Hockenbury Discovering Psychology 5th txtbk

Biomedical Therapies613are prescribed different drugs or combinations of drugs in different dosages until theyfind the regimen that works for them. Thus, patients may need to try multiple medicationsbefore finding an effective treatment. Many researchers believe that geneticdifferences may explain why people respond so differently to antidepressants and otherpsychotropic medications. The new field of pharmacogenetics is the study of howgenes influence an individual’s response to drugs (Nurnberger, 2009). As this field advances,it may help overcome the trial-and-error nature of prescribing not only antidepressants,but other psychotropic medications as well.How do antidepressants and psychotherapy compare in their effectiveness? Severallarge-scale studies have found that both cognitive therapy and interpersonaltherapy are just as effective as antidepressant medication in producing remissionfrom depressive symptoms (Imel & others, 2008; Thase & others, 2007). Brain-imagingstudies are just beginning to show how such treatments might change brainactivity—a topic that we showcase in the Focus on Neuroscience.FOCUS ON NEUROSCIENCEComparing Psychotherapy and Antidepressant MedicationBoth antidepressant medication and psychotherapy have beenused to treat major depression. As we discussed in Chapter 13,major depression is characterized by a variety of physical symptoms,including changes in brain activity (Abler & others, 2007;Sackeim, 2001; Thase, 2001). Antidepressants are assumed towork their effect by changing brain chemistry and activity. Doespsychotherapy have the same effect?In a recent study, PET scans were done on 24 people with majordepression and compared to a matched group of normal controlsubjects who were not depressed (Brody & others, 2001). Comparedwith the nondepressed adults, the depressed individualsshowed increased activity in three areas of the brain: the prefrontalcortex, the caudate nucleus, and the thalamus. The day after thefirst scan, 10 of the 24 depressed individuals started taking the antidepressantPaxil, an SSRI. The remaining 14 individuals with depressionstarted interpersonal therapy (discussed earlier in thischapter), a psychodynamic therapy that has been shown to be effectivein the treatment of depression. Twelve weeks after beginningtreatment, the participants’ depressive symptoms were measured,and all 24 study participants underwent PET scans again.Following either treatment, patients’ depressive symptoms improved.And the PET scans revealed that patients in both groupsshowed a trend toward more normalized brain functioning.Activity declined significantly in brain regions that had shownabnormally high activity before treatment began.The PET scans shown here depict changes in the prefrontalcortex, one of the regions that showed a significant change towardmore normal metabolic levels. Scan (a) shows activity levelsin the prefrontal cortex before treatment. Scans (b) and (c)show the metabolic decrease in activity following treatment withPaxil (b) or interpersonal therapy (c). In this comparison, notethat (b) and (c) show the amount of change from the baselinecondition, rather than the actual level of metabolic activity.As these findings emphasize, both psychotherapy and anti -depressant medication affect brain chemistry and functioning. Inanother study, both patients who were treated with interpersonaltherapy and patients who were treated with the anti -depressant Effexor showed improvement and similar changes inbrain functioning (Martin & others, 2001). Similarly, later studieshave shown that cognitive behavior therapy and antidepressanttherapy also produce distinct patterns of brain activity changesin people whose depressive symptoms have improved (Kennedy& others, 2007; Roffman & others, 2005).Source: Brody & others (2001).Prefrontal cortex Prefrontal cortex Prefrontal cortex(a)Baseline—before treatment(b)Decrease in activity after 12weeks of treatment with Paxil(c)Decrease in activity after 12 weeks oftreatment with interpersonal therapy