Psycho-LitReview

Running head: MAJOR DEPRESSIVE DISORDER 1

The Treatment of Major Depressive Disorder

Morgan J. Pearson

North Central University

MAJOR DEPRESSIVE DISORDER 2

The Treatment of Major Depressive Disorder

Major Depressive Disorder is one of the highest diagnosed depression disorders. The

purpose of this paper is to review literature regarding various treatment options when working

with patients with Major Depressive Disorder. This topic of disorder is important because it is

the most common clinical depression. The population at the highest risks for Major Depressive

Disorder is in the late teens and early 20’s. The main idea of this review is to analyze the

different treatment options for Major Depressive Disorder. The three main points of treatment

are pharmacotherapy, therapies, and electroconvulsive therapy. Each of the treatment plans are

important methods to combat symptoms of Major Depressive Disorder in patients.

Pharmacotherapy

Pharmacotherapy is a primary treatment approach when working with patients digonsised

with Major Depressive Disorder. Researchers Boylan, Romero, and Birmaher (2006) state early

detection of Major Depressive Disorder is key in order to provided proper treatment and help in

intervention of the severity increasing with a patient who has symptoms of the disorder. It is

important to have a correct diagnosis of the disorder to apply pharmacologic treatment according

to the patient (Boylan et al., 2006).

Antidepressants

One of the major forms of medicine in treating depressive symptoms is the form of

antidepressants. Dimidjian et al. (2006) states that antidepressants are the typical treatment

option for patients with Major Depressive Disorder. Yang and Scott (2010) highly recommend

antidepressant treatment for adolescent patients with high symptoms of Major Depressive

Disorder. The patient’s time-line of disorders, health history, and current state are serious

considerations when pharmacotherapy, and more superficially antidepressants; however, is the

first option of treatment (Boylan et al., 2006). IsHak et al. (2011) suggests the patient’s quality of


life is highly impacted by understanding their current personal health state. According to Köhler

et al. (2013) patients with acute moderate episodes of depression are recommended

antidepressants as a method of treatment. The medication fluoxetine and escitalopram (selective

serotonin reuptake inhibitor) are the main antidepressants that are used in the United States and

are specifically for adolescent patients (Yang & Scott, 2010). The treatment of antidepressants

for adolescent age patients is mostly selective serotonin reuptake inhibitors, but the patient’s

current health status of medications must be taken into account (Boylan et al., 2006). Adult

patients have been shown to have a positive response to selective serotonin reuptake inhibitors

(Yang & Scott, 2010). Research has discovered selective serotonin reuptake inhibitor is a better

fit for adolescent patients compared to tricyclic antidepressants (Milin et al., 2003). Overall,

antidepressants have high success rates, but may have short-term side effects such as: headaches,

changes in sleep schedule, restlessness, and unstable eating habits (Boylan et al., 2006). A major

complication in many patients with Major Depressive Disorder is the tendency of suicidal

thoughts (Yang & Scott, 2010). The use of antidepressant treatment is the sequence of acute,

continuation, and maintenance phases, and the ultimate outcome is to stop depression symptoms

from occurring (Boylan et al., 2006). The acute phase should last for about 10 weeks of

treatment for patients (Milin et al., 2003).

Combined Treatment

Suggested combined treatments are given according to the patient’s level of depressive

symptoms in order to positively work together (Köhler et al., 2013). Patients with relentless

depressive symptoms and episodes are recommended combined treatment of pharmacotherapy

and psychotherapy (Köhler et al., 2013). Adolescents who have Major Depressive Disorder will

more than likely, over a various time span, need combined treatment of pharmacologic and other

therapies (Boylan et al., 2006). Research shows that combination of pharmacotherapy and


psychotherapy have a great result when practiced simultaneously for treating depressive

symptoms (Köhler et al., 2013). According to Zobel et al., (2011), the results for the combination

treatment of psycho and pharmacotherapy does not instantly decrease symptoms of Major

Depressive Disorder; however, after five years, a increased rate of reduction took place from

being released from the clinic. Patients who had traumatizing events take place in early

adolescence positively improved from the result of combined therapy (Zobel et al., 2011).

