Chapter 13 Flashcards
What is depression often referred to as in modern society?
The ‘common cold’ of modern society
This term is controversial as it may downplay the seriousness of depression.
What do some scholars object to regarding the term ‘common cold’ as it relates to depression?
It implies that depression is a minor problem
This perspective is highlighted by Allen, Gilbert and Semadar (2004).
What did many psychoanalysts in the mid-twentieth century argue about depression?
It was a defense mechanism vital to normal psychological development
They believed it arose after a child realized not all wishes would be gratified.
Why is depression considered a major threat to children and adolescents?
It affects a substantial portion of the child and adolescent population.
What is the first topic discussed in the chapter regarding depression?
Whether depression often underlies other disorders like aggression.
What follows the diagnostic criteria in the chapter?
Prevalence rates for the population as a whole, boys and girls, children and adolescents.
What types of causes of depression are considered in the chapter?
Physiological, familial, and societal causes.
What patterns of impairment are emphasized in the discussion of depression?
Cognitive and interpersonal factors.
What is discussed regarding the stability of child and adolescent depression?
The stability of depression over time.
What is the final section of the chapter focused on?
Major treatment modalities for children and adolescents facing major depression.
What is masked depression?
A concept referring to depression that is not clearly visible, often seen in populations that discourage expressions of weakness or sadness
Populations include boys, men, and African-Americans
In which populations is masked depression commonly discussed?
Populations where showing weakness is discouraged, such as:
* Boys
* Men
* African-Americans
References include Addis (2008), Rabinowitz and Cochrane (2008), and Fuller (1992)
What types of behaviors have been frequently associated with masked depression?
Aggressive and anti-social behaviors
Discussed by Harper and Kelly (1985)
What are some other forms of psychopathology associated with masked depression?
Includes:
* School refusal
* Unexplained body aches
School refusal discussed by Kolvin, Berney and Bhate (1984); body aches by Mascres and Strobel (2000)
What do longitudinal studies indicate about children diagnosed with masked depression?
They often proceed to overt depression in subsequent years
Supported by findings from Christ et al. (1981) and Strober, Green, and Carlson (1981)
What was the belief about clinicians’ abilities regarding masked depression?
A well-trained clinician should be able to detect underlying depression
Maintained by Carlson and Cantwell (1980)
Why did the concept of masked depression decline in the professional community?
Due to increasing emphasis on clear diagnostic entities based on observable phenomena
This led to different clinicians reaching the same conclusions
What recent recognition has the professional community come to regarding children’s mental health?
Depression exists among children, not disguised as another condition
This recognition evolved over time, acknowledging the reality of childhood depression
True or False: Early acting-out behavior can lead to depression.
True
Supported by research from Patterson and Capaldi (1990)
What is the new name for dysthymia in DSM-5?
Persistent depressive disorder
This change reflects the merging of dysthymia and major depression with chronic specifier.
What is the minimum duration for experiencing a depressed mood in children and adolescents according to DSM-IV and DSM-5?
At least 1 year
Symptoms must include issues with appetite, sleep, energy, self-esteem, concentration, and hopelessness.
Can symptoms of persistent depressive disorder occur solely in the context of a psychotic disorder?
No
Symptoms must not be due to a psychotic disorder.
What must be ruled out regarding symptoms of persistent depressive disorder?
Effects of a substance or a medical condition
Both DSM-IV and DSM-5 stipulate this requirement.
What are the two specifiers included in both DSM-IV and DSM-5 for persistent depressive disorder?
- Early onset (before age 21)
- Late onset (after age 21)
The most recent 2 years of the disorder should also be noted.
In DSM-5, how can clinicians specify the status of persistent depressive disorder?
Partial or full remission
This allows for a clearer understanding of the patient’s current condition.
What additional specifiers does DSM-5 include for major and persistent depressive disorders?
- With anxious distress
- With mood-congruent psychotic features
These specifiers help to provide a more detailed clinical picture.
What option does DSM-5 provide concerning the history of major depressive disorder in relation to persistent depressive disorder?
Specify whether the patient ever met criteria for major depressive disorder over the previous 2 years
This helps in understanding the patient’s overall mental health history.
How must severity be specified in DSM-5 for persistent depressive disorder?
Based on number of symptoms and degree of impairment
This adds a level of detail to the diagnosis.
What is a core symptom of a depressive episode?
Depressed mood that is abnormal for the individual for most of the day and almost every day for at least 2 weeks.
This symptom is largely uninfluenced by circumstances.
What is another core symptom of a depressive episode?
Loss of interest and enjoyment in activities that are normally pleasurable.
This reflects a significant change in the individual’s emotional state.
What additional symptom is characterized by feelings of guilt?
Unreasonable feelings of self-reproach or excessive and inappropriate guilt.
This can contribute to the overall severity of the depressive episode.
What is a key criterion regarding the duration of a depressive episode?
Should last for at least 2 weeks.
This duration is essential for diagnosis.
