Treating Depression Using CBT

DEPRESSION SHOULD BE TREATED USING ONLY THERAPY

Depression Should Be Treated Using Only Therapy

Depression is the most common psychiatric disorder, with an estimated prevalence rate of 17 percent (Morgan et al., 2015). Depression involves episodes of pessimism, sadness, negative beliefs, decreased motivation, loss of interest, suicidal thoughts, behavioral passivity, changes in sleep, sexual interest, and appetite. Symptoms of depression can range from mild seasonal changes to severely disabling symptoms that limit the person’s ability to work or function (Morgan et al., 2015). It is estimated that about 17 million Americans experience a major depressive episode. With increased numbers of people being affected by depression, there has been a considerable push for prescription depression drugs in America. Antidepressant medications (ADMs) account for 5 out of 25 most frequently prescribed drugs. High blood pressure and high cholesterol medications were the only classes of medications prescribed more often than antidepressants. The positive thing about these ADMs is that more people can receive adequate treatment for depression (Boschloo et al., 2019). The negative side is that ADMs are the default medications for treating depression, even for patients who prefer therapy.

There are numerous studies conducted focusing on the efficacy of ADMs on depression. These studies have demonstrated that ADMs offer effective treatment for the disorder, and when used as prescribed, a person can lead a normal life. However, the side effects of these medications are never focused on in the studies. Other studies have shown how therapy is more effective in treating depression and the long-term effects reaped by the patient. The good thing about therapy is there are no side effects. The best treatment course is dependent on the patient and their preferences. Depression does not affect two people in the same way. Therefore, there cannot be a one size fits all treatment for depression. The patient’s willingness to try out the available treatments and desire to follow through should be the underlying focus of treatment. With the side effects experienced by most patients, it has been established that many depressed patients will fail to refill their prescriptions due to the side effects of the drugs. With such patients, the best treatment would be therapy. Therapy has no adverse side effects, and patients can receive adequate treatment by following the therapist’s guidelines.

Antidepressant Medications (ADMs)

Depression medications are more effective in treatment than therapy. The medicines offer an instant resolution to the depressive symptoms experienced by the patient, making them highly effective. More and more people can receive adequate treatment for depression using medications than using therapy (Morgan et al., 2015). The drugs used for treating depression include serotonin and norepinephrine reuptake inhibitors, selective serotonin reuptake inhibitors, and other medications related that target specific neurotransmitters (Boschloo et al., 2019). The mechanism of action for these drugs is different, but they all offer the same benefits to the patient. While ADMs are the most frequently used drugs for treating depression, an estimated 20% of the patients never refill their prescriptions (Boschloo et al., 2019).

Additionally, even if a patient starts on the course of treatment, they may discontinue the treatment before receiving adequate effects. The overall cause of failure to adhere to ADMs is the side effects experienced by the patients after taking the drugs. Over 60% of the patients who take ADMs have at least one adverse effect during treatment. Most of these negative effects are minor, but they discourage a patient from continuing with the medications. The most common side effects are diarrhea, constipation, and dizziness.

Patients prefer starting and switching treatment, which also plays a vital role in the efficacy of the drugs. When one drug has adverse side effects, patients might want to try a different drug, impacting their progress with the other drug. When patients discover the drugs have the same side effects, they might be willing to try psychotherapy treatment to avoid the adverse effects of the drugs. Also, some of the medications used to treat depression can be addictive, making them undesirable for patients afraid of being addicted to the drugs.

