Biomedical Therapy

4 Key excerpts on "Biomedical Therapy"

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  eBook - ePub

  Depression And The Medically Ill

  An Integrated Approach

  • Gary Gary Rodin(Author)
  • 2017(Publication Date)
  • Routledge

    (Publisher)

  9

  Psychological Treatments

  Considering the wide array of factors that may contribute to depression in persons with a physical illness, an eclectic and integrative approach is needed in the selection of optimal and appropriate treatment. Such treatment may include practical physical interventions, and pharmacologic, psychological, and social treatments. Additional interventions that may relieve depression include optimizing the medical status of the patient, restructuring the social environment, assisting with occupational functioning, and identifying and eliminating depressogenic drugs that are not essential to the medical treatment. Even when a broad range of factors can be identified that contribute to or perpetuate depression in a medical patient, attention to one specific underlying factor may alleviate the mood disturbance. For example, when major depression is associated with hypothyroidism, the gradual institution of thyroid replacement medication not only takes precedence over other specific antidepressant treatments, but may, by itself, relieve the depression. In other cases, medical treatments should be instituted concurrently with psychological and biological therapies for depression.

  In the medical setting, the etiology of depression should usually be understood from multiple perspectives. Similarly, treatment selection often requires the consideration of diverse modalities. For the purpose of clarity, we have divided into separate chapters our discussion of biological and psychological treatments. However, this literary convenience should not be taken to imply that the use of one treatment modality in any way precludes the concurrent or sequential use of others. In this regard, although the efficacy of antidepressant medication for major depression has been substantiated in a variety of controlled studies (see Chapter 11

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  Abnormal Psychology

  • Sarah Sifers(Author)
  • 2011(Publication Date)
  • Collins Reference

    (Publisher)

  Treatment of mental illness by direct alteration of bodily states has a long history. Even prehistoric people drilled holes into the skulls of those judged abnormal to allow evil spirits to escape. Long after that, primitive practices continued: purging the body of substances thought to cause mental disorders by laxatives; and bleeding, which continued through the eighteenth century as a common medical practice for physical and mental illnesses.

  Successful treatment of mental disorders has trailed far behind effective treatment of physical illness. But as bodily functions have become better understood and as science has learned the effect of surgery, drugs, and even electricity on those functions, progress in treating physical conditions has led to increased physical treatment of mental disorders.

  Some of those early efforts now seem as primitive and, in fact, were at least as dangerous as the archaic efforts of earlier centuries. Two of them, electro-convulsive therapy and psychosurgery, have all but disappeared. Today’s biogenic therapies for mental illness are relatively safe and easily administered. But as with all treatment, in the hands of hasty and careless therapists or as used by careless, severely disturbed patients, they can have uncertain consequences.

  The most progress in biogenic forms of treatment has come from developments in the field of pharmacology (the study of drugs and their effects on the body). Pharmaceutical drugs in current use aim at producing physiological changes that affect specific symptoms of mental illness. They have proven strikingly effective in the treatment of anxiety-based disorders, mood disorders, schizophrenia, and attentiondeficit/hyperactivity disorder.

  This section describes briefly electroconvulsive therapy, psychosurgery, and five types of drug treatment: antianxiety drugs; drugs for psychotic symptoms; antidepressant drugs; mood stabilizing drugs; and stimulants. All the described treatments are administered by a medical professional.

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  Cognitive Behavioral Psychopharmacology

  The Clinical Practice of Evidence-Based Biopsychosocial Integration

  • Mark Muse(Author)
  • 2017(Publication Date)
  • Wiley-Blackwell

    (Publisher)

  1 Evidence-Based Biopsychosocial Treatment through the Integration of Pharmacotherapy and Psychosocial Therapy

  Mark D. Muse

  The integration of psychotropics into a broader psychosocial therapeutic plan would seem more than justified by previous reviews of the benefits associated with such a multimodal approach to coordinated behavioral health treatment (Reis de Olivera, Schwartz, & Stahl, 2014). It is no longer enough to think along traditional lines of which is the best medication for a particular diagnosis, nor is it sufficient to adhere to one school of psychotherapy and apply it without much regard to diagnosis. Thus, CBT (cognitive-behavioral therapy) for CBT's sake, just as pharmacotherapy as a standalone, would appear to be paradigms with diminished futures. Evidence-based therapeutic strategies argue that treatments, or a combination of treatments, might best be selected according to their relative impact on a certain constellation of symptoms, together with accompanying psychosocial variables, not the least among these being subject variables. Such an approach advocates integrating different biopsychosocial approaches to optimize therapeutic result. In some instances it is a question of selecting one treatment over another, while in the majority of cases it is more a question of combining treatments, and often this means coordinating multimodal therapeutic interventions (Lazarus, 1981).

  “Evidence-based” is a lure that does not always provide us with clear-cut distinctions among multiple intervention strategies because, quite often, the evidence is not there. The evidence that is available, and it is substantial, is limited by its designs, which are driven by the interests of the investigators. Medications are largely tested against placebo, while CBT has rarely been pitted head-to-head against other psychosocial therapies, and where this has been done by resurrecting past studies in meta-analyses, the results are confoundingly ambiguous (Tolin, 2010), which is not a state to be cherished in science. Meta-analyses incorporate all of the shortcomings of the original randomized controlled trials (RCTs) that they attempt to digest (Kennedy-Martin, Curtis, Faries, Robinson, & Johnston, 2005; Walker, Hernandez, & Kattan, 2008). Oftentimes, meta-analyses find no difference between medication and psychotherapy, and no discernable advantage among various medications or among different psychotherapies. And, just as obfuscating is the fact that many studies are kept from public knowledge through selective publication, leading to a skewing of data toward a spurious impression of greater effectiveness than might otherwise be the case if all data were reported (Turner, Matthews, Linardatos, Tell, & Rosenthal, 2008). Still, one often finds that CBT is presented as having accumulated substantial data to support it as an efficacious therapy for the majority of psychiatric disorders (Butler, Chapman, Forman, & Beck, 2006), and this is certainly true because the number of studies completed with CBT as the independent variable far outweigh studies conducted on other psychotherapies. However, it is a stretch to say, based on the present data, that CBT is more

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  Depression

  • Constance Hammen, Ed Watkins(Authors)
  • 2018(Publication Date)
  • Routledge

    (Publisher)

  7 Biological treatment of depression    

  Stephanie experienced two bouts of major depression that each lasted for about six months. During one episode she sought counselling, but discussions of her life difficulties didn’t seem to relieve the symptoms of depression, and she dragged herself through the bleak days and endless nights until the depression just seemed to wear away. Recently, when she began to sink into yet another depressive episode, she sought treatment from a medical doctor who prescribed a common antidepressant medication. Within a week her energy improved and she slept more soundly, and within two weeks her mood was definitely better and she began to feel able to face some of the difficult personal events that had precipitated the depression.

       

  As we discuss in this chapter, there are several well-established biological interventions as well as several more experimental approaches to treatment. This chapter discusses antidepressant medications, omega-3 fatty acids, electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), light therapy, sleep deprivation and physical exercise.

  Comment on treatment of depression

  Before discussing biological or psychotherapy approaches to treating depression, it is important to emphasise a singular fact about treatment in general. The majority of individuals with major depression or persistent depressive disorder do not receive treatment for their condition, either because they do not seek out help, or because it remains undetected, or because treatment is not available or not offered appropriately. For example, of those screening positive for depression (8 per cent) in a large recent survey of US households (46,417 people), only 28.7 per cent received any treatment for depression (Olfson, Blanco and Marcus, 2016).

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