Treating unipolar depression: cognitive behavioural therapy (challenging negative thoughts) and drug treatments (antidepressants and how they work), and an evaluation of each.

What this dot point is asking

Edexcel wants you to describe and evaluate two treatments for unipolar depression: cognitive behavioural therapy (CBT), which challenges faulty thinking, and drug treatments (antidepressants), which change brain chemistry. You should link each treatment to its underlying explanation (cognitive theory for CBT, the role of serotonin for drugs) and weigh their strengths and weaknesses.

Cognitive behavioural therapy (CBT)

CBT follows from the cognitive theory: if negative thinking causes and maintains depression, then changing that thinking should treat it. The therapist helps the person identify their negative automatic thoughts and the negative triad (negative views of self, world and future). They then challenge these thoughts by examining the evidence for and against them, and replace them with more realistic alternatives. The behavioural side sets homework and activities, such as gradually returning to rewarding activities (behavioural activation), which breaks the cycle of low mood and withdrawal.

Evaluation. Strengths: it treats the cause (the thinking), gives the person lasting skills they can reuse, and has no physical side effects, so relapse rates are often lower. Weaknesses: it takes time and effort, depends on the person's motivation and a skilled therapist, and may not suit someone too unwell to engage at first.

Drug treatments (antidepressants)

This treatment fits the biological explanation, including the genetic link to serotonin found by Caspi et al.

Evaluation. Strengths: antidepressants work relatively quickly, need little effort from the person, and are cheaper to provide, so they help people too unwell to start therapy. Weaknesses: they can cause side effects, they do not address the cause (the negative thinking), and symptoms may return when the drug is stopped, so they can treat the symptom rather than the problem.

Choosing and combining treatments

Because each treatment has different strengths, they are often combined: drugs can lift mood enough for a person to engage in CBT, which then provides longer-lasting change. The best choice depends on the severity of the depression, the person's preference, and what resources are available.

Try this

Q1. What does SSRI stand for, and what does it do to serotonin? [2 marks]

• Cue. Selective serotonin reuptake inhibitor; it blocks the reabsorption of serotonin so more stays in the synapse.

Q2. State one strength of CBT for depression. [1 mark]

• Cue. It treats the cause and gives lasting skills, with no physical side effects.

Q3. Explain one reason drugs and CBT are sometimes combined. [2 marks]

• Cue. Drugs lift mood quickly so the person can engage in CBT, which gives longer-lasting change.