Stimulants to Help Depressive Patients

Stimulants to Help Depressive Patients Different methods have been developed to train and improve executive function. The implications of those developments could revolutionize treatments for depressive patients in which there are executive function deficits. This paper proposes a study for patients diagnosed as having recurrent major depressive disorder to undergo counseling sessions coinciding with a stimulant or a placebo treatment group. The aim is to identify a causal linkage supporting the therapeutic aid of stimulants in treating depression by providing cognitive enhancement to the patient. Literature Review The main part of research I am interested in is how researchers find relationships in phenomenon impacting everyday life. Establishing relationships between events and prove elements of life are interrelated is an intricate process. Professor Twamley helped spur thoughts behind my fascination in her assigned academic journal when she designed a group based cognitive therapy to help veterans, some of which were diagnosed with a traumatic brain injury (TBI), with impaired cognitive functioning skills. The goal of the research was to provide evidence that this specific treatment was able to help improve veterans overall quality of life. The success of the treatment was tracked by testing executive function and quality of life throughout the process. The results showed that the compensatory cognitive training (CCT) improved participants levels of executive function but CCT for TBI was not associated with improvements on processing speed measures or executive tasks that involved switching (Storzbach et al., 2016). Executive functioning skills in participants were improved overall by the treatment, but participants with a traumatic brain injury still had deficits in executive functioning. It was difficult to see why a participant couldnt improve a particular aspect of executive functioning because a previous traumatic brain injury had inhibited the positive results that treatment could bring. This relationship between executive function improvement and TBI blocking those improvements led me to research more on the topic and develop questions about how improvement to executive function in populations with cognitive dysfunction can improve quality of life. Executive Function Finding a definition for executive function is a difficult process. A concrete definition of the term does not exist to easily describe it and it is still widely debated amongst researchers (Alvarez Emory, 2006). Most theories define executive function as non-routine processing that operates within the brain when presented with a novel situation (Gilbert Burgess, 2008). Its how our brain responds to unique situations that we dont know how to respond to. Specifically, executive function is involved in the control and regulation of lower-level cognitive processes and goal-directed, future-oriented behavior (Alvarez et al., 2006). In its truest essence, executive function is the higher level thinking of an individual. Much of the brain activity for executive function is likely to happen in the frontal lobe (Biringer et al., 2005). This is because the frontal lobe is the area most associated with reasoning and decision making. This region of the brains association with executive functi oning tasks helps to establish the relationship between executive function and higher level thinking. Deficits in Executive Function. Most notable in studies about executive function is what conditions are associated with deficits in executive functioning tasks. The relationship between depression and executive function is widely noted, but not fully understood. This was shown in a study in which persons with a diagnosis depression were found to have deficits in executive function tasks in comparison to non-depressed people (Channon Green, 1999). In this study depressive persons were even less likely to use aids to help them with executive function tasks(Channon et al., 1999). Much of the research on this topic explains how the diagnosis of depression and executive functioning deficits are interrelated, but there is still debate on how the rates of depression or executive function affect one another. Improvements in Depression. There is evidence that once a patients depression levels improve so will their levels of executive function (Biringer et al., 2005). This experiment followed depressive patients two years after to diagnosis to see a full recovery from depressive symptoms was highly related to normal levels of executive function. This study begins to show that improvement to depression is associated with improvement with executive function tasks. This association between depression recovery and executive function lacks causal implication and leaves much more of the relationship to be discovered. Digging deeper into this, another study finds there is evidence to support improvement to executive function after a specialized treatment with transcranial magnetic waves stimulating the frontal cortex (Moser et al., 2002). Transcranial magnetic wave therapy is sometimes used in some cases of severe depression as a final resort to treatment and its effectiveness is debated. It is n ot known how transcranial magnetic wave therapy works in the treatment of depression. This relationship between this method of depression treatment and executive function might explain why this therapy is sometimes successful in the depressed patients. Further research will be required to determine that but other treatments that improve executive function have been partially investigated. Stimulant Assisted Treatments. Modafinil, a stimulant, is known to enhance the cognitive functioning in healthy volunteers to help improve performance on a number of cognitive tasks (Turner et al., 2002). This relationship between modafinil as well sas