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Cognitive Behavioural Therapy has become the treatment of choice for anxiety and depression - Discuss.

Introduction

Anxiety and depression are both mental illnesses widely prevalent in the UK today, with depression affecting 1 in 4 women and 1 in 10 men; and women twice more likely to suffer from an anxiety disorder than men (The Office for National Statistics Psychiatric Morbidity Report, 2001). Anxiety is described by the Diagnostic Statistical Manual (DSM-IV) for Mental Health Disorders as a heightened feeling of apprehension and worry; symptoms include panic attacks, irritability, loss of sleep and concentration due to worrying. Anxiety disorders include both panic disorder and generalised anxiety disorder. Depression is the manifestation of a depressed mood (i.e. sadness and feeling of emptiness) and a loss of interest in activities; accompanied by symptoms such as weight gain/loss, feelings of worthlessness, low energy and suicidal thoughts. Depression can be mild, moderate, severe or chronic. Overall both disorders cause severe impairments in functioning and are extremely distressing for the patient and for those around them. To take a particular example, a nurses' assistant working with elderly patients suffering from anxiety and depression would have a variety of treatments options available in order to endeavour to effectively treat such patients' e.g. cognitive behavioural therapy (CBT), medicines, electroconvulsive therapy and self-help.

One of the earliest forms of treatment available for dealing with mental disorders was Electroconvulsive therapy (ECT), which was first used in 1938 (Fitzsimons, 1995), and was most often used for the treatment of depression. One study found that ECT produced a positive outcome for 70% of depressed individuals (Fitzsimons, 1995). This was the most common treatment before the introduction of drugs in the late 1950's (Irvin, 1997), resulting in a dramatic decrease in the use of ECT. Its decreased use was mainly due to the negative side-effects which included memory loss, cognitive impairment, myocardial infraction and ventricular tachycardia; especially in the elderly patients, and strong criticism from practitioners (Sackeim, 1994b).

However it is important to note that the research underpinning these evidence-based guidelines is not without its limitations. In many cases it is just not ethical to carry out randomised controlled experiments e.g. to test the effectiveness of particular drugs. So despite the guidelines recommendations there may be particular treatments with lower evidence grades that are more effective in treating anxiety and depression than the treatments with higher grades. The choice of treatment the will most likely reflect the nurses past experience with dealing with such illnesses rather than relying solely on empirical research.

Conclusion

A nurse assistant dealing with elderly patients who suffer from anxiety or depression would have a number of treatments available in order to endeavour to effectively treat such patients. In particular CBT which has in recent years risen in prominence as the choice of treatment by many practitioners. According to the NICE (2004) who regulate treatment of mental health disorders within the NHS, the recommendations they make should usually be adhered to since they are evidence-based and as such will make sure the most effective treatments are selected. In the case of anxiety it appears that CBT would be the treatment of choice as it is much more effective in actually curing individuals of their disorder than medications (Toni et al, 2000). However, in the case of depression it is a little more complicated, although CBT has been proved to be an effective treatment, antidepressants still appear to be the choice of treatment especially for severe and chronic depression (NICE, 2004). In the case of elderly patients however, it may be the case that CBT and self-help is favoured over antidepressants due to possible co-morbidity which would compromise the suitability of drugs being used to treat anxiety and depression.

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