Cognitive Behavioral Therapy

While medications give instant patient relief to their depressive symptoms, therapy teaches the patient how to manage their thoughts, to fight off their depression. Cognitive-behavioral therapy (CBT) offers different interventions that are known to support the treatment of depression (Driessen & Hollon, 2010). The patient needs to receive treatment that will provide long-term treatment and not temporary treatment of the symptoms. Therefore, using CBT, the patient learns how to handle their mood swings and depression symptoms. Learning how to identify and modify destructive thought patterns is the goal of CBT. These destructive thoughts have a direct impact on the patient’s behavior and emotions. The patient learns different strategies to use when they find they are entertaining negative thoughts. CBT focuses on changing the patient’s automatic negative thoughts that worsen anxiety, emotional difficulties, and depression (Boschloo et al., 2019). Therapy might initially offer the patient some ADMs, but the therapist only does this for patients with severely disabling symptoms. There are no adverse side effects of CBT, and the patient needs to learn how to adjust their thought patterns to focus on the positive instead of the negative. Initially, the patient will find it difficult, and they might prefer medications. However, with assistance from the therapist, they can overcome the challenge and begin reaping the benefits of therapy.

Depressed patients need to find a lasting solution they can use without becoming addicted to the solution. CBT offers the best alternative to medications and has been proven to work. According to Driessen and Hollon (2010) CBT allows the patient to engage in healthier thinking patterns by being aware of their negative and unrealistic thoughts. Improvements can be seen in five to 15 sessions. Patients get to see their progress, and they can begin making changes to their lives in a short time. Since CBT uses behavioral changes, some patients might find it too structured. Therefore, it is best used for patients who are comfortable with a structured approach to therapy.

Critical Dilemmas

The medical ethics of non-maleficence denotes that one should not harm a patient. There are several moral rules supported by non-maleficence: do not kill, do not incapacitate, do not cause pain or suffering, and do not deprive others of the goods of life (Bailey & Burch, 2016). Medication treatment for depression offers the patients relief from their pain but results in addiction or adverse side effects. Physicians will presume they are doing the right thing and do not intend to harm the patient when prescribing ADMs to a patient. However, physicians should analyze the side effects of the drugs on the patient before prescribing ADMs. Harm is done to a patient if they become addicted to a medication prescribed by a physician. A physician should consider therapy or alternative treatment methods to ensure the patient receives the best treatment for depression. The second ethical decision denied to most patients is autonomy. ADMs are prescribed to patients without consulting them and seeking their input. The result is that patients will stop taking the drugs due to the fear of addiction or the side effects of the drugs. Autonomy is the capacity of a person to make an informed decision (Lee, Ortiz, Pavela, & Jennings, 2020). Therefore, patients should be given a choice to make a decision they deem fit for their treatment.

Culture plays a critical role when it comes to treatment. For depression, most cultures do not encourage medications, making it hard to treat patients from these cultural backgrounds using drugs. Physicians should be culturally aware of the patient’s background and need for treatment. Socio-cultural norms demand that patients seek alternative forms of treatment instead of taking prescription medications. If prescribed ADMs, these patients will not accept them, and they will continue to suffer their depressive symptoms since they don’t want to break their cultural rules. Women and people from ethnic minority communities will prefer therapy over medications. A physician who does not believe in therapy finds it hard to treat such patients, resulting in patients continuing to suffer. The flexibility of physicians is vital to ensure they can refer patients based on their preferences and not what they believe is suitable for the patient.

The only way to ensure that patients can get better medications is to reduce the adverse side effects of the drugs. Otherwise, therapy should be the first line of treatment prescribed to any depressed patient. Patients are becoming more informed, and they are opting for therapy as opposed to medications. Therefore, the projected trend for the future is that there will be fewer medications prescribed for depression and more people undergoing therapy. Also, as people learn how to cope with depressing situations and thoughts, we can have long-lasting treatments that reduce the number of people suffering from depression. Depression is a mood disorder, and the negative moods stem from the destructive thoughts a person entertains. With therapy, the patient learns how to stay more positive and analyze situations from a positive perspective. The patient’s need for medications reduces since they have learned how to cope with their condition. Therapy gives the patient a permanent solution they can rely on to overcome their depression instead of medications, which require the patient to keep taking them all their life. Until we can develop depression medications that have lasting effective treatment without requiring the patient to be on drugs all the time, therapy should be the best course of treatment for depression.