Discuss Assessing The Effectiveness of One Treatment

Discuss assessing the effectiveness of one treatment
Depression can be treated using a biological or psychological approach. The psychological approach
involves treatments where the affected person sees a therapist that can help identify unhealthy thought
patterns and provide strategies to improve well-being. The biological approach assumes that since depression
is caused by the imbalance of neurotransmitters, it can be regulated by medication that affects these
neurotransmitters. A positive response is when the medication can alleviate the symptoms of depression.
Remission is when an affected person no longer experiences the symptoms of the disorder. However, a
patient after remission may experience relapse, which is the recurrence of the symptoms. Studies that test the
effectiveness of biological treatments show mixed results. The research that surrounds medication is also
subject to many biases that result from pharmaceutical companies caring about their public image and sales.
By analysing studies conducted by Elkin et al, Kirsch and Sapirstein, Kiersch et al and Turner et al, it is
apparent that biological treatments have some positive effects, however, the studies may be biased.
Elkin et al wanted to compare the effectiveness of different treatments. They randomly divided the
participants into four groups that received either Cognitive-Behaivioral Therapy (CBT), Interpersonal
therapy (IPT), drug therapy with imipramine or a placebo pill. The groups with medication also received
clinical management so that ethical considerations could be met. All participants had to have been diagnosed
with major depressive disorder and suffer symptoms for at least two weeks prior. The treatments lasted for 16
weeks. Information was gathered from the participant, the therapist as well as a significant other if it was
possible. The results showed that there was no significant difference between any of the treatments except for
the placebo condition which had worse improvement. Furthermore severely depressed patients were less
likely to recover in the placebo condition while the less-severely depressed recovered similarly to the other
conditions. Imipramine eliminated the symptoms faster than the other conditions, however by the end of the
trial, psychological treatments caught up. After a follow-up study 18 months later, 20-30% of participants did
not experience relapse.
The study is quite problematic due to the complexity of the results. The study did not take into account that
treatments may work differently in different severity of symptoms and the fact that the treatments may not be
the same for every participant. Thus the treatments were not standardised. The sample was also not
representative since the participants only had depression and not related disorders like alcoholism,
personality disorders or suicidal tendencies. However, the study did use data triangulation which helped
eliminate demand characteristics that stem from self-reported data. The study also contains some ethical
issues, since the treatments were assigned randomly which did not take into account the personal needs of the
patients and some severely depressed patients received no treatment at all which could have potentially been
harmful to the participants. There was a 30% attrition rate in the drug condition which could point to
undesirable side effects that caused the participants to withdraw. It is hard to have definitive conclusions
from this study, however, it does indicate that biological treatments are about as effective as some forms of
psychotherapy.
A meta-analysis is a way of collecting data from many studies that have the same research question to have a
larger sample group and more precise results. Kirsch and Sapirstein carried out this type of study, where
they took into account patients diagnosed with major depressive disorder. The participants were either taking
antidepressants or placebo pills in 19 double-blind clinical trials. They found that 75% of the participants
showed an improvement in the symptoms regardless of if they were taking a placebo or antidepressant.
Another study by Kiersch et al studied the differences between taking Selective serotonin reuptake inhibitors
and a placebo. Similarly, they found no significant difference, however, participants that were severely
depressed did show more improvement with the SSRI medication.
There is a major issue with the Kirsch and Sapirstein and Kiersch et al studies. Meta-analysis depends on
published studies that are available to the public. However, many studies that have negative results are
simply not being published since they may be received negatively and pharmaceutical companies may have
an interest in keeping them hidden. This is called publication bias. Turner et al analysed the data from
antidepressant studies between 1987 and 2004. they found that out of 74 studies that were registered by the
FDA, 38 of them had registered positive findings and 36 had questionable or negative results. Almost all
studies with positive results have been published, but only 3 studies were published with negative results and
11 studies reported having positive results when in fact they were rated as questionable by the FDA. 95% of
all published studies had positive results, however out of all the studies only 51% had positive results.
The studies show how much bias affects the production of results in such research. There is no way of telling
how many of these studies were funded by pharmaceutical companies or done with a confirmation bias. The
studies do seem to point to the fact that biological treatment is better than no treatment at all, especially when
a patient is severely depressed. However, treatment should be personally adjusted for each patient. Some
severely depressed patients may need psychotherapy as well as medication while for some, medication may
bring very bad side effects.

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