What distinguishes mild, moderate, and severe depressive episodes?
The number of additional symptoms.
More symptoms indicate a more severe episode.
Fill in the blank: A depressive episode must not be attributable to _______.
[psychoactive substance use or any organic mental disorder].
What is a symptom of psychomotor activity change in a depressive episode?
Agitation or retardation (either subjective or objective).
This symptom reflects changes in physical activity levels.
What are the criteria for somatic syndrome in a depressive episode?
Four of the following symptoms should be present:
* marked loss of interest or pleasure in activities
* lack of emotional reactions
* waking in the morning 2 hours or more before usual time
* depression worse in the morning
* marked psychomotor retardation or agitation
* marked loss of appetite
* weight loss
* marked loss of libido.
These symptoms highlight the physical manifestations of depression.
What is the minimum period required for dysthymia?
A period of at least 2 years of constant or constantly recurring depressed mood.
This distinguishes dysthymia from other depressive disorders.
What is a characteristic of individual episodes of depression in dysthymia?
None, or very few, of the individual episodes are severe enough to meet the criteria for recurrent mild depressive disorder.
This indicates a chronic but less severe form of depression.
During periods of depression in dysthymia, at least three of which symptoms should be present?
- a reduction in energy or activity
- insomnia
- loss of self-confidence
- difficulty concentrating
- often in tears
- loss of interest in pleasurable activities
- feeling of hopelessness
- perceived inability to cope with routine responsibilities
- pessimistic about the future
- social withdrawal
- less talkative than normal.
These symptoms provide a comprehensive view of the impact of dysthymia on daily life.
What appears to be increasing among young people according to many sources?
Depression
Additionally, the suicide rate among adolescents has increased drastically over the past 50 years.
What should be considered when interpreting prevalence rates of depression?
Considerable caution
Increased awareness among parents, teachers, and mental health professionals may contribute to perceived increases.
What was the average prevalence rate of depression among adolescents reported by Costello et al. (2006)?
5.7 percent
This was part of a meta-analysis involving 60,000 observations.
What is the average concurrent prevalence rate of depression among children as per Avenevoli et al. (2008)?
1 to 2 percent
This rate is based on twenty-eight epidemiological studies.
What percentage of children and adolescents may experience a relapse of depression?
30–70 percent
The risk of relapse is higher with a family history of depressive illness or stressful life events.
What is the highest comorbidity rate associated with depressed youth?
Anxiety disorder (39 percent)
Other comorbid disorders include conduct disorder and ADHD.
What is a significant factor contributing to higher suicide rates among depressed youth?
Multiple disorders
Multiple disorders have been associated with dramatically higher suicide rates compared to single disorders.
At what age does the prevalence of depression in girls start to exceed that in boys?
Age 13
Most reviews indicate a prevalence rate for girls that is twice that of boys starting at this age.
What hypothesis suggests that cultural expectations for gender roles contribute to the gender gap in depression?
Gender-intensification hypothesis
Cultural expectations increase with the onset of adolescence.
Why might the true differences in depression prevalence between boys and girls be exaggerated?
Girls are more willing to acknowledge their depression and seek help
This willingness may lead to higher reported rates in girls.
What phenomenon describes the tendency for girls to ruminate on stressful events with friends?
Co-rumination
This can lead to increased susceptibility to depression.
What biological factor might contribute to the vulnerability of girls to depression during puberty?
Disruption of estrogen balance
This may chemically trigger depression by affecting serotonin processes.
What cultural factor may prevent individuals from seeking help for depression?
Beliefs and stigma surrounding depression
Some cultures may see seeking help as a confession of inadequacy.
What term describes the expectation among African-Americans to fight hard and alone against adversity?
John Henryism
This expectation may lead to underutilization of mental health services.
In which type of societies is self-reliance more valued in relation to mental health?
Individualistic cultures
Examples include the United States.
What cultural attitude may influence Chinese-Americans in seeking help for emotional issues?
Shame associated with depression
They may prefer seeking help for somatic problems instead.
What is a common response among minority groups in Great Britain regarding mental illness?
Relying on family for support
This often occurs instead of confiding in professionals.
What are physiological markers of depression?
Distinct physiological markers include differences in brain structures, such as smaller frontal lobe volumes
The frontal lobe is responsible for planning and directing behavior based on emotion.
What imaging techniques have been used to study depression in children?
Magnetic resonance imaging (MRI) and functional magnetic resonance imaging (fMRI)
These methods help visualize brain structure and function.
Which brain region showed a blunted response in depressed children when observing fearful expressions?
Amygdala
The amygdala is involved in processing emotions like fear.
What is a common neurochemical linked to adult depression?
Serotonin
Serotonin’s role in depression is well-established, though studies on children yield inconsistent results.
What is the role of cortisol in relation to depression?
Cortisol is known as the ‘stress hormone’ linked to depression
Elevated cortisol levels and flat diurnal slopes are associated with depressive symptoms.
