depression

• the 4 D's of depression?

  1. distress
  2. dysfunction
  3. danger
  4. deviance from social norms
• mood disorders

  A) pdd

  B) dmrd

  
• Major depression DSM-5 criteria

  • for at least 2 weeks, at least one symptom of:
  • core symptoms:
  • feelings of sadness or low mood
  • loss of interest in usual activity
• DSM 5 criteria of depression:

  • core symptoms must be accompanised by at least 5 other common symptoms of depression including:
  • change in appetite, losing or gaining weight
  • sleeping too much or not sleeping well
  • fatigue and low energy most days
  • feelings worthless guilty and hopeless
  • inability to focus/ concentrate that may interfere with daily tasks
  • movements that are usually slow ro agitated
  • thinking about death and dying; suicidal ideation or suicide attempts
• assessng depression in clinical practice

  • diagnoses most commonly made by GPs
  • initial assessment based on diagnostic criteria
  • questions about mood and behaviours
  • questions about lifestyle, events
  • questions about medical and/or family history
  • may or may not use questionnaires
• assessing depression in research

  • typically use self-report questionnaire
  • often use 'cut-offs' to classify individuals as 'depressed' or 'not depressed'
  • for example: PHQ-9
  • lack of gold standard assessment
  • diagnostic rates vary widely depending on whether interviews of questionnaires are used
• PHQ-9

  • 9 questions with a score ranging from 0 to 27
  • 10+ = mild major depression
  • 15+ = moderate major depression
  • 20+ = severe major depression
• prevalence

  • globally 300 million have depression
  • prevalence varies by country and gender, low of 2.6% among males in the western pacific region to 5.9% among females in the african region
  • prevalence of depression in the community from 30 coutnries between 1994 and 2014 (Lim et al)
• costs associated with depression

  • 7.4% of total disease burden in 2010 attributed to mental health problems
  • depressive disorders accounted for 40.5% of this
  • depression was the largest contributor to non-fatal burden
• biological risk for depression

  • twin studies apprx 37%
  • general population studies - approx 32%
  • however, heritability do not provide info about which genes, or the shared environmental influences involved
• biological risk: neurotransmitters

  • neurotransmitter: molecules used by nervous system to transmit messages between neurons/muscles
  • low activity levels of serotonin, dopamine linked to depression
  • serotonin a common treatment of depression
• biological risk: neural regions

  • meta analysis of 38 fMRI and 12 EEG studies
  • consistent neural aberrations during reward processing in depression
  • blunted neural response to reward, and this effect may be more pronounced in individuals under age 18
• social factors

  • biology is always necessary to enable experience, it is easy then to assume that it is the cause of our experience
  • faulty assumption
• social/ environmental factors

  • role of childhood trauma
  • emotional abuse strongest association with depression ()@ = 2.78) followed by neglect (OR = 2.75) and sexual abuse (OR = 2.42). Significant associations were also found for domestic violence (OR = 2.06) and physical abuse (OR = 1.98)
• Psychological risk factors: cognitive factors

  • Many cognitive theories of depression
  • Most influential theory 'negative triad theory' states tat depresssion arises from :
  • Negative schemas (unconscious set of beliefs that influence negative veiws of self, world, future)
  • Results in info processing biases (over sensitive to criticism, absolutist thinking)
• Psychodynamic psychotherapy:

  • Covers many theoretical approaches (an umbrella term)
  • Key assumption: lack of awareness of unconscious feeligns
  • Goal: make the unconscious conscious
  • Limitation: takes a long time, expensive, not applicable to everyone

   
• Cognitive behavioural therapy

  • Most popular
  • Focuses on problems in the here and now, on gaining psychological/ practical skills to navigate depression
  • Very hands on
  • Typically conducted over 10 sessions
• Family therapy

  • Aim: change interactions between family members and improve function
  • Goal: disrupt self-reinforcing cycles that maintain difficulties (turn vicious cylces into virtuous ones)
• Treatment for depression: medication

  • Many different types of psychoactive medications are used to treat depression
  • Selective serotonin reutake inhibitors (SSRIs) are often first-line pharmacological treatment for depression
  • Several meta-analytic reviews find that SSRIs are an effective method of treatment for depression
• • Psychodynamic Therapy
  • Description: Believes depression results from unconscious grief over real or imagined losses and excessive dependence on others. Aims to bring these issues to consciousness and work through them using basic psychodynamic procedures.
• key points of psychodynamic theory:

  • Unconscious grief as a cause of depression.
  • Excessive dependence on others.
  • Basic psychodynamic procedures.
  • Association, interpretation, and review of past events.
• • Goals of Psychodynamic Therapy
  • Description: Expects that depressed clients, through treatment, will gain awareness of losses, become less dependent, cope with losses effectively, and make corresponding changes in functioning.?

