Annette F. Gourgey

Hunter College, The City University of New York

Author Note

The author wishes to thank Ms. Ellen Helper for research assistance and Dr. Melvin Brainiac for assistance in preparing the manuscript.

The author cautions readers that all names other than the author’s and all statements, statistics and references reported in this paper are entirely fictitious and are presented solely for the purpose of demonstrating a simple example of a research paper in APA style.

Abstract

As depression is increasingly recognized as a common form of mental illness, there is growing debate about what kinds of treatment may be most effective. This study investigated whether Dulcinac, an herbal-based formula to relieve depression, may be as effective as analytic psychotherapy for depression without the side effects of SSRI antidepressants. Forty-five newly referred depression patients without prior experience of antidepressant medication or psychotherapy were randomly and equally assigned to one of three treatment groups: Dulcinac, Psychotherapy, or Placebo. Results showed that Dulcinac was equivalent to psychotherapy in lowering depression scores on the Miller Mood Inventory, and that both were more effective than a placebo. Further research is needed to compare Dulcinac’s effectiveness and side effects with SSRIs and to see if Dulcinac relieves depression in less time than psychotherapy.

Keywords: depression, antidepressant, psychotherapy, Miller Mood Inventory

A Comparison of Psychotherapeutic and Pharmacological Treatments for Depression

Depression is increasingly recognized as one of the most common mental illnesses in the United States (Smith, 2008). Because of this, there is growing debate within the psychotherapeutic profession as to what kinds of treatment are most effective for depression. Although psychotherapeutic methods have long been the primary method of treatment, new research suggests that medication may be equally effective for some patients.

An extensive review of clinical studies has identified both advantages and disadvantages of psychotherapeutic treatment of depression (Jones, Berman, & England, 2007). Most patients interviewed rated their therapy as at least somewhat helpful, because it allowed them to talk to a sympathetic person and to identify ways to cope with their problems. However, most of the studies reviewed by Jones et al. (2007) also indicated that meaningful benefits of psychotherapy may take months to occur.

In contrast, recent research on the effectiveness of psychoactive drugs has raised the possibility that antidepressant medication may be at least as effective as psychotherapy, with the benefit of producing results in a shorter period of time (Insbruch, 2009). The most popular antidepressant medications have been the selective serotonin reuptake inhibitors (SSRIs); however, SSRIs have been known to produce unpleasant side effects in susceptible individuals (Kogan & Rayburn, 1998).

The present study aims to test the effectiveness of a newly developed antidepressant, Dulcinac. Dulcinac, based on an herbal formula, has the potential to relieve depression with fewer side effects than SSRIs (Rayburn & Kogan, 2009), but its effectiveness has not yet been established. This study also aims to compare the effectiveness of Dulcinac with standard analytic psychotherapy. Specifically, it is hypothesized that Dulcinac and analytic therapy will produce comparable levels of relief from depression that are superior to that of a control group.

Method

Participants

Participants were 45 patients diagnosed with depression who were newly referred to the Acme Anxiety and Depression Clinic in New York City. Twenty-five patients (56%) were female and 20 (44%) were male. They ranged in age from 18 to 45 (M = 27.52, SD = 6.34). None had psychotherapy and none were prescribed antidepressant medication prior to participating in the study.

Materials

Participants in the Dulcinac treatment group were given one 50-mg Dulcinac capsule per day.  Dulcinac is an herbal-based antidepressant which is pharmacologically similar to St. John’s Wort, an herbal antidepressant widely used in Europe and by naturopaths in the United States (Rayburn & Kogan, 2009).  Participants in the Psychotherapy and Control groups were given an inert sucrose capsule visually identical to the Dulcinac capsule.  All three groups were tested for depression at the end of the study using the Miller Mood Inventory (Miller, 1986).  The MMI asks respondents to rate 20 aspects of their mood on a scale from 1 to 5, with a higher number indicating a higher level of depression.  Half of the MMI items are reverse-coded, to avoid response set.  A copy of the MMI is included in the Appendix.  

Procedure

Participants were randomly assigned in equal numbers to one of three treatment groups:  Dulcinac, Analytic Therapy, and Control (Placebo).  All three groups attended a weekly 45-minute session for a three-month period.  Each participant was given a capsule at the start of his or her weekly session; the Dulcinac group received a Dulcinac capsule while the Psychotherapy and Control groups received an inert sucrose capsule.  The Psychotherapy group received standard analytic psychotherapy with a qualified therapist for 45 minutes, while the Dulcinac and Control groups received 45 minutes of light social conversation with a laboratory assistant who was not a trained therapist.  The social conversation served as a “placebo” for the psychotherapy, to control for possible effects that could arise simply from 45 minutes of social contact apart from the psychotherapy itself.  Means and standard deviations on the MMI were computed for the three treatment groups and the mean differences were analyzed using a one-way analysis of variance.