Therapies

Bellino, Zizza, Rinaldi, and Bogetto’s (2007) study suggests cognitive therapy and

interpersonal therapy are the top two therapies to be used when treating Major Depression

Disorder, and states that combined methods of therapies are beneficial to patients. Psychotherapy

is proven to be more effective compare to antidepressant solo treatment (Zobel et al., 2011).

Different treatments of psychotherapy should be recommended to patients with mild to moderate

symptoms of Major Depressive Disorder (Köhler et al., 2013).

Cognitive Therapies

According to Klein et al., (2009), patients dealing with hardships throughout life maybe a

cause of Major Depressive Disorder occurring, leading to psychosocial treatments that focus on

reconstructing coping, interpersonal, and cognitive patterns. One of the most popular therapies

used with treating Major Depression Disorder is cognitive-behavioral therapy. According to

Cuijpers et al. (2013), cognitive-behavioral therapy remains the most studied and researched type

of psychotherapy, and this therapy is more beneficial for treatment compared to no occurring

treatment. Cognitive-behavioral therapy is described as “a therapy in which the therapist focuses

on the impact that a patient’s present dysfunctional thoughts affect current behaviour and

functioning (Cuijpers et al., 2013, p. 378). Other aspects of this therapy is practices such as: role

playing, working through hardship, and developing healthy thinking and behavioural methods


(Milin et al., 2003). When using cognitive-behavior therapy, it first aides the patient in reforming

the mind’s thought process in order to positively change their behavioral outcomes (Cuijpers et

al., 2013). Therapists that practice cognitive-behavioral therapy as a treatment method focuses on

a psychoeducational approach, by showing different methods to deal with stressors that may

occur; and the methods focus on assignments outside of current therapy sessions (Cuijpers et al.,

2013).

Another type of therapy intervention is cognitive-emotional training. According to

Iacoviello et al. (2014), the intervention is focused on improving the prefrontal cortical function

of the brain. This type of intervention helps patients with Major Depressive Disorder, because

the parts of the brain that are damaged are not only the cognition functional, but also the

emotional function; in which negative emotions are being produced and not positive emotions

(Iacoviello et al., 2014). The main function of cognitive-emotional training is to focus on the

damaged cognitive functions that impact emotion functions and target the damaged neural

network processes (Iacoviello et al., 2014).

Interpersonal Psychotherapy

Another important therapy used when treating Major Depressive Disorder is the use of

interpersonal psychotherapy. Research by Brakemeier and Frase (2012) states that interpersonal

psychotherapy was invented as treatment option when working with patients who needed almost

instant improvement with depression symptoms. Interpersonal psychotherapy is a controlled

therapy that focuses on the depressive symptoms (Milin et al., 2003). This therapy was inspired

from the Psychobiological Approach, Interpersonal School, and Attachment Theory formed by

different experts in the field, with the foundation of relationships, mood, and interpersonal

situations, all forming a unique individual (Brakemeier & Frase, 2012). The key is to positively

transform interpersonal development for the patient (Dimidjian et al., 2006). The initial phase,


middle phase, and termination phase are the three different groupings of weekly therapy sessions

for interpersonal psychotherapy (Brakemeier & Frase, 2012). In sessions, the therapist will focus

on the patients disorder and the make up of their personality, instead of trying to reform their

character altogether, and empower the patient in life situations and in any hardship they maybe

facing (Brakemeier & Frase, 2012). The therapist will also act as a supporter for the patient by

being positive, encouraging, and reassuring relationship in their life, yet the therapist is

recommended to keep an ethical/appropriate relationship with the patient (Brakemeier & Frase,

2012).

Combined Treatment

A combination of therapy that works successfully together is cognitive-behavioral

therapy and interpersonal therapy compared to pharmacotherapy treatment (Köhler et al., 2013).

A study conducted shows pharmacotherapy and cognitive-behavioral therapy working together is

more effective compared to only pharmacotherapy treatment (Cuijpers et al., 2013).

Pharmacotherapy combined with psychotherapy is a common and effective treatment plan

(Bellino et al., 2007). Most studies concluded that pharmacotherapy and psychotherapy have

higher success rates compared to the treatment of each one unaccompanied (IsHak et al., 2011).

