Discuss the use of eclectic approaches to treatment
Eclectic approaches to the treatment of depression
· The most common approach to the treatment of depression is antidepressive medication. This often relieves the depressive symptoms although it may take weeks before there is an effect and dropout rates are quite high because of the adverse effects of anti-depressants.
· Although nearly 50% to 60% of depressed outpatients experience an improvement in mood to the first trial of antidepressants, only 1 in 3 patients will experience a full and complete recovery with no symptoms (Keller et al. 2004). The risk of relapse is also high and there is risk of repeated depressive episodes (chronic depression). The combination of psychotherapy and drugs seems to be particularly valuable in the prevention of relapse.
Klerman et al. (1974) Treatment of depression by drugs and/or psychotherapy
· The aim of this controlled study was to test the efficacy of treatment with anti-depressants and psychotherapy, alone or in combination.
· Participants were 150 females diagnosed with depression. Patients were divided into three groups: (1) antidepressants alone, (2) anti-depressants and psychotherapy, and (3) no medication but more psychotherapy or (4) placebo and no psychotherapy.
· The results showed that relapse rates were highest for patients in the placebo group alone (36%). The group with anti-depressants alone had a relapse rate of 12% the psychotherapy (IPT) alone had a relapse rate of 16.7%; combination of drug and IPT had a relapse rate of 12.5%.
· There was no significant difference between drug therapy alone or drug therapy in combination with psychotherapy.
Pampallona et al. (2004) Meta-analysis of efficacy of drug treatment alone versus drug treatment and psychotherapy in depression
· The aim of the study was to analyse whether combining anti-depressants and psychotherapy was more effective in the treatment of depression.
· 16 randomized controlled studies were conducted including 932 patients taking antidepressants only and 910 receiving combined treatment. The patients had all been randomly allocated to the treatments.
· The results showed that patients in combined treatment improved significantly more compared to those receiving drug treatment alone. This was particularly true in studies that ran over more than 12 weeks and there was also a significant reduction in dropouts.
Why eclectic approaches could be more efficient than medication alone…
· There is always a risk that patients stop taking their medicine (e.g. antidepressants). This could be because the patient feels somewhat better after a while and then stops, or it could be because he or she experiences too many negative side effects.
· According to Pampallona et al. (2004) this could be a very good reason for the clinician to combine anti depressants with psychotherapy. Their review of randomized controlled trials shows that the combination of drugs and psychotherapy generally leads to greater improvement. The study also showed that psychotherapy helps to keep patients in treatment.