Biological treatments

Major Depresive Disoder (MDD) is mood disoder that is characerized as persistent low moods . diagnosis via the DSM-5 states that paitents needs to have at least 5 symptoms such as constant low mood, loss of ability to feel pleasure from pleasurbale experience, intense feelings of sadness and guilt, apathy, lack of sleep of oversleeping, over or under eating

Antidepressents

biological treatments for depression that work by altering neurotransmitter levels (e.g: serotonin) in the brain to improve mood and behavior. for example SSRIs and MAOS

Selective serotonin reuptake inhibitors (SSRIs) such as prozac. SSRI block the receptors that absorb serontine (type of neurotransmitters). This leads to a build up of sertonine in synpaptic cleft this increases the likleyhood of serotonin binding to receptors and causing physiological and behavior such as happiness

Treatment of adolescents with depression study (TADS)

To examine the short and long term effectiveness of drug treatment (SSR) and psychotherapy (CBT) for the treatment of depression in adolescents

multi-site, randomized controlled clinical trial (RCT)

Particpents: 13 clinics in the USA were used with 439 participants from 12-17 with MDD. The study was funded by the National Institute of Mental Health.

The study lasted for 36 weeks and was conducted in 3 stages.

Stage 1: Acute Treatment (12 weeks)Participants were randomly assigned to one of four conditions: fluoxetine alone, CBT alone, combination or placebo AND clinical management (Wbere cliens and therapist talk but no specfic pyschtherapeutic technqiue is used),

Stage 2: Consolidation Treatment (6 weeks)At the end of stage 1, participants in the placebo were told they were in the placebo and were allowed to choose any other condition but were no longer included in the study

Stage 3: Continuation Treatment (18 weeks)Used to assess long term effects and response rates were used to indicate this. This is the percentage if participants who showed a 50% decrease or more on a standardised depression scale e.g. HAM-D

Results used response rates to measure effectivness (a 50% decrease in scores using hamilton depression rating scale (HAM-D) a standardized depression scale)
At the end of stage 1, combination treatment had the best response rate (71%), fluoxetine (61%), CBT (44%) and placebo (35%)
At the end of stage 2, CBT caught up with treatment (65%), fluoxetine (69%) but combination was still the best (85%)
At the end of stage 3, combination (85%), fluxoetine and CBT had the same percentage (81%)

all three active treatments outperformed the placebo
CBT gradually catches up with medication
drugs may have ubpleasent side effects and dont allow induvals to learn new behaviours but is needed for its quick action espically if depression is severe
Antidepresent are effective for the treatment of depression in both short and long term
supports the chemical imbalance theory (the proposition that depressive symptoms are caused by netransmitter imbalances in brain and restoring balance will lead to reduction in symptoms)

A: Study is highly applicable for choosing effective treatment plans for paitents with depression as it shows that a mixture of both Cognative and drug treatment lead to decrease in depression scores and thus is a more effective. However since the study only uses particpents from America, lowering global generalizability. It also lowers global applicability as attiudes towards mental health treatment and access to medication/therapy may vary globally and across cultures


C: High construct validity as the effectiveness of treatments was assessed using a standardized depression measuring scale ( The HAM-D) to measure response rates strengthening reliability. However, depression as a construct is complex so by reducing it to a numerical score it may oversimplify the expeirence of the disorder.


U: Attempts were made to reduce research bias through randomly assigned participants, standardizing procedures, standardizing procedures and using a placebo group, thus strengthening internal validity. However since medication (fluxatocine) was used there may have been pharmaceutical influece which may have altered the study. Participants may also have attempted to guess their treatment group even though there were precautions in place to limit that effect

Ethics: The study used deception, through the use of clinical management (in which client and therapist meet and talk but the technique was used) participants did not know if they were in a placebo group or one of the controls. However ethical considerations were taken into a as at the end of stage 1 those in the placebo group were told about the study and if they had no improvement were given the option to choose the three modes of treatment (but did not partipate in the rest of the study). However there was no mention of informed consent from parents of the particpents as most of them were under 16 (the age range was 12 to 17)

Although the Treatment for Adolescents with Depression Study (TADS) provides strong support for the effectiveness of biological treatments in the acute phase of depression, it does not address the long-term maintenance of these improvements. This gap is addressed by Hollon et al. (2005) relapse study, which examines the likelihood of relapse after treatment discontinuation.

the percentage of individuals who experience a return of symptom

To identify relapse rates in patients dependent on treatment.

USed patients with moderate to severe depression

Participants were randomly assigned to one of three treatment groups:
CBT
Antidepressant medication (paroxetine)
Placebo treatment
Treatment phase
The treatment lasted 16 weeks.
Depression symptoms were measured regularly using standardized clinical depression scales.
Follow-up phase
Participants who recovered were followed for 12 months after treatment.
Researchers measured relapse rates.

Patients withdrawn from CBT
(30.8%) were less likely to
relapse than patients withdrawn
from medications (76.2%)

Effect of CBT extends to the
prevention of recurrence

- medication mainly targets the symptoms of depression but not the cause
- drugs are useful for short term management

T: The study uses a controled experimental design which has a defined IV (Type of treatment) and DV (relaspes rates over time. Relapse were also operationalized by using a standardized depression diagnostic criteria (17-item Hamilton Rating Scale for Depression (HRSD)). However, relapse is influenced by many external factors (life, stress, supporrt systems) which are difficult to control, reudcing full testability

A: The study's focus on the long-term effects of cognitive therapy - examining sustainability and enduring benefits post-treatment. This insight is crucial for healthcare policy and treatment planning, providing evidence that could support the use of cognitive therapy for lasting impact in treating depression. However partipents were USA based and were treated in controlled clinical setting as a result it limits the studies global generzability and ecological validity as treatment adherence varies in a real-world context and different countries and cultures treat mental health differently.

P: high predictability by showing a consistent pattern in long-term outcomes: patients treated with antidepressant medication tend to show higher relapse rates after treatment, whereas those treated with CBT show lower relapse rates. This allows researchers to predict that CBT is more likely to produce more sustained recovery, while medication alone may be more effective in the short term but less stable over time. However, predictability is not perfect, as individual differences such as severity of depression, personality, and environmental factors mean that relapse outcomes cannot be accurately predicted for every patient.

In conclusion, both studies highlight the importance of biological treatements in treating MDD. But while TADS shows that a mix of drug treatments and CBT are effective in reducing remission rates, Hollon argues that biological treatments are not as effective as CBT in mainting long term improvents and in reudcing relaspes rates. Therefore, while biological treatments play an important role in the initial management of depression, a combined or psychological approach may be more effective for sustaining recovery over time.