1, introduction
Depression is a mental illness with low mood, lack of pleasure, lack of energy or fatigue as its core symptoms. According to the latest data from the World Health Organization in 2017, there are approximately 322 million people suffering from depression in the world. It is estimated that by 2030, depression will become the first global burden of disease, and depression is becoming a serious global problem. The treatment of depression is not only a topic of public concern, but also a hot spot in scientific research. In real life, the treatment of depression is full of flowers. Half of the treatment of depression is medication, and the other half is psychotherapy. So which method is better than medication or psychotherapy? Which method is better for treating depression? Today's article will use the "big data" of scientific research to provide you with a reference.
2, drug treatment
Source: To get over
drugs skips the external causes of emotions, and directly changes brain function through chemical methods. Many patients will feel that after taking drugs, their depressed mood is lifted up by the drugs.
3, psychotherapy
Although the treatment of depression is based on drugs, for depression caused by social and psychological factors, psychotherapy can effectively alleviate the relapse of depressed patients and their dependence on drugs. At present, the effect of psychotherapy on the treatment of depression has been confirmed by research. Source of
: unsplash
(1) Individual psychotherapy
Individual psychotherapy is based on psychological consultation and has derived various genres and methods. In addition to the well-known cognitive behavioral therapy, other psychological treatment methods, such as psychoanalysis and systematic family therapy , Interpersonal relationship therapy, etc. are used in patients with depression. Because of the many schools, this article uses cognitive behavioral therapy and mindfulness therapy as examples (all the treatment methods mentioned in this article are only examples, and you should choose the treatment method according to your own situation).
Cognitive Behavioral Therapy (CBT) is a structured psychotherapy method developed by Beck in the 1960s. It has been proved to be effective in the treatment of depression, anxiety and other psychological diseases. This is also the most used psychotherapy for depression. CBT is an integration of behavioral therapy and cognitive therapy. Through cognitive reconstruction, behavioral techniques such as exposure, social skills training, and structured problem solving are used to help patients solve problems. Researchers conducted a meta-analysis on 796 depressed children and adolescents. They found that CBT has a very good therapeutic effect on adolescents with depression, anxiety and interactive symptoms[3].
Mindfulness Cognitive Therapy (MBCT) is the 9th century It was developed by Segal, Teasdale, and Williams in combination with cognitive behavioral therapy in the decade. This is an 8-week group therapy model that includes practice techniques such as sitting and meditation, body scanning, three-minute breathing space, and cognitive recording. MBCT enables depression patients to perceive their current physical and emotional state during mindfulness meditation, and focus their attention on the perception and experience of this state without judgment. Improving the level of mindfulness is one of the important ways to suppress ruminant thinking and prevent the recurrence of depression. The reduction of depressive symptoms after MBCT intervention is closely related to the improvement of patients' mindfulness and the decrease of rumination thinking. The mindfulness level after MBCT treatment can predict the risk of recurrence of depression during the one-year follow-up period [4].
(2) Group psychotherapy
Group psychotherapy technology is to provide patients with a group context, prompting them to experience, learn, re-recognize and accept themselves in the process of interpersonal communication, thereby improving their relationship with others and enhancing their confidence in returning to society the wrist of. my country began to apply group psychotherapy in the late 1990s. It was first used in group psychological counseling for college students' interpersonal communication, and then widely used in hospitals and communities. The introduction of group psychotherapy techniques to depression patients during the nursing period has achieved good results. With the help of the positive influence of different depression patients in the group, the effect of effective treatment is finally achieved. By pre-designing the treatment ideas, the depression patients are guided to participate in the whole process of the group treatment, and the initial suspiciousness among members is turned into mutual acceptance. , Open, trust, and generate sympathy, mutual support, provide a good atmosphere for emotional catharsis, and then encourage patients to effectively solve their own problemsDecide, improve their mental health and reduce depression symptoms [5].
psychotherapy does not have such obvious adverse effects as drug treatment, and it is milder for patients. However, the public has doubts about the effects of psychotherapy, and the long and high cost of psychotherapy also hinders the promotion of psychotherapy.
