|Drugs and Depression: A Special Investigative Report
|Sunday, May 29, 2005
|9:00 AM–10:20 AM
|Private Dining Room 1 (3rd floor)
|Area: CBM; Domain: Service Delivery
|Chair: Christeine M. Terry (University of Washington)
|Discussant: Rainer Franz Sonntag (Private practice)
|Abstract: Antidepressant medication is currently the most popular means of treating depression. In research and clinical practice alike, this treatment is generally considered the first line of defense. Numerous clinical trials have found antidepressant medications to be one of the most efficacious treatments for depression (Keller, Hirschfeld, Demyttenaere, & Baldwin, 2002). Although helpful for many individuals, this treatment needs closer examination. Some issues associated with the delivery of antidepressant medication treatment will be addressed in the following papers. First, how do clients respond to treatment rationale? Does the client’s response impact the course of treatment? What influences the client’s response to the rationale? Second, how do pharmacotherapist behaviors impact the client’s response to treatment? What pharmacotherapist behaviors are more helpful or harmful in achieving therapeutic outcomes for clients? Third, what assumptions underlie antidepressant medication treatment? What impacts do these medications have for the client and for society?
|Client Reactions to an Antidepressant Treatment Rationale: Correlates, Implications, and Bears, Oh, My!
|REO NEWRING (University of Washington), Robert J. Kohlenberg (University of Washington)
|Abstract: Antidepressant medications are considered the first line of treatment for depression by many doctors, psychiatrists, and psychologists. However, not all clients agree with the idea that addressing neurotransmitter imbalances will correct distressing symptoms that they experience, much less the problems in their lives. A rationale for providing this treatment is often presented to a client at the beginning of therapy, especially in research protocols. How do clients respond to this rationale? What affects how clients respond? Does the client response predict treatment outcome? Data from a recent study of treatments for depression was analyzed for client responses to antidepressant treatment rationales, client variables that correlate with those responses, and the relationship between those responses and outcome.
|Do Pharmacotherapist Behaviors Matter? An Investigation into the Influence of Pharmacotherapist Behaviors on Patient Adherence
|CHRISTEINE M. TERRY (University of Washington), Robert J. Kohlenberg (University of Washington)
|Abstract: The use of treatment manuals to guide therapist interventions has become increasingly popular. In randomized clinical trials, manuals are used to standardize the practices of the research therapists and to differentiate the treatments being studied. Therapist fidelity, the degree to which a therapist follows the interventions specified in the manual, is often measured in clinical trials and is required in order to make comparisons among treatment modalities (Waltz, Addis, Koerner, & Jacobson, 1993). Antidepressant Medication (ADM) is the most commonly used empirically supported treatment for depression (Sirey et al., 1999). The most widely used manual for pharmacotherapy treatment in research settings is the Clinical Management-Imipramine/Placebo Administration Manual (Fawcett et al., 1987; referred to as the Fawcett manual). Although widely used, no published research studies to date have examined whether pharmacotherapist fidelity to the Fawcett manual is predictive of patient outcomes. The current study examines the role of pharmacotherapist fidelity to the Fawcett manual and patient outcomes, specifically patient adherence to the ADM regimen.
|Evolutionary Hypotheses and Antidepressant Medication
|MADELON Y. BOLLING (University of Washington)
|Abstract: Evolutionary psychiatry has examined psychoactive drug use-including caffeine, alcohol, street drugs and prescription mood altering substances-from the point of view of adaptation. Although our understanding of when and how emotional reactions are adaptive is not well developed, preliminary considerations and studies are suggestive. Negative emotions may be analogous to physical defense reactions such as pain, cough, fever, diarrhea, and vomiting. Like these physical reactions, there are times when blocking a psychological defense may be contraindicated. Several hypothetical evolutionary models have been proposed, outlining possible adaptive functions of depressed behaviors in humans. Such models are generally based on ethological data and are eminently behavioral, laying out probable behavior patterns based on variables such as gender, age, and social position, with explanatory power over and above individual histories of reinforcement. These models offer intriguing explanations for some of the puzzling responses to antidepressant medication we encountered in our research. Specific instances of these atypical responses and implications for treatment will be examined in the light of evolutionary hypotheses.