Psychological disorder is a mental condition associated with abnormal feelings, thoughts, emotions and behaviours, leading to cause distress in an individual (WHO, 2019). Allan is a 47 years old man who is suffering from prolonged depression, one of the mental disorders which can be caused by various factors. There are several treatments for mental conditions, however in Allan’s case, cognitive behavioural therapy (talking therapy) and biological (drugs therapy) therapy are the two appropriate methods of treatment that can be applied for his depressive disorder. Although the combination of these two distinct treatments are suggested to be effective, they also have some unavoidable disadvantages.
Depression is a mood disorder- a common disorder in which an individual suffers from persistent lack of satisfaction or happiness in life (King, 2013). Allan’s loss of appetite resulting in significant amount of weight loss and his recent withdrawal from activities such as cooking and playing golf he once enjoyed, exhibit typical symptoms of depression. Other depressed characteristics include distorted thinking, anxiety, trouble sleeping or oversleeping, lethargy, hopelessness and suicidal thoughts.
An individual experiencing any five of these symptoms continuously for at least two- week period define Major Depressive Disorder (MDD), whereas depressive disorder which is more chronic with fewer symptoms and is ongoing for at least two years or more define Dysthymic disorder (DD) (Glassman and Hadad, 2013). While Allan’s symptoms indicate MDD, a variety of biological and psychological or social factors play a role in its development.
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Generally, the cause of MDD is linked not just to one event or issue but is linked to many factors. The predisposition of developing depression can be inherited. For instance, Allan may inherit depression which are carried on genes that pass from one generation to the next (Eysenck, 2003). Research showed that the concordance rate of MDD was 46% for monozygotic (identical) twins and 20% for dizygotic (non-identical) twins, revealing that genetic influence is a factor (McGuffin et. Al, 1996). Additionally, it is suggested that chemical imbalance in brain, such as low levels of neurotransmitters serotonin and norepinephrine produce depression.
Allan might be experiencing major life changes and stressful events including loss of loved one, difficult relationship, or financial problems that can trigger depression. Similarly, the cause could be due to any negative feelings or beliefs from negative experiences, learned helplessness or history of drug abuse (King, 2013).
One of the common methods used in treating depression is biological therapy, developed from the biological model approach. This approach is highly adopted by psychiatrists while psychologists reject it and favour psychological models. Biological model assumes that mental disorders result from physical causes, hence, it regards such disorders as illnesses of body (Eysenck, 2003).
Moreover, it focuses on genetics, brain structure and its function, neurotransmitters, etc, and its probable treatment are based on the study of sciences such as drugs and biochemistry. Biological therapies are treatments that help reduce or eliminate mental disorder symptoms by modifying aspects of body functioning. These therapies include drug therapy, Electroconvulsive therapy (ECT)and psychosurgery. In Allan’s case, antidepressant drugs are considered as the suitable option which are popular form of biological therapy.
Antidepressants are medications to relieve symptoms of MDD by maintaining the level of essential neurotransmitters that affect mood and emotions. There are three main classes of antidepressant drugs: selective serotonin reuptake inhibitors (SSRIs), tricyclics and monoamine oxidase (MAO) inhibitors (King, 2013). Although all three antidepressants help regulate mood, SSRIs (Fluoxetine) will be prescribed to Allan as it is most effective in reducing depressive symptoms. Fluoxetine works by increasing the levels of serotonin that carries signals between brain neurons. It blocks reabsorption or uptake of serotonin in brain, regulates the amount of serotonin to help brain cells transmit neurons to each other, resulting in better, stable mood (Nordqvist, 2017).
Fluoxetine is a widely used drug with fewer side effects than other antidepressants. Allan will benefit from using this drug as it also improves sleep, energy level, appetite and help restore interest in daily living (Psychcentral, 2018). Fluoxetine usually takes 4 to 6 weeks to work and its usual prescribed dose in adults is 20mg a day. Doses can be lowered or raised to 60mg a day depending on its working effects (NHS, 2018), however if Allan’s symptoms do not improve, ECT can be prescribed for further diagnosis.
In recent years, use of antidepressants has increased rapidly. Out of 100 users, 40 to 60 people noticed an improvement in MDD symptoms within 6 to 8 weeks which confirms its rapid effectiveness (NCBI, 2017). The affordable price of these drug therapies also explains an increase in the number of antidepressant users. However, there are side effects (mild and severe) involved, for instance Allan on SSRIs will probably experience nausea, diarrhoea, nervousness and headaches. It is also suggested that teenagers on SSRIs are more likely to consider suicide and make actual attempt to take their own lives (NCBI, 2017). Additionally, antidepressants are dangerous and prolong use of these drugs might raise the possibility of health risk and drug abuse.