other stimulants and cognitive improvement has been covered a lot in the media as smart drugs. Some of these drugs are labeled as cognitive enhancers, but there is little talk about how smart drugs can be used medicinally to help depressed populations. Since the relationship between depressive disorders and executive function deficits was established, trials for the treatments of depression in the 1980s with a stimulus drug were reviewed for this study because of the potential positive effects simulants have on executive function. In a meta analysis of stimulant use for the treatment of depression, Satel (1989) found that that more studies involving a placebo would need to take place in order to establish a causal relationship between improvement in depressive symptoms and stimulant treatments . Establishing a relationship between depressive symptoms and stimulant treatment could be beneficial to the overall treatment of depression. More studies need to be conducted to support this claim and the drug used should be investigated more as well. Werneke (1990) said that stimulants very useful role in the treatment of certain categories of depression as well as other psychiatric syndromes and such patients should not be deprived of symptom relief by these drugs. This paper follows that philosophy and intends to provide evidence that this is a viable treatment that should not be overlooked. Proposed Study This study will aim to identify that stimulants can assist already existing therapy for depression on the basis that executive function will improve with the use of stimulants. Participants will take a stimulant drug before the start of a therapy session to ensure that the drug will only be working during the therapy session. Depressed patients seeking care will first be placed in either a stimulant (Modafinil) or placebo condition , following that all volunteers will receive problem solving therapy (PST). This study will be double blind in order to ensure that therapists and patients will not have knowledge that would have an effect on treatment. Participants will be randomly assigned to each group. The goal of this study is to establish that stimulant aided depression therapy will be more effective than non-stimulant aided therapy. Ethical Guidelines In an effort to be ethical and to not cause unnecessary harm, patients will be provided with a form of therapy to coincide with either a placebo or stimulant pill. With this methodology, no patient will be purposefully put in danger of not receiving the care that is needed to treat their depressive symptoms and they will be attended to under a treatment plan by a psychologist to ensure that the study is not negatively affecting their lives. In any psychopharmaceutical area it would be the utmost importance to protect participants from any unforeseen harms. At any point, for whatever reason any participant can choose to withdraw from the study or a researcher can choose to withdraw any participants. Participants. To adequately represent the effect of stimulants on depression this study will recruit 200 participants in total aged 18-80 This age limit is designed to designate the study towards patients who have the right to get consent and that the depression scale used can accurately measure. Each person will be diagnosed with major depressive disorder according to the DSM-V. Each person should be diagnosed as a recurrent major depressive disorder patient ranging from mild to severe symptoms. Participants should be excluded if any hold a comorbid diagnosis or had concurrent symptoms with any of the following: an anxiety disorder, substance abuse or drug dependency, any symptoms of delusions, had experienced psychosis in the past six months, experienced a traumatic brain injury in their lifetime, or any other condition the researcher may conclude would affect the levels of executive function in an individual besides depression. Participants on medication for depression treatment will also be excluded from this study. These exclusions follow previous research for similar concerns. In this study we will not be controlling for level of executive function because the study is within subject design and we are interested in measuring overall improvement of individuals. Therapy Condition. Over the course of treatment each patient will be given counseling treatment for depression. A treatment will occur once a week for six weeks. Coinciding with this behavioral treatment, a patient will be receiving a pill. The pill will either be a low risk stimulant (Modafinil) or it will be a placebo. This pill will be taken at the start of each therapy session to allow the individual in the stimulant condition to have improved executive functioning skills throughout the duration of the therapy. These therapies were chosen specifically for their efficacy with their treatment populations. The problem solving therapy (PST) group was chosen in order to establish a successful treatment method. In a meta-analysis by Bell and DZurilla, PST was found to be equally as successful as medication treatment for depression (2009). By using this therapy we can evaluate if stimulus aided PST is more effective than non stimulus aided PST in the role of social problem solving. In addition, this study may determine if deficits in executive function are an epiphenomena of depression or not. Other studies have yielded conflicting results in relation between severity of depressive symptoms and impairment in executive function (Austin, Mitchell Goodwin, 2001). However, positive results could be the result of the combination of PST with stimulant aided therapy. To truly understand the relationship between stimulants and depression, the results of the stimulant group will be compared with the placebo. PST will focus in areas that have been proven to have the most effective results on participants. These