4, drug therapy VS psychotherapy
(1) Therapeutic effect
In 2020, 114 psychiatric experts from the Japanese Society of Clinical Neuropsychopharmacology (JSCNP) reached a consensus on a series of problems in the treatment of depression. The full text was recently published in Affect Disord magazine. Image source of
: Yimaitong
is a first-line treatment for mild depression (7.6±1.9, 50.0% of experts give 9 points), and other new antidepressants are second-line treatments. In view of the effects of different drugs in the treatment of moderate to severe depression, first-line treatment includes mirtazapine (mean ± SD, 7.8 ± 1.5, 9 points given by 45.6% of experts), duloxetine (7.5 ± 1.5, given by 32.5% of experts) 9 points), escitalopram (7.3±2.1, 43.0% of experts gave 9 points), venlafaxine (7.0±2.0, 28.9% of experts gave 9 points). All tricyclic and tetracyclic antidepressants are third-line treatment. (See the table above). Studies have shown that the effective rate of antidepressants is 60% to 80%, and the cure rate is 30% [7]. Source of
: China HowNet
is limited by genre, duration and form of psychotherapy. There is no research on the effectiveness of various psychotherapy methods for the treatment of depression. However, in recent years, the use of psychological counseling to treat depression has been increasing year by year, which can also reflect the effectiveness of psychological treatment. Among more than 10,000 depression-related literatures in the past five years, 3,994 have used psychotherapy or intervention. Articles published in journals all show that psychological intervention can effectively reduce depression scores (scale scores) and improve life satisfaction (quantity). Table scores) to reduce symptoms of depression.
(2) Recurrence rate
Source: unsplash
The high recurrence rate of depression is an important factor in refractory depression. Studies have shown that the recurrence rate of patients with the first depressive episode is at least 50%, and the recurrence rate of patients with two depressive episodes is as high as 80% to 90%[8]. Generally, the patient's condition will be more severe after recurrence, and the treatment time will increase. Therefore, to determine which treatment is better, the recurrence rate must also be considered.
Drug therapy is the main means to control symptoms and prevent recurrence. However, in actual situations, patients who only use drug therapy have a high recurrence rate after stopping the drug, probably above 50%. Studies have shown that in clinical antidepressant treatment studies, 40% to 70% of patients did not follow the doctor's treatment plan, and with the longer treatment time, the proportion of patient compliance showed a decreasing trend, and the treatment dropout rate for depression was as high as 50%. ~ 70%. Non-compliance behaviors of include patients who reduce the drug dose by themselves or discontinue treatment early [9]. These factors lead to the high recurrence rate of drug treatment.
psychotherapy shows that it can effectively reduce the recurrence rate of patients, but the effects of different treatment methods are different. Taking mindfulness cognitive therapy as an example, Teasdale et al. [10] conducted mindfulness intervention on patients who had relapsed from convalescent depression and found that the recurrence rate of depressive disorders with multiple recurrences was reduced by 50% after passing MBCT. Ichalak et al. [11] found that after eight weeks of MBCT training, the recurrence rate of depression after 1 year can be reduced. Further research found that after MBCT, the recurrence rate of patients with multiple relapses decreased from 78% in the conventional treatment group to 36%. %.
(3) Treatment time
Source: unsplash
Depression treatment is often long-term, but both patients and family members hope to be able to see results quickly and cure as soon as possible. Therefore, special attention is paid to the length of treatment time when choosing a treatment method.
drug treatment generally takes effect within 1 to 4 weeks, and patients can see obvious effects soon after taking the drug, such as increased energy and decreased depression. The APA guidelines for the treatment of depression recommend treatment in 4 phases: acute treatment phase,The consolidation treatment period, maintenance treatment period, and drug withdrawal treatment period generally take 1 to 2 years or even longer to complete the 4 treatment cycles, which is a great challenge for patients and their families. The cycle of drug treatment is also related to the patient's compliance and understanding of the disease. If the patient reduces the drug during the medication-or changes the drug, the treatment cycle will also be affected.
psychotherapy has different onset times because of its different schools. According to the consultation time, it is divided into short-term consultation (1-6 months), medium-term consultation (6-12 months) and long-term consultation (1-3 years). Psychological counseling for depression generally focuses on medium- and long-term counseling. It can be seen that the treatment time of psychological counseling is longer than that of medication. However, in recent years, research has been exploring short-term psychotherapy. Taking interpersonal support psychotherapy as an example, a randomized trial was designed to study the effect of interpersonal support psychotherapy on depression in 40 female college students suffering from depression. There are reports that after an average of 4.6 short-term interviews, the treatment effectiveness is 80% [11]. But this method only studied 40 patients, which has certain limitations.
(4) Treatment costs:
Source: unsplash
Due to the long-term nature of depression treatment, patients and their families have to consider the cost of treatment when choosing treatment options. There is no relevant research data on this topic. Here is . Please participate in the small survey at the end of the article. How much did you spend on drugs and psychotherapy?