Those abusing these drugs are likely to increase the risk of overdosing and developing seizures. Research showed that people taking SSRIs and other antidepressants lowered the risk of relapsing but could not be prevented completely, though a recent study also revealed that more people relapsed after discontinuation of antidepressants than when they were continued (BMJ, 2017). Nevertheless, as biological therapy focuses on relieving biological depressive symptoms, Allan can also benefit from cognitive behavioural therapy to help him reduce his possible psychological problems.
Cognitive behavioural therapy (CBT) is a form of psychotherapy that is developed from behavioural and predominantly cognitive theories. The cognitive model describes how one’s thoughts or perceptions about situations influence emotional and behavioural reactions (Beck, 2007). In addition to that, cognitive behavioural theories focus on the interactions between thoughts, feelings and behaviour altogether and how the thinking affects feelings and behaviour. CBT widely covers many different therapies that share some common foundations and is derived from Ellis’ (1957) rational emotive behaviour therapy (REBT) and Beck’s (1967) cognitive therapy (CT) (McLeod, 2019).
REBT suggests that peoples’ irrational assumptions lead them to act and react in ways that are inappropriate and interferes with their situations in life. Additionally, Ellis’ ABC model proposes that (A)ctivating event or situation is not the one that causes emotional and behavioural consequences, but a person’s interpretation on these unrealistic events leads to irrational (B)eliefs that helps in causing the (C)onsequences (McLeod, 2019). For instance, Allan’s cooking is distasteful, here, activating agent is his distasteful cooking, belief is excelling in his cookery skills and consequence is Allan feels depressed.
Beck’s theory is similar to Ellis’ but is more focused on depressive disorder. He suggests that people’s reactions to certain distressing thoughts contribute to abnormal behaviour. One of his mechanisms he put forward was cognitive triad that is responsible for depression. It implies that negative views on the self, the world and the future leads to the cause of depression.
These three elements tend to interact with each other, interferes with cognitive processing, leading to negative perceptions and becoming obsessed with negative thoughts (McLeod, 2019). For instance, if Allan views himself as an awful golfer, he will develop negative perception, such as everyone viewing him as a loser and will develop obsessive negative thoughts, like never being able to be a good golfer, which then results in causing depression. In such case, CBT will be recommended to Allan.
CBT is based on present thinking, behaviour, and interaction rather than on past experiences. Its techniques aim to reduce distorted and irrational thoughts and to change behaviour by modifying own behaviour (King, 2013). CBT helps to deal with problems in a positive way by breaking them down in parts, such as thoughts, feelings and actions. For Allan to reduce his possible maladaptive thinking and behaviour through CBT, it’s crucial he finds a psychotherapist with whom he can have a close, trusting working relationship.
In the therapy sessions, he will be asked to explain his problems and expectations in order to form the basis to discuss goals and plan of the therapy (NCBI, 2013). Allan will also be asked to keep the journal of his thoughts to check with him continually and proceed with appropriate and realistic method. Once therapist demonstrates on how to deal with negative patterns and make changes to improve the way he feels, he will then be asked to practice these changes in daily life. Gradually, this therapy will help manage the problems and stop from having negative impacts on daily life.
Often CBT sessions with therapist are held once a week or once every 2 weeks, whether individually or in a group, that lasts for 30-60 minutes (NHS, 2019). In comparison to other psychotherapies, this treatment is short- term and lasts between 5 to 20 sessions. Thus, CBT is as effective as drug therapy and it can be recommended to Allan in conjunction with drug therapy if antidepressants alone fails to improve his symptoms.
With the increasing MDD symptoms among people, CBT compared to other therapies has been classed as a highly structured and efficient nature of treatment. It teaches very useful and practical approaches in terms of problem- solving on daily life even after completing the course of treatment. Unlike, biological therapy, no side effects have been ruled out yet, as hardly any studies have been conducted with its regard (NCBI, 2013). Although CBT is a short-term treatment among others such as psychoanalysis, there is no definite time scale and can take longer depending on the severity of the disorder.
Research showed that during 1 year follow- up, relapse rate among patients who was unmarried, had a history of depression with higher level of depressive symptoms was 32%, patients who fully recovered during therapy had significant low risk of relapse of 9% and patients who partially recovered had higher chances for relapse of 52% (Thase et. Al). Furthermore, CBT indicates that the individual’s irrational thoughts and beliefs are the cause of MDD and implies that disorders are mainly their own fault which raises several ethical issues (Eysenck, 2003). It may be stressful for individuals to accept responsibility of their own mental disorder and would be unfair to blame them, especially if there are other factors involved such as childhood experiences.
