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Depression - Coggle Diagram
Depression
Treatments
- 54% recover within 6 months, 70% in 12 months
- 12-15% don’t recover and often develop unremitting chronic illness > this could be due to the fact that there is a comorbid disorder, or we do more invasive interventions.
- There is evidence for the efficacy of a number of psychological interventions: Interpersonal psychotherapy, Problem-solving therapy
CBT
- The goal is to identify and modify maladaptive appraisals
- Identify automatic negative thoughts
- Recognise connections between environment, thoughts, feelings and behaviours
- Examine evidence of automatic thoughts
- Susbsitite more realistic interpretations (leading to different emotional responses)
- NOT more positive, more REALISTIC.
- Teaches clients to understand the role of thoughts in the relationship between events and emotions
- Helps clients to evaluate how realistic and helpful their thoughts are.
- Clients learn skills that they practice in sessions and between sessions
- Structured, time-limited, active therapy
Behavioural activation
- Rationale:
- Life events lead to decreased positive reinforcement and increased punishment
- This leads to secondary problems (avoidance, escape, rumination, decreased activities)
- This leads to lethargy (inactivity cycle) that can initiate and maintain depression
- Treatment focuses on increasing activity: pleasure and mastery, activity scheduling, and problem-solving.
antidepressant medication
- Waves of pharmacological treatment of depression
- 1950s: Monoamine Oxidase Inhibitors (MAOIs) - stop the breaks down in NTs serotonin and norepinephrine, leading to a rise in activity
- Can lead to high blood pressure and even death when taken when you eat common foods (cheese, wine, beer, liver, beans) > very restrictive on diet
- Rarely used due to side effects
- Tricyclics > block reuptake of NTs serotonin and norepinephrine
- Some side effects and in overdose are cardiotoxic and potentially fatal
- 1990s: SSRIs (Selective Serotonin Reuptake Inhibitors) > specifically inhibit serotonin reuptake
- Fluoxetine, paroxetine, sertraline
- Similar efficacy as tricyclics but with fewer side-effects > first-line medication intervention for depression
- Effective in treating MDD and PDD but 40-50% of people do not respond to medications.
- Lots of people will take medication and engage in psychological treatment (polytherapy)
Pharmacology vs psychological interventions:
- CBT is as effective as antidepressants for mild to moderate depression
- The picture is less clear with severe depression > evidence that pharmacology (but not CBT) is superior to control groups, effects of psychotherapy are not moderated by depression severity, and more severe depression responded better to psychotherapy than pharmacology
- Treatment guidelines (RANZCP): first-line treatments
- Mild-moderate depression > evidence-based psychotherapy
- Moderate-severe depression > combined pharmacotherapy and psychotherapy
- Chronic disorders > combined pharmacotherapy and psychotherapy
Major Depressive
Disorder
DSM 5 Criteria
- One or more major depressive episodes:
- Five or more symptoms within a two-week period, and represents a change from previous functioning, and at least one of the symptoms is
- 1) Depressed mood most of the day, nearly every day
- 2) Markedly decreased interest or pleasure in all, or almost all activities (anhedonia)
- Self-reported and observed
- Significant weight loss (when not dieting) or gain (more than 5% in a month) or decrease in appetite nearly every day
- Insomnia or hypersomnia nearly every day
- Psychomotor retardation or agitation nearly every day
- Fatigue or loss of energy nearly every day (without physical exertion)
- Feelings of worthlessness or excessive inappropriate guilt
- Vary from inadequacy to unrealistic negative evaluations of self-worth
- Diminished ability to think or concentrate or indecisiveness nearly every day
- Suicidality > ideation, intent, plan
- Symptoms cause clinically significant impairment or distress
- Not due to effects of substance or other medical conditions
Prevalence
- 12-month prevalence in the US- 10%
- lifetime prevalence in females is 22.9% and in males is 15.1%.
- Less prevalent in the 60+ age group
- Women are twice as likely to have MDD than males
- MDD is 1.5 to 3x more common amongst first-degree biological relatives > hereditary.
Onset
- The mean age of the first episode is usually 26.2 years, but epidemiological data suggest that the age of onset is decreasing
- Early onset is associated with a greater frequency of depressive episodes (although with a shorter duration)
- Major life events are a strong predictor of initial depressive episodes, but this relationship diminishes with subsequent episodes.
- Loss of someone, relationship breakdown, loss of job, post-partum, etc.
Course
- Chronic course
- Variable course > some rarely experience remission, while others have years between episodes
- Early age of onset associated with more lifetime episodes, greater severity and greater suicidality
- Recovery typically begins within one year of onset
- Average 6-9 month duration of episode if not treated.
- relapsing course
- The majority of cases experience complete remission from MDE
- 20-30% cases remain in partial remission > subclinical symptoms
- Approx 80% of people with an MDE will have at least one more episode
- Incomplete inter-episode recovery > increase likelihood of subsequent episodes
- Periods of remission are longer early in the course of MDD.
Causes
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Response style theory of depression
- Duration, severity and course are consequences of symptom appraisal
- Ruminative response style > focusing on causes, meanings, and consequences of symptoms
- Increases the likelihood of developing depression and impairs remission
- Predicts depression onset and duration
- Predicted depressive symptoms 7 weeks post-earthquake
Cognitive model > Aaron Beck
- Depression results from a tendency to negatively and unrealistically interpret events
- Types of thoughts implicated in depression
- Negative schemas from childhood events
- Negative beliefs
- Negative automatic thoughts
- Cognitive triad
- Negative interpretation of self, world and future
- Cognitive errors
- Overgeneralization > Bad things always happen
- All-or-nothing thinking
- Filtering > filtering out all the good things and focusing on the bad
- Emotional reasoning > Emotions impact the way you reason and make decisions.
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