  • Gain awareness of losses.
  • Reduce dependence on others.
  • Cope with losses effectively.
  • Make changes in functioning.
• Effectiveness of Long-Term Psychodynamic Therapy

  • Occasional effectiveness in unipolar depression.
  • Limitations: client passivity and weariness.
  • Potential for discouragement leading to early termination.
• • Conditions for Effective Psychodynamic Therapy
  • Description: Psychodynamic therapy is more effective in cases of moderate depression with a clear history of childhood loss or trauma, extreme self-criticism. Short-term psychodynamic therapies, especially when combined with psychotropic medications, have shown better results.
• strengths of psychodynamic psychotherapy

  Strenghts

  • Exploration of unconscious process
  • Can lead to better understanding of the root cause of depressive symptoms
  • Integration of transference and countertransferance - therapy acknowledges and utilises the phenmomen of transference (clients feelings projected onto the thereapist) and countertransference (therapists emotional reactions). Understanding these dynamics can offer valubale info about unresolved issues and interpersonal difficulties
• Limitations of psychodynamic psychotherapy

  • Limited empircial support and validation through controlled research studies, especially in the treatment of specific conditions like depression
  • Length and intensity - not approproate for everyone, - individuals seeking more time limited or focused interventions, esp. considering the current trend toward shorter therapeutic modalities
  • Subjective - falsifiable
  • Limited focus on symptom reduction - more un understanding underlying dynamics. In cases of severe depression, symptom relief may be a primary concern for clients
• • Cognitive-Behavioral Therapy (CBT)
  • Description:
  • CBT therapists combine behavioral and cognitive techniques to help clients with depression.
  • On the behavioral side, they aim to increase clients' engagement in and enjoyment of activities.
  • On the cognitive side, they guide clients to think in more adaptive, less negative ways.
  • Key approaches include behavioral activation and Beck's cognitive therapy.
• cognitive behavioural therapy?

  • Combination of behavioral and cognitive techniques
  • Behavioral activation and cognitive therapy are key approaches.
• • Behavioral Activation
  • Description: Therapists systematically work to increase constructive and pleasurable activities in a client's life. Based on the work of Peter Lewinsohn, it ties mood to life rewards. Involves reintroducing clients to pleasurable events, consistently rewarding non-depressed behaviors, and helping clients improve social skills.
• behavioural activation?

  • Increase constructive and pleasurable activities.
  • Reintroduce clients to pleasurable events.
  • Consistently reward non-depressed behaviors.
  • Improve social skill
• • Positive Activities and Mood
  • Description: Therapists select pleasurable activities for clients and encourage them to set up a weekly schedule. Studies show that adding positive activities can lead to a better mood (Dimidjian).
• monitering negative behaviours:

  • Monitor negative behaviors.
  • Try new, positive behaviors.
  • Smartphone apps for tracking.
  • Contingency management approach.
• • Contingency management: systematically ignoring depressive behaviors and reinforcing constructive statements and behavior.
• Stenghts

  • Effective just as effective as antidepressants has no side effects 81%, 86% combined (March et al)
  • Adopts external LOC
  • Empirical support
  • Changes brain processes
  • Versatile and can be applied to individuals of different ages, cultural backgrounds, and with diverse mental health concerns
• overemphasis on the role of cognitions.

  • a person’s irrational thinking is the primary cause of their depression and CBT does not take into account other factors. CBT therefore ignores other factors or circumstances that might contribute to a person’s depression.
  • a patient who is suffering from abuse, does not need to change their mindset, but in fact needs to change their circumstances. Therefore, CBT would be ineffective in treating these patients until their circumstances have changed.
• limitation of cbt:

  Llimitations

  • Not effective for those with severe depression - having to get out of bed. Requires active participation
•  

  Becks approach is tailored to the specific cognitive errors and behaviours found in depression

   

   Becks approach

  Phase 1: Increasing activities and elevating mood

  • Using behavioural techniques to set the stage for the cognitive dimensions of treatment, therapists first encourage clients to become more active and confident. Clients spend time during each session preparing a detailed schedule of hourly activities for the coming week. As they come more active from week to week, their mood is expected to improve
• Phase 2: challenging automatic thoughts- once people are more active and feeling some emotional relief, therapists begin to educate them about their negative automatic thoughts. The individuals are instructed to recognise and record automatic thoughts as they occur and to bring lists to each session. Here again, clients may use smartphone apps to accurately identify and document such thoughts as they arise in their daily lives

   

  The therapist and client then test the reality behind the thoughts, often concluding that they are groundless
• Phase 3: identifying negative thinking and biases - as people begin to recognise the flaws in their automatic thoughts, the therapists show them how illogical thinking processes are contributing to these thoughts. The therapists also guide clients to recognise that almost all of their interpretations of events have a negative bias and to change that style of interpretation
• Phase 4: changing primary attitudes - therapists help clients change the maladaptive attitudes that set the stage for their depression in the first place. As part of the pricess, therapists often encourage clients to test their attitudes, as in the following therapy discussion