The aim of the paper is to collate the different research related to the treatment method employed to alleviate or minimize if not to cure the symptoms of depression and anxiety. Anxiety is defined as a state of being in fear, a state of mind commonly manifested with perceived and anticipated threat of the unknown. Most commonly, being anxious indicates that a person is not concretely aware of the causes of that fear usually coupled with confusion. Whilst anxiety is a normal state of being experienced as early as childhood, according to Erikson’s theory can deter a person’s level of functioning, so much so when it rises above a level alter the patient’s view of reality. Depression on the other hand is a feeling said to be caused either by biological, physiological and social factors that deviates man’s disposition and manner of relating others. According to Michael Yapko in a May 21, 2004 issue of Psychology Today, “depression is helped most when we encourage people to be active on their own behalf, to challenge their own thinking, to find out whether the thoughts that hurt them are true or not” (2004. pg. 1). This paper however, does not answer what depression and anxiety is all about, as it is rather confined to the various ways of managing the disorder through scientific means. Thus, the succeeding paragraph will illustrate the different researches collated and discuss to point out what these treatments and how relevant they are to the purpose of containing said illness.
Every person goes through a state of anxiety and depression at one point in their lives; this is a given stress to test the adaptable nature of man. Man encounters several forms of stressors in his every day life as part of nature’s means to hone the survival skills of mankind encouraging him to handle and cope with stress. There may be times when the stress is too much for man to handle thereby rendering him unable to withstand the pressures, necessitating time for recovery. Ultimately, man is able to recuperate and bounce back to its normal state of being. There are a few who may prematurely bounce back to their old self despite inadequate healing, thinking that the depression and anxiety brought about by certain circumstances should be and can be overcome. There are also others who does not recover at all and continue to regress in the state that totally deters the way they live their lives consequential to weight loss, physiological problems and inability to effectively relate with others. This is what happens when ineffective coping mechanism does not work to the advantage of man. Whether this disorder has something to do with biological or genetic reasons or whether this is more of a psychological impairment, this is prevalent where 20 million Americans suffer from depression and anxiety (NMHA. 2001. p. 24). Depression becomes potentially fatal on the onset of suicidal tendencies where about 50% try and commit suicide while 15% of patients suffering from severe depression commit suicide successfully.
Over the years, various forms of treatments have been discovered, from Electro Convulsive therapy in the 30s, pharmaco management through antidepressant medications in the 50s in an attempt directly treat depression both neurologically, until the recent most prominent treatment styles using a combination of TCAs or tricyclic antidepressants and SSRIs or selective serotonin re-uptake inhibitors in the forefront, as well as the integration of Cognitive therapy and psychotherapy. SSRIs are among the most widely distributed antidepressant drugs when it comes to treating adolescents but several studies in 2003 raised a concern about the effectiveness of SSRI’s in children (Hayes 2004) purporting a baffling increased suicidal tendencies. A concurrent study was conducted to compare SSRI versus placebo in children aged 5-18 years where it was concluded that, except for fluoxetine, risks from SSRI’s outweigh benefits in the treatment of adolescents (Whittington et al. 2004). Studies with paroxetine and sertraline also concluded that there was an increase risk of suicidal thoughts and weak improvement in depressed mood (Keller et al. 2001, Wagner et al. 2003). TCAs are the oldest group of medications used for depression where studies have shown that although these antidepressants are effective in adults, they are not useful in children and adolescents (Renaud et al. 1999, Findling et al. 1999). Furthermore, TCA’s are often associated with adverse effects, some of which are potentially life threatening (Findling et al. 1999). Tricyclic antidepressants also have a higher risk of toxicity when compared to SSRIs (Walsh et al. 1994, Kutcher 1998). Thus the question as to what pharmacologic treatment has been defined as the safe, a pilot study was conducted to show how fluvoxamine seems to be effective and well tolerated in children with cancer and comorbid depression and anxiety disorders. Of the 15 subjects tested, this study concluded that fluvoxamine is well tolerated even in children with cancer, provided that no chemotherapy is simultaneously administered since it counteracts the potency of the drug (Gothef Et Al. 2005).
