Introduction: and Statistical Manual of Mental Disorders, Fifth


            The history of depression treatment in the early years
had small amounts of evidence about how depression was treated or diagnosed as
a mental disorder. Depression also known as major depressive disorder which is
characterized by depressed mood in which one feels sad or empty without any
sense of pleasure in one’s activities (Ray, 245) and affects more than 16.1 million
American adults (American
Psychiatric Association, 2013). According to Diagnostic and
Statistical Manual of Mental Disorders, Fifth Edition (DMS-V), one’s depressive
state can be brought along by traumatic events, hormonal changes, caring for an
ill loved one, drug abuse, contraction of diseases, financial hardships and
much more. Symptoms such as “feeling sad, loss of interest or pleasure in
activities once enjoyed, changes in appetite, trouble sleeping, difficulty
thinking/making decision or even thoughts of suicide or death, which presents
for at least two weeks is an diagnosis for depression” (American Psychiatric Association, 2013).

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            Currently, studies that many clinicians have done shows
different types of depressive states that evolved from Sigmund Freud first
ideas of treating depression. Treatments from past generations to present for
depression include Sigmund Freud (1800’s) psychoanalysis, electroconvulsive
therapy (1930’s) which is still practiced today, along with other stimulation
therapies, antidepressant drugs (1950s -1960s) and psychological therapy
treatments for depression which is a very common approach to present time treatments.

Freud Psychoanalysis:

            In the 1800s, Sigmund Freud was a psychoanalytic who was
the first to develop a method for the treatment of depression. He believed this
form of therapeutic approach, helped cure people by noticing their unconscious thoughts
and speaking about them. An approach of repression is the “discomforting
painful memories that one feels from the unconscious mind” (CITE SOURCE). Freud’s repression
approach was not successful because instead of understanding emotional life, it
became too painful for his patients to handle traumatic events that arose from
past experiences.    Another phenomena
called free association is also a method that his patients “spontaneously
expressed without leaving anything that comes to mind” (CITE SOURCE). According to Freud,
free association technique “will provide clues to the unconscious conflicts
leading to a person’s problems” (Sigmund, Freud). This method did work because
patients would relax and speak upon what was on their mind and not feel any type
of shame.

and Stimulation Therapy:

            A second type of
therapeutic approach, for treating depression is electroconvulsive therapy
(ECT) and stimulation therapy. This treatment is also known as electroshock
therapy which is a simple medical procedure that is painless and one is put
under general anesthesia.  Electroconvulsive
therapy (ECT) is used when a patient with severe depression has not improved
from other treatments such as medications or psychotherapy. ECT sends small
amounts of electric currents to the brain when a patient is in a catatonia
state. The National Institute of Mental Health, “have studied that having
multiple ECT treatments are presented to be effective but several treatments a
week is needed to be a successful one” (CITE SOURCE). The benefits of this treatment are
to lessen the chances of going back to a catatonia state and works faster than
being placed on medications.

            Other stimulations, for instance vagus nerve (VNS),
repetitive transcranial magnetic (rTMS), magnetic seizures therapy (MST) and
deep brain stimulations (DBS) are methods being used as well. Vagus nerve and
deep brain stimulation both use devices called pulse generators to control stimulations.
The differences in both stimulations are VNS sends messages from the brain to
different parts of the body and DBS is continuous stimulation throughout the
body, which the stimulus is set at a certain setting to the individual’s
tolerance. According to Food and Drug Administration (FDA), VNS “helped treat
epilepsy but also showed that these individual moods had a significant mood
improvements” (NIMH). Which lead to believe that this therapy would help but
“the effectiveness of the treatment has ranged from 31% to no effect in
treating depression” (Ray, 259). However, in DBS “current research suggest that
18% to 60% of individuals with treatment resistant depression show improvement
with DBS” (Ray, 260).

            Also, under the umbrella of stimulation therapy are
repetitive transcranial magnetic (rTMS) and magnetic seizure therapy (MST)
which uses magnetic pluses, rather than electric currents to stimulate the
brain. In these stimulations, one can “specifically choose a part of the brain
that regulates moods” (NIMH). Repetitive transcranial magnetic is done by “placing
electromagnetic coil against the part of the brain that is chosen for mood
regulation” (NIMH). The magnetic coil is trying to activate the brain by small
amounts of electrical currents, “which depolarizes the neurons” (Ray, 259). As
for MST, it’s common where it resembles to ECT and rTMS because “like rTMS, MST
uses magnetic pluses instead of electricity to stimulate a precise target in
the brain” (NIMH), but not much research is done to specifically know what is
main focus of this treatment.                              


            An antidepressant
is another approach used to treat depression by balancing brain
neurotransmitters level to alleviate depression. The following three
antidepressant are prescribed medication as a treatment.  Iproniazid an monoamine oxidase inhibitors
(MAO) “is an enzyme that produces oxidative break down of biogenic amines such
as serotonin, dopamine, epinephrine, and norepinephrine and sympathomimetic
amines” (CITE
SOURCE). MAO inhibitors is made within the body to maintain neurotransmitters
and produce good brain cell interaction to elevate moods. This inhibitor aims
at the synapse activity. The second antidepressant is selective serotonin
reuptake (SSRIs) “would increase serotonin at serotonin transporters, and as a
result would increase serotonin concentrations within the synaptic cleft to
further stimulate postsynaptic serotonin receptors” (CITE SOURCE). SSRI’s
tries and help the mind to reorganize itself and letting the changes in one’s
mind happen. Lastly, Tricyclics “refers to the three-ring chemical structure of
the drug” (Ray, 257). Tricyclics can relate to MAO inhibitors because it has
the same mechanisms but in some cases tricyclics are given to individuals who
have comorbid diagnosis, such as anxiety. 

Therapy Treatments:

            In psychotherapy,
there are three fundamentals used to help individuals live happier and
healthier lives. The three fundamentals are dynamic, cognitive behavioral, and
emotion focused approaches. “Cognitive therapy suggest that dysfunctional
thinking and negative information processing maintain depression” (Ray, 261).
This suggests that an individual can recognize what’s causing this behavior and
change the awareness of their thoughts. Next, psychodynamic therapy is
“understanding of how the depressive symptoms developed” (Ray, 262). This
method is similar to Sigmund Freud’s psychoanalytic method because the
connection between conscious and unconscious motivation is practiced. Freud
used extensive and more concentrated thoughts with the method of “talk therapy”
(Sigmund Freud). Rather than, interpersonal therapy with short and less
concentrated thoughts of the past. Which leads into emotion focused therapy
“involve bringing past emotional experience and memories into the present”
(Ray, 262). This is expressing that individuals learn how to not hind their
emotions but utilize them as a guidance to gain emotional health.




              As the evolution of depression treatments
continue it is seen that some clinicians are geared to use pharmacology then
psychotherapy or psychotherapy then pharmacology, but in some circumstances
both medications and therapy is needed depending on the individual that is in


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