Comparing Five Different Treatment Modalities for Major Depressive Disorder (MDD)

Finding a Best-Fit Treatment for Major Depressive Disorder: A Review of Five Context-Dependent Modalities
Finding a Best-Fit Treatment for Major Depressive Disorder: A Review of Five Context-Dependent Modalities
This paper will attempt to survey five different treatment modalities for Major Depressive Disorder (MDD). Each of these treatments is associated with a body of evidence described in peer-reviewed psychological literature. The final section of the paper will compare and contrast the surveyed modalities, in an effort to develop context-appropriate recommendations for MDD treatment.
Light Therapy
Tao et al. (2020) investigated whether light therapy can offer relief from key symptoms of MDD. Light therapy is a non-pharmacologic treatment that involves daily exposure to a bright light, typically in the form of a fluorescent light box or ceiling unit. While the exact mechanism of the therapy is unknown, it is thought to involve the stimulation of retinal ganglion cells, which in turn trigger a release of glutamate, a substance involved in regulating the sleep/wake cycle in the brain. In this way, light therapy has been demonstrated to be an effective therapeutic option for sufferers of seasonal affective disorder, especially those who report problems with sleep/wake patterns.
Tao et al. reasoned that, since a number of these symptoms also appear in MDD sufferers, light therapy may offer relief from aspects of MDD as well. If so, the therapy could be particularly helpful for those who cannot easily access psychotherapy or psychiatric assistance.
Tao et al. conducted a meta-analysis of 23 studies of the relationship between light therapy and MDD symptoms, particularly sleep problems. They concluded that light therapy has “a mild to moderate effect in improving depressive symptoms compared to placebo/control” (9). In addition, they found that efficacy was strongest when light therapy was applied daily, in a single 60-minute session, using a bright white light.
Electroconvulsive Therapy
Ferrier et al. (2021) conducted a non-systematic analysis of recent literature on the efficacy (and safety) of electroconvulsive therapy (ECT) in treating symptoms of MDD. Electroconvulsive therapy is a procedure given under general anesthesia in which low-level electric currents are sent through the brain. The goal is to trigger immediate changes in brain chemistry that are capable of ameliorating symptoms of depression, as well as a number of other mental health disorders.
Ferrier et al. draw on two large meta-analyses from 2003 and 2004 to contend that “ECT is the most effective short-term treatment for major depression,” with “remission rates around 60-80%” (295). They claim that these rates are particularly applicable to those with severe depressive symptoms, as well as those who meet the criteria for psychotic depression and depression with suicidal features. The contention that ECT is particularly useful as a short-term treatment appears to be related to its relatively high degree of effectiveness when compared to the short-term effectiveness of psychotherapy and antidepressant medication.
Not surprisingly, the safety of this procedure is commented on by Ferrier et al., as this treatment has a somewhat odious place in the history of psychology. Ferrier et al. seem aware of this treatment’s stigma when they note that, in 2018, the U.S. Food and Drug Administration conducted a review of ECT and subsequently downgraded the designation of ECT machines from class III (high risk) to class II (moderate). Ferrier et al. call this “a strong endorsement of the importance of ECT for the treatment of the most serious and sometimes life-threatening conditions” (296).
Group Physical Activity
Stevens et al. (2021) observed that, over the last two decades, a growing body of evidence has pointed to physical activity as both a protective factor against the development of MDD and a viable treatment for existing MDD symptoms. These researchers attempted to take this understanding further by exploring the potential effectiveness of physical activity in a group setting as a treatment modality. Rationale for their study included the observation that those who engage in regular group exercise tend to maintain their exercise regime over a longer period of time; that the risk of dying over a 10-year period may be 1.27 times higher for those who exercise along versus those who exercise as part of a group; and that group exercise may also protect against the deleterious psychological effects of loneliness.
Stevens et al. investigated their research question via the observation of two study groups: a large (n=4,549) cohort of older adults followed over a 6-year period, and a different sample of group exercises who had recently lost the capacity to engage with their groups due to the COVID-19 pandemic. They found that, in study 1, group exercise did indeed appear to protect against the symptoms of depression; meanwhile, in study 2, they found that losing the ability to engage with a group as part of a regular exercise regimen “was associated with more severe depression symptoms” (9). These findings lend support to the notion that physical activity in a group setting may be even more beneficial than solitary exercise as part of a treatment approach to MDD.
Radically Open Dialectical Behavior Therapy
Radically Open Dialectical Behavior Therapy (RO DBT) is a treatment modality that targets “overcontrol,” or the maladaptive cluster of characteristics that include cognitive and behavioral inflexibility, perfectionism, high threat sensitivity, suppressed emotional expression, and reduced reward processing. According to Baudinet et al. (2021), these characteristics are often associated with social isolation, difficulty with attachment relationships, and a range of diagnosed mental health problems, including MDD. In their case-series study, Baudinet et al. investigated whether RO DBT might lead to improvements in overcontrol – and secondarily improvement in MDD symptoms, among others – in an adolescent population.
For their study, Baudinet et al. organized a group of 28 adolescents, from the ages of 13-18, who had been referred to them by a local hospital and an outpatient mental health clinic specializing in DBT and CBT therapies. The group had a high rate of MDD diagnosis – 78.6%. Over the course of 8 months, the group received 20 weekly skills classes (90 minutes each), as well as weekly individual sessions (60 minutes each). After 8 months, symptoms of depression reduced markedly, and were correlated with changes in reward processing and increased social connectedness. For many in the study, the quality of attachment relationships improved, which was correlated with increased confidence and reduced need for approval.
Baudinet et al. interpreted these findings as evidence that targeting overcontrol characteristics in a therapeutic context – specifically via an RO DBT modality -- may be a mechanism by which some adolescents can find relief from related MDD symptoms. They summarize their findings this way:
“[What RO DBT appears to do] is provide adolescents with a range of skills to mitigate against several poten...