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Treatment of Major Depressive Disorder

Numerous ways of treating Major Depressive Disorder have been used and some of them have been questionable. An author has noted that at one time amphetamines and barbiturates were used as a treatment; both of these drugs are, of course, highly dangerous, and the barbiturates are physically addictive.  Non-pharmacological treatments have included behaviorism based therapy, cognitive-behavior therapy, and interpersonal psychotherapy.  Behavior therapy monitors activities and involves setting up regimes designed to alter behavioral responses to stimuli. Treatment of Major Depressive DisorderNathan et al have stated that some studies have found these methods to be effective. Cognitive-behavioral therapy aims to change the patient’s views of the self, world, and his/her personal future; AN author has stated that this has been found to be effective and that it is often used as an adjunct to pharmacological treatment.  Interpersonal psychotherapy focuses on altering the patient’s patterns of interpersonal behavior.  The results, An author has stated, have been found by at least two major studies to be positive.

But for a long time the treatment of choice for MDD has been pharmacological. Tricyclic antidepressants, e.g. imiprimine, have been around since the early sixties and were once hailed as the answer to depression. However, the tricyclics are currently out of favor because they have significant side-effects, and because, while they have a “tonic effect,” their efficacy in the treatment of depressive syndromes is questionable.

The new answer to depression is thought to be the serotonin uptake inhibitors, of which Prozac, introduced in 1988, is the best known. Nathan et al have noted that over 25 million patients have been given prescriptions for this class of drugs.  The use of these substances is based on the notion that drugs which increase the concentration of serotonin in the brain make for better mood.

Several things about this approach are noteworthy.  First, a biochemical approach reinforces the growing tendency to “medicalize unhappiness.”  What is seen as “depression” is cured by administering drugs which, by virtue of their molecular architecture, bind with other molecules in the brain and thereby alter mood.  This is inherently controversial.

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