Major Depressive Disorder (MDD) has been
reported across the world as far back as Ancient Egypt (Burton, Westen, &
Kowalski, 2015).  Burton, Westen, &
Kowalski, (2015) has defined MDD as a sadness that appears and continues for a
long time without a clear reason.  The
symptoms of MDD can include a depressed mood, loss of interest in activities that
a patient would normally enjoy and a lack of energy and concentration.  MDD will be experienced by one in seven
Australians with people over 30 being more at risk.  MDD has been linked with suicide which is the
largest leading injury-related death in Australia (Burton et al., 2015).  There is a need for more research into other
methods for patients with MDD.  Newer methods
of MDD treatment include Interpersonal Psychotherapy (IPT), internet Cognitive
Behavior Therapy (iCBT) and Positive Psychological Interventions (PPI).  It will be argued that PPI will be a good
therapy for patients with MDD.

IPT is a therapy that focuses on an
individual’s persons stressors and building a strong social support (Koszycki,
Bisserbe, Blier, Bradwejn, & Markowitz, 2012).  This is done in three stages that is spaced
over at least eight sessions.  Stage one
focuses on the education of the illness depression, building a therapeutic
trust between the therapist and person, the relationships in the persons life
and linking depressive symptoms to personal areas or life circumstances that may
have changed.  Stage two addresses the
problem areas that were identified in stage one and starts to build social
support and skills.  Stage three reviews
the treatment in previous stages and establishes a foundation of strategies for
coping with depression in the future (Koszycki et al., 2012).

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A trial on IPT versus brief supportive
psychotherapy (BSP) by Koszycki, Bisserbe, Blier, Bradwejn, & Markowitz,
(2012) was conducted on women suffering from infertility to see if IPT managed
depressive symptoms.  The study focused
on women that were experiencing infertility for more than one year, receiving
treatment for infertility and had scores above 15 according to the Hamilton
Depression Rating Scale (HAM-D) (Hamilton 1960, as cited in Koszycki, Bisserbe, Blier, Bradwejn, & Markowitz, 2012).  Lifetime history of bipolar and psychosis was
excluded in the study as well as substance abuse that occurred within the last
6 months and women that had a high suicide risk.  Patients were placed in two groups one for IPT
and one for BSP.  Patients were assessed
at four, eight and 12 weeks for improvement and follow up was conducted at six
months.  It was found that patients from both
groups had improved depression symptoms, with IPT having a higher reduction in
depression.  As this study was focused on
women with infertility it does not represent the wider populations suffering
from MDD (Koszycki et al., 2012).  Other
studies on IPT have found similar results with IPT being a viable first line treatment
for MDD that have more participants of both genders and ages. (van
Hees, Rotter, Ellermann, Evers, 2013; Spijker, van
Straten, Bockting, Meeuwissen, & van Balkom, 2013).  Unfortunately, all studies have a small
number of participants that are largely females.  IPT will have to be studied further on the
male population to see if it is a viable option for treatment on the population
with MDD.

 Rosso,
Killgore, Olson, Webb, Fukunaga, Auerbach, Gogel, Buchholz, & Rauch, (2016)
have conducted a study on the Sadness Program that was developed in Australia
and its effectiveness in treating MDD.  Treatment
with iCBT will be able to help people that are restricted in accessing help for
depression due to various reasons including financial and distance related problems
(Rosso et al., 2016).  Rosso et al.,
(2016) adapted the iCBT for an American population with the outlook that if it
is a viable option in treating MDD more people will be able to access help.  The adapted form of iCBT is a short-structed
treatment that is done over eight – 10 weeks. 
Treatment includes six lessons with homework and optional extra
materials for participants to access. 
There is also email reminders and a weekly phone call from a technician
(Rosso et al., 2016).

The study included two groups, one that
received iCBT and a monitored attention control (MAC) that only filled out a
depression scale when they logged on.  Participants
were recruited through advertisements online and community fliers.  All 77 recruited participants that completed
the trial had a primary diagnosis of MDD. 
People that had severe depression or suicidal ideation, history of
bipolar and schizophrenia, a current or part substance abuse history including
alcohol, participation in other therapy and anyone with a ninth grade or lower
education were not included in the study (Rosso et al., 2016).  Results from this study indicated that the
iCBT group responded better to the treatment.  A clinically significant improvement was found
between the two groups favoring iCBT for treatment in MDD (Rosso et al., 2016).  After the completion of the 10 weeks the MAC
group was able to access the content that was supplied to the iCBT group.  How ever there was no information on what
online CBT activities were completed and no follow up information to see if the
treatment was successful six months to one year later.  This is the second study on the usefulness on
iCBT as a treatment method for MDD and results indicate that it may be a good
option for treating MDD in the future.  More
controlled studies will need to be conducted before it can be considered an
effective treatment (Rosso et al., 2016).  