Results

Our hypothesis stated that Dulcinac and analytic therapy would produce comparable levels of relief from depression that are superior to that of a control group.  Table 1 presents the posttest means and standard deviations for the three treatment groups on the MMI.  As these results show, the Dulcinac and Psychotherapy groups had similar levels of depression on the MMI after treatment:  the mean score for Dulcinac recipients was 46.25 (SD = 7.63) and the mean score for Psychotherapy recipients was 47.76 (SD = 8.01).  The mean score for the Placebo group was noticeably higher, M = 54.82 (SD = 7.78).  Table 1 also shows the results of the one-way analysis of variance comparing the posttest means of the three treatment groups.  The test result was significant, F(2, 42) = 122.48, p < .01.  Post-hoc tests showed no significant difference between the Dulcinac and the Psychotherapy groups, but the Control group mean was significantly higher, F(2, 42) = 119.27, p < .01.  Therefore, the hypothesis that Dulcinac is as effective as analytic psychotherapy in relieving depression compared to results obtained by a control group was supported.

Discussion

The results of the experiment support the hypothesis that depression patients without prior treatment who receive Dulcinac have lower scores on a depression inventory than patients in a control group, and that these scores are equivalent to those obtained from analytic psychotherapy. This study thus provides evidence supporting the contention of Rayburn and Kogan (2009) that herbal-formula antidepressants can be useful in treating depression patients, with effectiveness comparable to that obtained by analytic psychotherapy (Insbruch, 2009).

The effectiveness of naturopathic substances to treat depression is very useful, since they entail fewer side effects than SSRIs, which have been known to cause headaches, digestive problems, tremors, insomnia, weight gain, anxiety, sexual dysfunction, and even suicide (Rayburn & Kogan, 2009). They may also act faster than traditional psychotherapy, saving patients time and money (Jones et al., 2007). Since, as Smith (2008) noted, depression is one of the most common mental illnesses, and, as Roth (2010) discussed, certain types of depressive patients may respond poorly to psychotherapy, new antidepressants that are safe and effective may be extremely valuable and may provide a new avenue for treating people unable to respond well to existing methods.

Although the study found Dulcinac and psychotherapy to be effective in treating depression, it has several limitations.  First, even though patients were selected who did not have prior treatment with antidepressants or psychotherapy, it cannot be assumed that they were completely naïve.  Depression patients who attend an outpatient clinic are not randomly selected but come voluntarily, and their choice to seek treatment may already make them different from, and possibly less severe than, depression patients who did not seek treatment.  Second, even though Dulcinac is not available without prescription, we do not know whether some of these patients had previously self-medicated with other naturopathic remedies that are available over-the-counter, or with alcohol or other legal or recreational drugs not explicitly prescribed for depression.  Some may have received another type of counseling such as that provided by a minister or a school counselor.  These prior experiences might affect some participants’ receptivity to the effects of a new medication or a new experience with psychotherapy.    This study presumed that Dulcinac, as an herbal-based formulation, has fewer side effects than SSRIs for depression.  This assumption needs to be fully tested by a randomized, controlled and blind study comparing the effects on depression of Dulcinac and its side effects as compared with conventional prescription medications, before it can be recommended as a more benign but equally effective alternative.  Future research on the effects of Dulcinac should compare its effectiveness to SSRI and tricyclic antidepressants and to explore whether the type of drug that works best may vary depending on participant variables such as sex, age or medical condition.  Finally, although some medications for depression may act more quickly than conventional psychotherapy, this study did not examine Dulcinac’s speed of action.  A study that regularly monitors patients’ mood levels over time when they receive Dulcinac or psychotherapy would be extremely useful in determining whether Dulcinac can indeed save patients time and money over conventional treatments.

References

Insbruch, L. V. (2009). Medication vs. psychotherapy for depression: A comparative study. Psychiatric Research, 43(3), 75-82. doi: 456321/o06

Jones, A., Berman, Y. I., & England, G. E. (2007). A comprehensive review of psychotherapeutic treatments for depression. Journal of Consulting Psychology, 34(4), 56-65. doi: 2345624/jj52

Kogan, J. K., & Rayburn, L. (1998). Common side effects of SSRIs in the treatment of depression. Journal of Psychopharmacology, 7(1), 2-15. doi: 9876587/kl6

Miller, G. (1986). The Miller Mood Inventory: A new way to assess depression. Psychological Measurement, 76(2), 100-105. doi: 345876/j22

Rayburn, L., & Kogan, J. K. (2009). New herbal remedies may alleviate depression. Naturopathic Bulletin, 2(1), 32-36. Retrieved from PsycInfo database.

Roth, S. N. (2010). When conventional psychotherapy fails, what next? Journal of Clinical Social Work, 10(3), 15-28. doi: 675298/cw3

Smith, C. R. (2008). Prevalence of clinical depression in the United States. Journal of Clinical Psychology, 56(1), 245-259. doi: 465783/z54
Table 1

Means and Standard Deviations for the Three Treatment Groups on the Miller Mood Inventory

Group N Mean (SD) Min. Max. df F p
Dulcinac 15 46.25 (7.63) 32 58 2, 42 122.48 .003
Psychotherapy 15 47.76 (8.01) 33 62
Control 15 54.82 (7.78) 44 78

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Appendix

The Miller Mood Inventory

Sample Solution