5, summary
Depression, as a specific disease, has complex causes and is a comprehensive result of "biology-psychology-society". In view of this specificity, there is no best treatment for depression, only the most suitable. When choosing a treatment plan, it is necessary to consider comprehensive factors such as the patient’s age, condition, symptoms, predisposing reasons, economic conditions, and support system, and choose the most suitable treatment plan. At the same time, combined with international general guidelines, there are the following TIPS for reference:
1, patients with mild depression, adolescents and children are recommended to use psychotherapy first, which is safer than medication. If the condition continues to progress to moderate or severe, antidepressant drugs can be used to relieve the symptoms of depression and relieve suicide or sadness and despair. However, it is still recommended to combine psychotherapy. European guidelines on the treatment of children and adolescents suffering from depression can be used as a reference.
2, the dosage and type of adult medication may not be suitable for the treatment of depression in children and adolescents. The European Medicines Agency (EMEA) recommends fluoxetine for the treatment of depression in children and adolescents over 8 years of age. Most of the dosages mentioned in the instructions of antidepressant drugs are adult standards. Because children and adolescents have different metabolic functions from adults, the dosage of drugs for children and adolescents should be reduced according to the doctor's advice.
3. Consult a physician for adding and reducing medicines. The increase and decrease of medicines must be carried out slowly.
4. Chinese physique and social culture are different from Westerners. The use of medicines and psychotherapy must take this into consideration.
This article compares the difference between medication and psychotherapy from the perspective of scientific research. All medications and psychotherapy methods mentioned in this article are examples and cannot be used as a basis for your medication and treatment! Please follow the doctor's advice and cooperate with the doctor for treatment of depression.
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References
[1]Wang Xiaoqin,He Minghua,Wang Qin.Overview of the development of antidepressants[J].Capital Medicine,2007(22):33-34.
[2]Yu Ying,Huang Hailiang,Zhang Gong,Han Tao .Net Meta analysis of the clinical efficacy and safety of commonly used antidepressants[J/OL]. China Journal of Traditional Chinese Medicine: 1-14[2020-03-28].https://kns-cnki-net-s.era.lib.swjtu.edu.cn:443/kcms/detail/ 21.1546.R. 20200319.1009.008.html.
[3]David Daniel Ebert,Anna-Carlotta Zarski,Helen Christensen,Yvonne Stikkelbroek, Pim Cuijpers,Matthias Berking,Heleen Riper. Internet and computer-based cognitive behavioral therapy for anxiety and depression in youth: a meta-analysis of randomized controlled outcome trials.[J]. PLoS ONE,2017,10(3).
[ 4] Oller-Canet Silvia,Fernández-San Martín Maria I,García-Lecina Raquel,Castro Rodríguez Jose I,Font-Canal Teresa,Lacasta-Tintorer David,Martín-López Luis M,Flamarich-Zampalo David. [Do depressed patients comply with David. with treatments prescribed?: a cross-sectional study of adherence to the antidepressant treatment].[J]. Actas espanolas de psiquiatria,2011,39(5).
[5]钱源.Research progress of continuous nursing mode[J ].Contemporary Nurses (Mid-day issue),2014(11):13-15.
[7]Luo Junyu,Liu Fang,Luo Yaohui,Luo Henghui,Deng Qin.Progress in the treatment of depression with traditional Chinese and western medicine[J].Yunnan Traditional Chinese Medicine Chinese Medicine Journal,2019,40(05):84-87.
[8]Zajecka John M. Residual symptoms and relapse: mood, cognitive symptoms, and sleep disturbances.[J]. The Journal of cl inical psychiatry,2013,74 Suppl 2.
[9]Schramm Elisabeth,van Calker Dietrich,Dykierek Petra,Lieb Klaus,Kech Sabine,Zobel Ingo,Leonhart Rainer,Berger Mathias. An intensive treatment program of interpersonal psychotherapy plus pharmacotherapy for depressed inpatient : acute and long-term results.[J]. The American journal of psychiatry,2007,164(5).
[10]Teasdale JD,Segal ZV,Williams JM,Ridgeway VA,Soulsby JM,Lau M A. Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy.[J]. Journal of consulting and clinical psychology,2000,68(4).
[11]Michalak Johannes,Heidenreich Thomas,Meibert Petra,Schulte Dietmar. Mindfulness predicts relapse/recurrence in major depressive disorder after mindfulness- based cognitive therapy.[J]. The Journal of nervous and mental disease,2008,196(8).
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