IPT on the other hand was originally used
to treat acute depression.  New studies have
focused on using PPI to treat MDD.  PPI
is used to enhance positive thinking and using wellbeing-promoting exercises
(Bolier, Haverman, Westerhof, Riper, Smit, & Bohlmeijer, 2013).   Practicing kindness, setting of personal
goals, expressing gratitude and using individual strengths are part of PPI
interventions intended to enhance wellbeing (Chaves, Lopes-Gomez,
Hervas, & Vazquez, 2017).   Chaves,
Lopes-Gomez, Hervas, & Vazquez, (2017) conducted a
study out of a women’s center to compare IPT to a clinically proven therapy.  After excluding women with substance abuse
disorders, manic episodes, psychotic disorders and women with intellectual
disabilities including dementia that would inhibit participants from following
the interventions, 96 women were included.  47 of the women were put into the PPI group
and the remaining 49 to the cognitive behavior therapy (CBT) group.  The results of both groups had only minor
differences in the outcome of treatment.

An analysis of PPI was conducted by Bolier,
Haverman, Westerhof, Riper, Smit, & Bohlmeijer, (2013) to study its
effectiveness for the public.  A search
from PsychInfo and PubMed for articles between 1988 and 2012 that had a positive psychology intervention and an outcome
evaluation.  In the 39 studies that met
the inclusion criteria 4043 participants were in PPI groups and 2096 were in
the control groups.  10 of the studies
had follow ups between three and six months on the participants and found that
the effects of the treatment were sustainable over time.  PPI that was given over a longer duration
improved results in participants.  Also
rates for in person PPI as well as individual session improved results (Bolier et al., 2013).  PPI could be used as a preventative measure in
a stepped care approach which could be self-directed or guided by a mental
health professional with the option of more intense treatment if symptoms
persist or worsen (Bolier et al., 2013).  Considering both studies were of small sample
sizes they can only give a general view on how PPI may be beneficial to
treating MDD. PPI could be used as a supportive therapy alongside a clinically
proven therapy to help patients with MDD in the long term as it helps to build
individual strengths and positive thinking (Bolier et
al., 2013).

In conclusion, IPT is the best method for treating
MDD. As the iCBT and IPP studies have mostly consisted of women they do not
offer enough information on how men respond to the treatments.  IPT has been proven to be a good first line
method in treating MDD.  However, iCBT
with more study may prove to be a good supportive therapy in the future with a
wide range of applications in mental health.  PPI in comparison has shown that while it helps
patients with MDD more studies need to be conducted.  Although PPI does help MDD, IPT has been
proven with more studies that it is the most effective way to treat MDD.

 

References

Bolier, L.,
Haverman, M., Westerhof, G. J., Riper, H., Smit, F., & Bohlmeijer, E.
(2013). Positive psychology interventions: A
meta-analysis of randomized controlled studies, BMC Public Health, 13,
1-20

Burton, L., Westen, D., &
Kowalski, R. (2015). Psychology: 4th
Australian and New Zealand edition. Milton, Qld: John Wiley & Sons
Australia.

Chaves, C., Lopes-Gomez, I., Hervas, G.,
& Vazquez, C. (2017). A comparative study on the efficacy of a positive
psychology intervention and a cognitive behavioural therapy for clinical
depression, Cognitive Therapy and Research,
41, 417-433. doi:10.1007/s10608-016-9778-9

van Hees, M. L. J. M., Rotter, T., Ellermann,
T., & Evers, S. M. A. A. (2013). The effectiveness of individual
interpersonal psychotherapy as a treatment for major depressive disorder in
adult outpatients: a systematic review, BMC Psychiatry, 13,
22-31. doi:10.1186/1471-244X-13-22

Koszycki, D., Bisserbe, J., Blier,
P., Bradwejn, J., & Markowitz, J. (2012). Interpersonal psychotherapy
versus brief supportive therapy for depressed infertile women: first pilot
randomized controlled trial, Archives of Women’s Mental Health, 15,
193-201. doi:10.1007/s00737-012-0277-z

Rosso, I. M., Killgore, W. D., Olson,
E., Webb, C. A., Fukunaga, R., Auerbach, R. P., Gogel, H., Buchholz, J. L.,
& Rauch, S. (2016). Internet-based cognitive behaviour therapy for major
depressive disorder: A randomized controlled trial, Depression and Anxiety,
34, 236-245. doi:10.1002/da.22590