areas are a training for positive problem orientation, problem definition, problem formulation, generation of alternatives, decision making, solution implementation and verification (Bell et al., 2009). This therapys focus is to mediate between stressful life events and wellbeing (Bell et al., 2009). Over the course of treatment we will see how stimulant aid will impact pre and post test analysis for levels of executive function and depression. Executive Function Measures. Three measures for executive function will be assessed in this study. Executive function of the participant pool will be tested at baseline and five weeks after the study has been completed both occurring without any use of stimulants. If there is improvement from before to after treatment it will reinforce other studies that state absence of depressive symptoms is associated with rejuvenated executive function skills. It is intended to see if there was improvement from before to after treatment without the use of stimulants in assessment to gauge the overall effect of treatment. The executive function measure used in this study has already been tested on depressed populations and was found that depressed populations did worse on the tasks below than non-depressed populations (Channon et al., 1999). Since the prior study had been used to compare group differences in executive function it is a suitable measure in our experiment for a between groups within subject design. All measures below are used from a previous study by Shelly Channon in the Department of Psychology of the University College London (Channon et al., 1999). Memory for categorised words task This task asks participants to remember 16 words presented in a random order. Each word would appear on a computer screen for 2 seconds and participants were asked to remember them so they could write them down after this session. They were asked to write down as many words as they can after the words had been shown in an unlimited time period. After that another session of 32 words would appear on the screen, again for 2 seconds each. Participants would have to identify which of the words presented were distractors or the correct 16 words. Response suppression task An experimenter will read 30 sentences in total to the participant with the final word omitted from the sentence. The participant would then be asked to insert a word to complete the sentence that made no logical sense to the sentence. Response would be categorized as nonsensical, semantically related word choice, and straightforward sentence completion. Multiple scheduling task These tasks were broken into four groups of mirror reading, identifying the position of words, object knowledge questions, and drawing objects. In mirror reading, words are presented backwards and participants are asked to write the correct word. In position of words task, participants are asked to write the word corresponding with a location in a certain row of a table. The table would consist of 176 numbers in column one and 176 unique words in column two. Finding words more efficiently was a way of measuring executive function. The object knowledge questions would ask open ended questions about everyday objects for them to identify. An example is, where would you find a keyhole?. For the final drawing objects task, participants are asked to draw everyday objects. Depression Scale. The Beck Depression Inventory-II (BDI-II) will be used to assess the levels of depression in this participant population before each session of treatment. No participant should have their depression levels assessed while they are under the influence of Modafinil. This aim is to see how mood is progressing throughout the treatment not how stimulants are directly altering mood. The BDI-II assessment correlates highly with depression rates by the Hamilton Rating for Depression (Steer, Ball Ranieri, 1996). It is in a 21 multiple choice format and the severity is assessed on a scale of zero to sixty-three. The scores are broken into scores from 0-12 as nondepressed patients, 13-19 as dysphoric patients, and 20-63 as dysphoric or depressed patients (Beck, Steer Brown, 1996). The higher the decrease in rate of depression will be the basis for finding success of the treatment for depression. This depression measure was chosen for its accuracy in identifying depressive sym ptoms and its ability to be completed in two minutes (Beck et al., 1996). Potential implications of this study[1] This study has the potential to establish a causal linkage between positive effects of therapeutic depression treatment utilizing the aid of stimulant assisted therapy. Successful results in PST with stimulant aid versus PST without stimulant aid would infer that executive function aid could improve the success of a therapy. The results can determine that executive functioning and depression are more interrelated than we think. If a link is proven between depression and executive function improvement it could expand our treatment practices for depression. Fluoxetine, one of depressions most utilized treatment options, was found to be ineffective in some women who have low levels of executive function coinciding with their depression (Dunkin et al., 2000). If we are able to advance executive function, then we can further enhance treatments so that depressive symptoms would continue to decrease instead. In addition, stimulants can have less side effects than other psychiatric medicatio ns (Satel et al., 1989). Findings from this study can provide safer, more effective treatment for populations that have difficulty finding dependable treatment options. References Gilbert, S. J., Burgess, P. W. (2008). Executive function. Current Biology, 18(3). doi:10.1016/j.cub.2007.12.014 Beck, A.T., Steer, R.A., Brown, G.K. (1996). Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation. [1]how to assess this?