DEPRESSION

DEPRESSION

1. Models of Depression

   • Cognitive Behavioural Model
     • Biological
       • Genetics
       • Indirect biological mechanisms
         • Neurotransmitter models
           • Changes in NT related to stress
           • Changes in the structure of the brain associated with depression
           • Changes in hormones and inflammatory responses
         • Sleep
           • Some evidence suggests sleep problems precede depression
     • Cognitive
       • Depressive schemas
       • Maladaptive beliefs
       • Information processing (attention/memory) negatively biased
       • Rumination
       • Negative automatic thoughts
       • Pessimism
     • Social
       • Early experiences developing schema (negative triad - self, world, future
       • Attachment and temperament
       • Social support (family experiences, intimate relationships)

2. Assessment and Diagnosis

   • Cognitive Behavioural Theory
     • Conducted on immediate experience
     • Identify affective responses, cognitions during events, and behavioural responses
     • Further assessment may be conducted on past events
       • Context for developing schemas
       • Patterns of thinking established early in life
       • Behavioural responses based on past experiences
   • Clinical Tools
     • DSM5
     • Interviews and questionnaires
     • ICD-10
   • Case history and context

3. BIPOLAR AND RELATED DISORDERS

   • Bipolar I disorder: manic preceded or followed by MDE
   • Bipolar II disorder: hypomania preceded or followed by MDE
   • Substance induced Bipolar and related disorders
   • Bipolar and related disorders due to medical condition

4. Depressive Disorders

   • Disruptive dysregulation mood disorder
     • Severe recurrent temper outburts manifested verbally and/or behaviourally that are grossly out of proportion in intensity or durations to the situation ("rages")
   • Major Depressive Disorder
     • Five or more of the following symptoms present for two weeks and present a major change in functioning
       • Depressed mood
       • Diminished interest in pleasure
       • Significant weight loss/change
       • Sleep distrubance
       • Psychomotor agiitation (noticed by oithers
       • Feelings of worthlessness or guilt
       • Dimiinished ability to think
       • Recurrent thoughts of death/suicidal ideation
         • Suicidal ideation is a fearture of a number of disorders
         • Suicidal behaviours can result from symptoms other than depressed mood
           • Psychotic symptoms (delsuions and hallucaintions)
   • Persistent Depressive Disorder (Dysthymia)
     • Depressed mood for most of the day, more days than not, for at least 2 years
     • Double depression
   • Post Natal Depression
     • Affects 14% of women who give birth
     • Neuroticism and introversion associated with 4-6x risk
     • Severe repercussions for mother and baby if left untreated (long term implications)

5. Special populations

   • Adolescents
     • Critical period for vulnerability to depression 15-18 years
       • Risk of depressed symptoms rises 14-15 years
     • Low mood or dysthymic disorder prior to age 21 lasts longer/ more treatment resistant
     • Symptoms similar to adult presentation
     • Risks at this time: bullying, peer group isolation, problems at home, illness
   • Men
     • Lower rates than women but less likely to seek help
     • Higher risk for suicide
     • Australian men in rural settings have higher rates of suicide compared to metro men
   • Elderly
     • 6-15% suffer from MDD and more from milder forms
     • Aypical presentations inc. somatic symptoms

6. Depression and Relationships

   • Interactional Nature of Depression (Coyne)
     • Negative reassurance seeking behaviours place strain on interpersonal relationships
   • Self-verification Theory
     • Individuals with negative views solicit negative information about themselves
       • Confirming feedback more comforting this nonconfirming feedback

7. Treatment

   • IPT
     • Three stages
       • History of links b/w depressive symptoms and interpersonal problem areas
       • Identify interventions focusing on problem areas
       • Maintenance and preparing for independence from treatment
     • Efficacy
       • In 16 weeks IPT as effective as antidepressants
       • More effective than CBT in severely depressed individuals
       • Social skills improvement 8-10 months later
       • Benefits remain 8-10 months after treatment ends