Effectiveness of Psychotherapy and Pharmacotherapy on Depressive Patients
Definition of Depression
Depression is one of the most common mental health disorders in the United States. It is a mental disorder caused by genetic, biological, environmental, and psychological factors. Depressed people experience sadness and persistent depressive symptoms that last more than two weeks. The condition can be comorbid: a person having depression with another health condition (psychological or physical). In such cases, depression may have caused the second condition or arose due to a preexisting the second condition. If no intervention is deployed, depressive symptoms may worsen, making it harder for one to be productive. For example, the condition is associated with high suicidal deaths. In 2017, depression was the single cause of 47,173 suicide deaths, making the suicidal death rate to be 14.5 per 100,000 American people (Kochanek 10). For that reason, psychiatrists prescribe the use of psychotherapy, pharmacotherapy, and combined forms of therapy to help relieve the symptoms and treat depression.
This research aims to study the effectiveness of therapy and medicine on the management of depressive mental disorders. It will help understand and compare the progress in the mental health of patients undergoing treatment. The questions that the research will answer are “What happens when the person stops medication after a period of psychotherapy with medicine?” and “Does the person have to start over again with the whole therapeutic process or does the incomplete dosage has an effective influence on the brain?” My study will identify the most effective therapy for the patient in the long run, but, to do that, I must first examine separately and then compare the psychotherapy and pharmacotherapy.
Prevalence of Depression
The prevalence of depression depends on many factors. According to 2018 CDC report, 8.1% of American people aged 20 years and above suffered depression during the period the data was collected. Women were 10.4% more likely to be depressed, whereas men were 5.5% likely to develop the condition. Depression rates were lower among non-Hispanic Asian adults than they were among Hispanic, non-Hispanic whites and non-Hispanic blacks. As family income levels increase, the depression preference decreases. Moreover, the CDC reported that about 80% of those suffering from depression experience difficulties at home, work, and social gatherings. The effects of this condition can be devastating, and, therefore, strategies must be sought to stem its adverse effects on people.
Significance of this Research
This research is essential in that it tests whether psychotherapy, pharmacotherapy, or a combination of both is the best for management of depression. The goal of identifying the best therapy is to reduce the healing time, adopt the treatment process to individual needs, manage depressive symptoms, and prevent the cases from reoccurring in the future. It is hypothesized that undergoing psychotherapy alone yields better outcomes than the use of pharmacotherapy and relieves users of the burden of overdependence on medicines to stabilize mental functionality. Nevertheless, psychotherapy takes a long time to manage psychological disorders effectively. Hence, deploying psychotherapy requires patience and is more effective, whereas the pharmacotherapy is quick but increases a patient’s dependence on drugs for effectiveness.
Background and Context
In the research process, two basic terminologies surface relapse and remission. Understanding these two terms helps psychiatrists to design the therapeutic process in a way that ensures the patients derives optimal benefits from the treatment process. Relapse is the return of the depressive symptoms after a patient had undergone treatment and experienced relief. In comparison, remission denotes the period during which a person does not experience mental symptoms. It is essential to know the period of the significant risk of relapse for a person undergoing pharmacotherapy is during the 6-month frame after full remission. During that period, it is recommended that patients continue taking medicine for six additional months. While psychotherapy helps to prevent relapse, knowing the high-risk period reveals the length of time a person needs to undergo therapy, especially when the therapeutic sessions are paired with medication (“Depression: Facts, Statistics, and You”). This information is ensuring that the patients derive maximum benefit from the treatments to minimize chances of treatment failure and having to restart the therapy.
Effectiveness of Combined Psychotherapy and Pharmacotherapy
Depression is one of the most prevalent mental condition in the world, but access to treatment is still insufficient, especially among the low and middle-income individuals. Lopes et al. opine that 78.8% of people who suffered from depression did not receive treatment, and 14.1% received pharmacotherapy only (158). Men shy from seeking treatment, while women are more likely to attend therapies. Therefore, to increase the access to treatment, the public should be sensitized about the importance of seeking timely treatments and overcoming stigmatization. The psychotherapy services are also expensive, and the government can subsidize the cost to allow many low-income victims to access treatment. Therefore, the cost of treatment, stigmatization, and sex-associated shame minimize access to mental assistance.
Cost of Combination, Pharmacotherapy, and Psychotherapy
If the patients were to pay for each treatment from their pockets, the psychotherapy would be more expensive than pharmacotherapy. Psychiatrists, psychologists, and counsellors who offer the services are paid highly to help restore the mood status of the patients without the use of drugs. In comparison, drugs require much less. The use of combination therapy is even more expensive. Sado et al. researched Japanese participants and determined that the cost of combination treatment is higher than the cost of either pharmacotherapy or psychotherapy (539). Thus, pharmacotherapy is the cheapest among the three treatment strategies.
