An integrative and selective treatment approach

Article Abstract:

Depression occurs in an assortment of psychiatric disorders as well as during normal bereavement and as part of ordinary fluctuations in emotion. Most normal mood fluctuations are relatively benign, appropriate, and transient. Depressive disorders are considered an illness, which lasts for a long time and can pervade a person's entire life. Depression differs from ordinary sadness or the reaction to a real loss of a loved one in duration and intensity, but manifests similar symptoms, except that in melancholia (pathological depression) there is a fundamental low self-regard, which results in the extreme self-denigration and self-reproach that permeates the patient's being. There are many unclear boundaries in the classification of depression, having to do with severity, duration, quantity and quality of symptoms. Therapy is therefore unstandardized and the patient usually receives the treatment favored by the particular therapist rather than one which may benefit him or her most. Also, diagnosis on the basis of symptoms alone cannot accomplish a clear patient profile, which should include a family and personal history and evaluation. Three approaches to psychotherapy and drug therapy are reviewed: psychodynamic, cognitive and interpersonal. Because of the mind-body dichotomy that has always been at the core of modern medicine, therapists often have an either/or approach to treatment, relying more heavily upon either drugs or psychotherapy. The integration of both is a recent development. Much concern about drug therapy is based on Freud's premise that the patient's symptoms are the motivation for change and continuing psychotherapy, and that the reduction of these symptoms by drugs could negatively reduce or destroy this important motivation. The predominant psychodynamic stance is to resort to using drugs for acute, health-threatening situations only. Cognitive therapy is very effective for a wide range of depressive symptom states and drug therapy is only included if results with therapy are poor. Combining interpersonal therapy with drug therapy has been found to be more effective than either type alone, the drug effects occurring early and the effects from psychotherapy occurring later on. A model of combined psychotherapy-pharmacotherapy is included, with a breakdown of specific symptoms and treatment recommendations and limitations. Variation of depression in terms of etiology, manifestations and response to treatment is discussed. Recognizing depression as a spectrum phenomenon is the first step toward clarifying treatment guidelines and approaches. (Consumer Summary produced by Reliance Medical Information,Inc.)

Drug therapy, Psychotherapy, Combined modality therapy

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Toward a clinical model of psychotherapy for depression, I: systematic comparison of three psychotherapies

Article Abstract:

Traditional psychoanalysis and physical treatments have been two distinct types of therapy used to treat major affective disorders. In recent years, three primary approaches have evolved for the treatment of depression. In the first part of a two-part series, the author has defined and outlined psychodynamic, cognitive, and interpersonal therapeutic approaches. These major clinical approaches are described and compared schematically. Although they may be conceptually different, similarities can be observed in basic characteristics such as strategies, goals, and theoretical orientation; each model also has distinct limitations and advantages. The psychodynamic approach has evolved primarily from Freud's general personality theories of intrapsychic conflict and infantile sexuality. In particular, modern dynamic theory focuses upon early childhood disappointment and loss, damaged self-esteem, persistence of narcissistic rage, and other unresolved developmental issues. The return to a regressive pattern of behavior is viewed as a by-product of the belief that repetition is the result of an unexamined life. The roots of the cognitive approach are based in ancient Greek and Eastern philosophies which in the twentieth century have evolved into phenomenology and behaviorism. The current cognitive model is also largely dependent upon Beck's cognitive theory of depression. Major goals and mechanisms of change include the monitoring, recognition, and modification of connections between thought, feeling, and behavior. The interpersonal approach incorporates a pluralistic view, which asserts that no single factor explains depression. This method relies upon clarification of communication and environmental considerations, along with the goal of providing symptomatic relief by resolution of interpersonal problems and reduction of stress. Recent studies have suggested that 80 to 90 percent of all major depression can be successfully treated using one or more of these approaches. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Causes of, Interpersonal relations

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Marital therapy: a viable treatment for depression and marital discord

Article Abstract:

A comparison was made between the clinical benefits derived from behavioral marital therapy and cognitive therapy in cases involving a depressed spouse. Marital disruption is frequently observed just prior to incidents of depression. In more than 50 percent of unhappy marriages, at least one spouse is depressed. Thirty-six discordant married couples were separated into one of three groups; 12 were assigned to individual cognitive therapy for the wife only; 12 underwent marital therapy together; and the remaining 12 were placed on a waiting list. All of the wives had been diagnosed as clinically depressed. After approximately 16 weeks, significant reductions in depression were observed in the women in the joint marital therapy or individual cognitive therapy group. Higher levels of martial satisfaction were reported by the women who participated in marital therapy as compared with the other two groups. Marital therapy improved both the symptoms of depression in the women and their overall sense of marital satisfaction. This suggests that this method may be the most appropriate and effective therapy in cases were clinic depression is concurrent with general marital discord. However, it is emphasized that marital dissatisfaction is frequently more difficult to relieve than depression, because it requires change to take place in two individuals, and the couples need to have mutual goals for marital satisfaction to achieve successful results. (Consumer Summary produced by Reliance Medical Information, Inc.)

Marital psychotherapy, Couples therapy

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