Psychotherapy vs. Pharmacotherapy

Removed ==BOP== My opponent accepts the burden to prove that drugs cannot be used to treat MDD, unless talk therapy is used first. I will advocate that the first response be adapted to the patient, meaning it could be talk therapy only, drugs only, or both talk therapy and drugs. ---MDD is caused by chemical imbalances in the brain--- First, I'd like to draw a distinction. My opponent makes it seem like we're talking about people who just have a bad case of "the blues." Clinical depression (MDD) only exists in people who have serious imbalances in their brain chemistry (much lower levels of norepinephrine, dopamine, and serotonin). It should be distinguished from people who are just going through a "bad time in their life," which is a temporary bout of regular (non-clinical) depression. Drugs are often needed to increase norepinephrine, dopamine, and serotonin levels. My opponent brings up a twin study showing that only 37% of clinical depression is attributable to genes. However, even "completely genetic" diseases like schizophrenia only have a 50% concordance rate in twin studies.[1] The "environmental" causes of a mental illness, according to the Handbook of Psychology, means that the mental illness has an environmental trigger, such as a traumatic event, that causes the genetics to manifest itself.[2] This does NOT mean, as my opponent suggests, that most clinical depression is caused by having stressful or difficult life experiences that one must learn to cope with. What her study means is that if one twin has MDD, there is only a 37% chance the other twin will get it, because the second twin might not engage the environmental "trigger." But once the trigger is engaged, MDD is just as much a problem in brain chemistry as is schizophrenia, and thus it must often be treated with drugs to correct the imbalance. To further illustrate the degree to which MDD is caused by brain chemistry, consider the following. It was discovered a few years ago that smoking cigarettes can raise norepinephrine and dopamine levels; it turns out many people with MDD were actually self-medicating by smoking cigarettes. When Wellbutrin came out, the first drug to act on norepinephrine/dopamine instead of serotonin, many people with MDD found the drug also eliminated their cigarette cravings. Keep this in mind throughout the debate: many studies of talk therapy's effectiveness fail to take smoking (self-medicating) into account. ---The best treatment is BOTH--- According to Laura Pinsky of Columbia University's Psychology Center, "The best treatment for both major depression and dysthymia is a combination of medication and talk therapy. . . A recent study (and a great deal of clinical experience) indicates that a combination of the two is most effective in treating depression . . . Many therapists report that patients who are treated with antidepressants make more progress in talk therapy because they have the ability to grapple with emotional and practical problems when the depression is lessened with medication." So drugs actually enhance the effectiveness of talk therapy because patients (on anti-depressants) can more readily confront and cope with their "issues." ---Miracle cures--- Sleeping pills are one less well-known treatment for depression. Clinical depression can often be caused by problems in the sleep cycle. According to Psychology Today, "among the depressed, REM sleep typically occurs too early, lasts too long, and is marked by excess activity. Interestingly, the sleep disturbance correlates with prognosis for both recovery and relapse."[4] 5-HTP is a pill that is used to treat both clinical depression and sleep problems simultaneously; studies show it is quite effective.[5] If a patient is having severe trouble sleeping due to his or her depression, his talk therapy sessions will not be effective, due to his extreme exhaustion, and 5-HTP or a similar pill will be necessary. In addition, scientists at Yale have recently discovered that an injection of ketamine can permanently cure depression within 7-10 days and even re-grow neurons that have been damaged from constant stress. [6] When this treatment reaches market, it may well be the most effective and quickest cure for MDD. ---Speed of effect--- Talk therapy takes at least 13 sessions (approximately 3 months of sessions) to have any significant effect; in contrast, anti-depressants can have a profound effect as quickly as 1 week. [7] For someone who is suicidal already, 3 months might be too slow of progress. This individual might be frustrated by the lack of results and commit suicide in the interim. Suicidal people should be prescribed drugs to quickly restore their brain's chemical balance before they attempt suicide. ---Stigma--- Many people "aren't comfortable with the idea of psychotherapy." [8] There is a stigma in our society for going to a psychiatrist, and thus, many people refuse to engage in talk therapy. If we adopt my opponent's approach, we would be forced to deny drugs to people with MDD (even if they wanted the drugs) if the patient refused to try talk therapy first. ---Quality of therapist--- Drugs have consistent results because every pill has the same composition. The quality of therapist varies greatly, which can be problematic. Freud, for example, was notorious for making the sane feel insane and spending his therapy sessions fantasizing about his female patients. Patients who cannot find a quality therapist that they trust should be allowed to try drugs first. ==Rebuttal== Benefits of Psychotherapy – Con side subsumes all these benefits because I advocate patients seek both talk therapy and drugs, when possible and if they so desire. (I) Relapse rates are the same. This isn't surprising, since people who are on medication must continue taking their medication for it to be successful. (II) Not every clinically depressed patient is the same. Many have feelings of helplessness because of imbalances in their brain chemistries; these feelings will go away with the introduction of drugs. (III) The "teach a man to fish" analogy is interesting, but not applicable. Would you rather have one easy vitamin pill or learn the correct combination of 20 different foods to get the same nutrients? Many people prefer the quicker method. Downsides of drugs (IV) My opponent got her study completely wrong (especially the 63% statistic). Of the people with suicidal ideation (SI), 74% improved on anti-depressants, only 4% worsened. Of the "normal" people with no SI, only 7% had SI emerge, and OF THESE 7%, 63% had it go away again by their final visit. The study notes that most of the "normal" people who became suicidal were either drug abusers or suffered clinical depression. [9] My opponent thus drastically exaggerates how often SSRI's cause suicidal thoughts; also, SSRI's act on serotonin. She does not address drugs, like Wellbutrin, that act on norepinephrine and dopamine. Lastly, my opponent's study proves that SSRI's have a 74% success rate in stopping suicidal thoughts in the suicidal. That's quite a ringing endorsement for my side. (V) My opponent provides no evidence on how common manic episodes are. I wouldn't mind being "too happy." (VI) It is possible to have good coping skills and still have a chemical imbalance in the brain. Drugs alone would solve this. Others should do both talk therapy and drugs. (VII) Sorry, won't debate something that's not explained in the debate itself I look forward to my opponent's response. ==Citations== [1] Handbook of Psychology (p. 69), http://tinyurl.com... [2] Ibid [3] http://tinyurl.com... [4] http://tinyurl.com... [5] http://tinyurl.com... [6] http://tinyurl.com... [7] http://tinyurl.com... [8] http://tinyurl.com... [9] http://tinyurl.com...