The use of a given therapy depends on provider characteristics, patient preferences, insurance plans, and geographical factors. Soria‐Saucedo et al. observe that the use of combination therapy to treat depression results in fewer relapse episodes and high chances of patient’s adherence to proper treatment. Soria‐Saucedo et al.’s research results confirmed that only 1.1% of depression patients received combination therapy (53). Despite the effectiveness of the combined therapy, about 20% of the patients prefer using either psychotherapy or pharmacotherapy, with the former strategy acting as the ‘de factor mental health remediation service’ in the U.S., and the rest of the patients use generalists’ treatment. The choice of a combination treatment depends on the availability of fee-for-service insurance policies, the age of the patient, and the patients’ residence. Young patients from the South have low combination therapy utilization rates. Thus, improved access to insurance plans and sensitizing the people on the usefulness of combination therapy can boost the utilization ratios.
In some cultures, the combination therapy is entirely unpopular. Among the Borana community members in South Ethiopia, the causes for mental disturbance vary widely. Some believe that mental illness results from evil spirits, bewitchment, curse, overthinking, and alcohol abuse. However, the treatments for severe mental illness include indigenous approach such as consulting the wise man, visiting healers, using holy water, and prayers (Teferra and Shibre 81). It implies that non-Western cultures neighbor emphasize psychotherapy, pharmacotherapy, or a combination of both. It is a challenge promoting combined therapy to people from such cultures.
The use of combination therapy is effective in treating depression in the people who fail to respond well to short-term cognitive behavior therapy (CBT). In a 2015 study, Payne et al. found that participants in the SSRI group recovered from illness faster than the ones in the CBT cluster especially if they had an inadequate response to short-term psychotherapeutic approaches (394). The research proves that the use of medication is far more effective than long-term psychotherapeutic sessions in treating depression among patients who respond poorly to short-term CBT. From this research, it noticeable that combined treatments improved the patients’ experience. The use of medicine can make a person focus more and be attentive during therapy, which may change the therapist experience and improve the effectiveness of combined therapy.
Combination therapy remains the best choice for the treatment of depression. However, most specialists prefer using pharmacotherapy to psychotherapy. Still, only about 1.1% of the patients in the U.S. use combination therapy. Despite depression being the most prevalent mental illness, access to treatments services remains low, most probably, because of stigmatization, high treatment-costs, and sex-related shame. Medications relieve the depression symptoms in people who fail to respond to CBT. However, in East African cultures, especially the Borana in south Ethiopia, treatment depression involves consulting wise men. Thus, constant sensitization is needed to encourage people to seek treatment and enhance therapeutic experiences.
“Depression: Facts, Statistics, and You”. Healthline, n.d., www.healthline.com/health/depression/facts-statistics-infographic#8. Accessed 9 Dec. 2019.
Kochanek, Kenneth D., et al. “Deaths: Finals Data for 2017.” National Vital Statistics Reports, vol. 68, no. 9, 24 June 2019, https://www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_09-508.pdf. Accessed 9 Dec. 2019.
Payne, Laura A., et al. “Second‐Stage Treatments for Relative Nonresponders to Cognitive Behavioral Therapy (CBT) for Panic Disorder With or Without Agoraphobia—Continued CBT Versus SSRI: A Randomized Controlled Trial.” Depression and Anxiety, vol. 33, no. 5, 2016, pp. 392-399.
Sado, Mitsuhiro, et al. “Cost-Effectiveness of Combination Therapy versus Antidepressant Therapy for Management of Depression in Japan.” Australian and New Zealand Journal of Psychiatry, vol. 43, no. 6, 2009, pp. 539-547.
Soria‐Saucedo, Rene, et al. “Receipt of Pharmacotherapy and Psychotherapy Among a Nationally Representative US Sample of Privately Insured Adults With Depression: Associations With Insurance Plan Arrangements and Provider Specialty.” Journal of Pharmaceutical Health Services Research, vol. 7, no. 1, 2016, pp. 53-62.
Teferra, Solomon, and Teshome Shibre. “Perceived Causes of Severe Mental Disturbance and Preferred Interventions By the Borana Semi-Nomadic Population in Southern Ethiopia: A Qualitative Study.” BMC Psychiatry, vol. 12, no. 1, 2012, pp. 79-88.
Lopes, Claudia Souza, et al. “Inequities in access to depression treatment: results of the Brazilian National Health Survey–PNS.” International Journal for Equity in Health, vol. 15, no. 1, 2016, pp. 154-162.
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