Studies also indicate that cognitive-behavioral therapy is best suited for long-term treatment,

because the relapse rates were lower after a one to two year follow up compared to patients

treated with only pharmacotherapy (Cuijpers et al., 2013). The solo treatment of interpersonal

psychotherapy has shown benefits for patients, but positive results have been concluded with a

combined treatment of pharmacotherapy (Brakemeier & Frase, 2012). Patients have higher

success rates when treatments of therapies are being practiced at the same time (Bellino et al.,

2007). Studies have shown that the correct balance of therapies has the best long-lasting results

compared to medication treatment alone (Zobel et al., 2011).


Electroconvulsive Therapy

According to Lam, Bartley, Yatham, Tam, and Zis (1999), electroconvulsive therapy is

one of the highest beneficial biological therapies available. However, it is one of the most

argumentative forms of therapy for adolescences patients, but positive results have been shown

for adult patients (Milin et al., 2003). Enns, Reiss, and Chan (2010) state electroconvulsive

therapy has been used in the clinical world for about 70 years of an active treatment element,

specifically for Major Depressive Disorder, and with the years of experience has created clear

means of procedure and out comes. Informed consent is mandatory from the patient for the

medical procedure to be done, which includes a short electrical stimulus to occur in order to

produce a controlled cerebral seizure (Enns et al., 2010). Electroconvulsive therapy is best used

when the intensity of the used stimulus is more than the lowest threshold needed for a seizure

(Lam et al., 1999). The details of the procedure during the electroconvulsive therapy are

controlled amounts of: anesthesia, muscular relaxation, preoxygenation, electrical stimulation,

unilateral and bifrontal stimulus electrode placements, and electroencephalogram seizure

monitoring (Enns et al., 2010). The number of electroconvulsive therapy treatments differs

according to the specific patient and their unique needs, but on average the treatment is given

about two to three times a week (Enns et al., 2010).

It is common and more effective for electroconvulsive therapy to be used when the

patient is not responding to antidepressant medications for treatment, and the patient needs close

to immediate improvement and response to treatment (Lam et al., 1999). Tsuchiyama et al.

(2005) suggests electroconvulsive therapy is found to be more impactful with the patients has

symptoms of depression, but also symptoms of other types of disorders, such as delusions. The

practice of electroconvulsive therapy is considered as second or third option when other

treatments are not responding with the patient, and consideration of the patient’s consent, risks,


and benefits (Enns et al., 2010). A study of treatment conducted showed that electroconvulsive

therapy had a high short-term outcome for patients who were dormant to a positive response to

antidepressant medication treatment (Lam et al., 1999). Electroconvulsive therapy is most

effective when partnered with pharmacotherapy, in order to not create a dependency on

electroconvulsive therapy alone and to hinder a relapse taking place of depression (Enns et al.,

2010). Several studies have concluded that electroconvulsive therapy is most effect with adult

patients (Tsuchiyama et al., 2005). An important factor to consider is that proper

pharmacotherapy is given before electroconvulsive therapy is considered (Tsuchiyama et al.,

2005). It is key to evaluate the long-term impacts and outcomes of treatment, because patients

with Major Depressive Disorder have the possibility of having occurring symptoms throughout

their life (Zobel et al., 2011).

Limitations of the Research

Similarities of research are themes were found is that the first treatment option is

pharmacotherapy, and secondly are different psychotherapies. Electroconvulsive therapy was

discussed with caution, especially to adolescent patients. Difficulties were found in constant

usage of the same treatments methods being used at the same time. Suggestions would be to use

pharmacotherapy along with various types of individual therapies together and use

electroconvulsive therapy in extreme depressive cases.

The purpose of this paper was to review the treatment options available when diagnosing

patients with Major Depressive Disorder. Positive conclusions were found from the literature

regarding using different treatment approaches and even combined. The three main findings of

treatment were pharmacotherapy, therapies, and electroconvulsive therapy. Pharmacotherapy is

best used with antidepressant medication. The major therapies suggested are cognitive and

interpersonal therapy for best results. Electroconvulsive therapy is only recommended for adults


with extreme cases of depressive symptoms. Overall, the best treatment concluded was a

combination of pharmacotherapy along with therapy sessions, such as interpersonal and

cognitive therapy.


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