad side effects, cost, and so on, all contribute to negative
outcomes over time (Paradise & Kirby, 2005)
• Side effects for these medications include insomnia, nausea,
vomiting, tremors, and memory impairment, to name just a few
(Paradise & Kirby, 2005)
Graduate Work

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Dr. Peter Horvath

Acadia University

Personality and Depression
Dr. Kate L. Harkness

Queen’s University

Etiology and pathology of major depression in adolescents and
adults.
Dr. Peter Mcleod

Acadia University
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Depression, Anxiety, Stress, & Coping; The Psychology of Control
Dr. David Zuroff

McGill University

Relations between personality, especially dependency and selfcriticism, and psychopathology, especially depression.
Question
 Do
you believe that medication should be
used to treat individuals with depression?
References
Kraft, J.B., Slager, S.L., McGrath, P.J., & Hamilton, S.P. (2005). Sequence
analysis of the serotonin transporter and associations with antidepressant
response. Biol Psychiatry, 58, 374-381.
Mash, E.J., & Wolfe, D.A. (2005). Mood Disorders. In E.J. Mash & D.A. Wolfe,
Abnormal Child Psychology (3rd ed., pp. 224-225). Toronto: Thomson
Wadsworth.
Michael, K.D., Heulsman, T.J., & Crowley, S.L. (2005). Interventions for child
and adolescent depression: do professional therapists produce better
results? Journal of Child and Family Studies, 14(2), 223-236.
Pinel, J.P.J. (2003). Affective Disorders: Depression and Mania. In J.P.J. Pinel,
Biopsychology (5th ed., pp. 468-469). The United States of America: Allyn
and Bacon.
Paradise, L.V., & Kirby, P.C. (2005). The Treatment and
Prevention of Depression: Implications for Counseling and Counselor
Training. Journal of Counseling and Development, 83, 116-119.
Winston, A., Been, H., & Serby, M. (2005). Psychotherapy and
psychopharmacology: different universes or an integrated future? Journal
of Psychology Integration, 15(2), 213-223.
http://hawthorne.mfriends.org/faculty/Biology/cmb-2000/cmbkd/Biochemical Causes.htm (Retrieved on October 15, 2005).