Mischa Shimogaki

Psychology, Period 1

5/19/10

Compare and contrast cognitive, electroconvulsive, and

psychopharmacological treatment for Major Depressive Disorder.

An old clergyman who had recovered from a severe depression later

badly scalded his genitals, thights, and abdomen. When asked which kind of

pain is worse he replied, “I would suffer the scalding a hundred times rather

than have a depression again. Every night I pray to God to let me die before

the depression returns. When I was scaled I prayed for relief and I was heard,

but during the depression I lost my faith. There is no comparison between

those two kinds of pain.'" Major depressive disorder has become a

widespread disorder that causes million to suffer around the world and

leIads many of them to death. A recent World Health Organization report

predits that depression will be the deading cause of disability and premature

death in the industrial world by the year 2020. While different kinds of

therapies exist, each kind has its pros and cons and depends highly on the

severity and stage of major depression for it to achieve maximum

effectiveness. Here I will compare three major types of treatement methods

for Major Depressive Disorder: cognitive, electroconvulsive, and

psychopharmacological treatment.

Cognitive therapy is a type of psychotherapy developed by American psychiatrist Aaron Beck

in the 1960s. It is a therapeutic approach within the larger group of Cognitive Behavioral therapy, whch

states that the patient’s excessive self-rejection and self-criticism causes major depression. Cognitive

therapy can treat depression on three progressive levels. First, supportive counseling helps ease the pain

of depression, and addressing the feelings of hopelessness. Second, it changes pessimistic ideas and

unrealistic expectations, helping them recognize their problems and developing positive life goals. Third,

problem solving therapy changes ideas of a person’s life that are creating stress and contributing to

depression. This can be done through behavioral therapy, or interpersonal therapy. Cognitive therapy runs

on the basis that cognitive and behaivioral experiences are intertwined, therefore they are studied as an

interactive pair. Some cognitive factors in depression include negative and critical self-evaluation,

identification of skill deficits, negative evaluation of life experiences, and irrational ideas and beliefs.

Cognitive therapy aims to bring these problems into acknowledgement of the patient, and support them

turn their perspective into a more positive one. The drawback however, is that a recent review of

scientific literature concluded that cognitive behavioral therapy for depression was promising, but not yet

adequately tested. Also, recent research suggests that for moderately to severely depression patients,

pharmacotherapy is superior to cognitive behavioral therapy, and critics of the therapy have argued that

the depressed patient’s pessimistic, negative thoughts are a result of their major depression, not its cause,

and that pharmacotherapy removes these negative dysfunctional attitudes.

Electroconvulsive is almost a “last resort” for patients of extreme depression who have tried

other treatments and failed, and when they are too suicidal to do anything else and too severe for drugs to

work. It is expensive compared to drugs, and often requires hospitalization, demanding greater

commitment from the patient. A treatment consists of a medically controlled seizure initiated by passing

an electric current between two scalp electrodes. First the patient receives anesthetic in the vein, then

receive drugs to relax muscles. To prevent interference with breathing from the seiqure, oxygen is sent

through a face mask, and the treating physicial pases electric current for several seconds to start the

seizure. Subsequent to ending the seiqure, they stay in recovery for a short while, where ECT often causes

mental confusion. Despite the seemingly the intense procedure of ECT, it is proven a safe medical

procedure. A noted side effect would be the effect it has on memory; ETC interferes with long-term

memory, and events that occur during the course of the procedure may be forgotten. However events

already stored remain intact, and after the procedure memory runs to normal, and there is no evidence of

permanent brain damage it could cause. ECT has proved a highly effective procedure for Major

Depression, most studies having found that approximately 80% of patients recover or are much improves.

It is specifically powerfully effective for catatonia, so much that patients often improve after a single

treatment.

Psychopharmoacological therapy has proven effective on higher levels of depression. This

was tested in a study done by the National Institute of Mental Health in 1989. Patients with Major

Depression were assigned at random one of four treatments for 16 weeks: antidepressant drug

(imipramine), placebo pill, interpersonal therapy, and cognitive behavioral therapy. For severely

depressed patients, the antidepressant drug therapy was highly effective as 76% improved on imipramine

as compared to only 18% on placebo. Interpersonal therapy was moderately but not as effective as

antidepressant drug therapy. For Non-severe Major Depression, time-consuming or antidepressant drug

therapy is not needed, as it usually spontaneously recovers on its own. For severe Major Depression, once

there is a major impairement in social or vocational functioning, antidepressant drug therapy must be

given. It proved highly effective in the NIMH study, as 76& improved and only 18% on placebo.

Antidepressant therapy must be given atleast 6-12 months, and it must be given combined with some

form of frequent, supportive counseling. Critics of pharmacotherapy however, have argued that

antidepressant medication only removes the symptoms of depression, but doensnt treat the patient’s

underlying dysfunctional attitudes, unlike cognitive behavioral therapy which focuses on getting rid of

these attitudes.

The National Institute of Mental Health experiment was one of the first carefully conducted

experiments concerning therapies of Major Depression. While cognitive, electroconvulsive and

psychopharmalogical therapy each have its pros and cons, each seem to aim at curing depression on

differing levels; cognitive by surfacing and changing the negative and pessimistic mindset of the patient,

electroconvulsive by stimulating the brain of extremely depressed patients, psychopharmalogical by

altering the biological functioning of severely depressed patients. As demand for the depression therapies

grow, old treatments will be upgraded and new ones surely developed.