The history of the use of antidepressant medications dates back as early as 1950s were an investigation purported the ill effects of the antihypertensive drug called Reserpine that while patients undergoing this medication experienced relief of high blood pressure, they were likewise found to be severely depressed. Accordingly, this kind of drug interferes with the balance of the hormone dopamine and nor epinephrine in the brain advancing the idea that the said two chemicals are very minimal during the state of depression. It is stated the deficiencies in one or more of the neurotransmitter in the brain such as nor epinephrine, dopamine, and serotonin usually produces depression and may be due to genetic predisposition or external psychosocial factors. This ultimately led to the development of psychotropic drugs which includes the like TCA, SSRI and MAOI. In 2005 however, a group of physicians conducted a research aimed at evaluating the efficiency of SSRI therapy for anxiety or depression, most specifically in the aspect of comparing the potency between branded and generic drugs (Sheehan Et al. 2005, p. 403). Of the 21,430 patients, 71.2% or 15,256 took a generic SSRI in the likes of citalopram, fluoxetine, fluvoxamine, paroxetine while 28.8% or 6,174 patients started treatment with branded SSRI such as Zoloft, Lexapro, or Paxil (Ibid). Their conclusion provided evidence that there is not much of a difference whether the medications taken in by the patient is branded or generic. In addition, the initial choice of antidepressant is most likely to change due to other factors that needs to be considered, one of which may involve the efficacy of such drug as suppose to the metabolic rate of the patient taking such medication. It is therefore essential to account for clinical efficacy, tolerability, adherence, as well as the possibility of other comorbid mood disorders present, prior to the prescribing SSRI (Ibid).
At present the most preferred form of treatment for anxiety and depression is cognitive therapy or psychotherapy (Young Et al. 2006. p.904). It is most often applied as a combination of cognitive-behavioral therapy, but recently it has been found that interpersonal psychotherapy works best for patient suffering from depression. It has been observed that the efficacy of psychotherapy in treating depression is evident but little is known when the case present itself with comorbid conditions on whether it would thus respond favorably (p. 906). A study was once conducted in 1989 to analyze the benefits of such therapy where the researchers concluded that cognitive therapy was more effective than pharmacotherapy and is found to be superior to any other forms of psychotherapy in the treating depression (p. 907). The essence of this therapy is getting the patient to set aside aberrant schemas to give way for a new one. With this kind of therapy, the patient is taught to replace the self defeating thoughts with cognitive restructuring otherwise simply known as self talk where they are encouraged to view their personal thought patterns as hypotheses requiring validation every once in a while. According to Young Et Al, after a thorough research on the benefits of Interpersonal Therapy, their result claims that adolescents with depression accompanied by panic or anxiety symptoms should receive a structured treatment in the likes of IPT-A to ensure adequate management of this condition as well as the prevention of relapse (p. 909). Another form of therapy commonly used with severe cases right now, is the combination of Psychotherapy and Pharmacology where in the patient is confined to an institutional care. This form of therapy is a brought about through the collaboration of psychiatrist, psychologist and counselors who’s primary objective is to bring the patient back to its realistic phase (NMHA. 2001. p.24).
Still, another form of treatment which at the moment has been faced with a lot of controversy is the CES or Cranial Electrotherapy Stimulation which is a treatment that has been neglected and considered to be obsolete. CES is now more preferred by practitioners due to the recent government warnings mandated to be labeled in SSRIs meds (USFDA. 2005). In so far as the treatment using CES is concerned. No adverse effect has been reported yet which means that while practitioners were busy looking for the efficient medical solutions to depression and anxiety, CES after all is the safest and less invasive form of treatment posing no issues relative to shortage of stocks, counter indications with other medication, dosage computation and so on (Gilula & Barach. 2004, p. 1269). According to Gilula in her article published in the Southern Medical Journal, “It is both noninvasive and considerably less expensive as suppose to the Neurosurgical implantation techniques of deep brain stimulating electrodes and vagal nerve stimulators that are currently used and studied for the treatment of affective disorders are more expensive” (2005. p. 1269). Just any other form of treatment, CES requires continuing observation, assessment and supervision since the potency may be a case to case basis.
In conclusion, what is important in the management of these disorders is not the availability, nor the efficiency of the modality of the treatment employed, but rather the response and the relevance of such treatment to the patient. It must be well considered that every person is unique which therefore warrants the assumption that each disorder symptomatically differs. Another factor to consider is the ability of the practitioner managing the case because with out the dedication of the physicians and other health care providers, a therapy may not work to the patient’s advantage. There is no claim as to which treatment is best to employ in managing depression and anxiety. The decision as to what treatment mode to implement is highly dependent the assessment, diagnosis and best judgment of the person taking care of
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