What characterizes cortisol levels in depressed adults?
Elevated baseline cortisol levels and high, flat diurnal slopes
These traits are observed in about 50% of depressed individuals.
What psychological effects can prolonged exposure to elevated cortisol levels have?
Physiological consequences include exhaustion and irritability
These symptoms parallel those of depression.
How does the severity of depression relate to cortisol levels?
Higher cortisol levels are associated with more severe depression
The most depressed individuals typically exhibit the highest cortisol levels.
What was found regarding cortisol slopes in youths with negative affect?
Youths with negative affect have flatter diurnal cortisol slopes
This contrasts with those without problems who show more typical cortisol patterns.
What is the cortisol awakening response (CAR) and its significance in depression?
The CAR is exaggerated in depressed adults and youths with internalizing problems
This response reflects how cortisol levels react upon waking.
True or False: Neurochemical studies on children regarding serotonin are consistent.
False
Studies in children and adolescents regarding serotonin levels have yielded inconsistent results.
Fill in the blank: The frontal lobe is important for _______.
[planning to achieve goals and directing behavior based on emotion]
Which brain regions have shown low blood flow in depressed adolescents?
Regions include left parietal lobe, anterior thalamus, and right caudate nucleus
These findings contribute to understanding the physiological aspects of depression.
What does parental depression predict in children?
Elevated cortisol levels
Elevated cortisol levels suggest that chronically increased HPA activity might contribute to the emergence of depression.
What did longitudinal studies find about elevated cortisol in adolescents?
Elevated cortisol predicts later depression symptoms
This was shown in studies conducted by Goodyer, Herbert and Tamplin (2003) and Mathew et al. (2003).
What is neuroticism?
An aspect of personality involving high levels of negative emotions
Neurotic individuals are more likely to develop depression.
How much more likely were participants with highly elevated CAR to develop depression?
Three times more likely
This finding was based on a study by Adam et al. (2010).
What did Lopez-Duran and colleagues conclude about cortisol levels in depressed children?
Depressed children had significantly higher circulating cortisol levels than non-depressed peers
This conclusion was based on a meta-analysis of seventeen studies.
What does the dexamethasone suppression test (DST) measure?
HPA activity and cortisol production
Dexamethasone suppresses HPA activity, leading to less cortisol production.
How did depressed children respond to the DST compared to non-depressed children?
Depressed children responded less strongly
This indicates their overactive HPA axis systems resisted the pharmacological agent.
What is the relationship between cortisol reactivity to stress and depression in adolescents?
Increased cortisol reactivity is related to a higher likelihood of depression
This has been supported by studies such as Rao et al. (2008) and Klimes-Dougan et al. (2001b).
What did a longitudinal study find about cortisol reactivity and suicide attempts?
Elevated cortisol reactivity in adolescence predicted suicide attempts in the following 10 years
This finding was reported in a study by Mathew et al. (2003).
How does elevated circulating cortisol affect the hypothalamus?
It signals the hypothalamus to end cortisol secretion
This process may be impaired in depressed youths.
What is the impact of hypercortisolism on health?
It has adverse consequences on physical and mental health
Hypercortisolism can contribute to lethargy, anhedonia, and irritability in depressed youth.
What is respiratory sinus arrhythmia (RSA)?
A measure of parasympathetic nervous system (PNS) control of cardiac activity
Low baseline RSA is associated with depression in adults.
How is RSA related to pediatric depression?
Higher RSA is weakly associated with fewer depression symptoms
Findings by Bosch et al. (2009) and Greaves-Lord et al. (2007) support this.
What did studies find about children of depressed mothers?
They have poorer vagal regulation and slower recovery of PNS activity
This was shown in studies by Field et al. (1995) and Forbes et al. (2006).
What is the relationship between sympathetic nervous system (SNS) activity and pediatric depression?
Increased SNS activity may be linked to children’s risk for depression
This is suggested by studies like those of Shannon et al. (2007).
What do diathesis-stress models of depression explain?
The interaction of underlying vulnerabilities with immediate environmental stressors
This model is foundational in understanding how stress can trigger mood disorders.
What is the heritability range of major depressive disorder in children?
30 to 80 percent
This is based on findings from twin studies.
How does childhood depression relate to parental depression?
Children of depressed parents are at higher risk for depression
Evidence includes familial patterns and genetic studies.
What factor is more determinant of middle childhood depression compared to genetic factors?
Environmental factors such as family adversity and harsh parenting
This was noted in findings by Rice, Harold, and Thapar (2002).
What is the significance of gene-environment interactions in childhood depression?
Genetics plays a substantial role but interacts with environmental factors
This complexity is highlighted in studies by Kaufman et al. (2006).
True or False: Depression is solely a biological disease.
False
While biological factors are significant, depression also has psychological and environmental components.
What is the estimated percentage of school-age or adolescent children of depressed mothers who have experienced a depressive episode?
20 to 40 percent
This statistic highlights the increased risk of depression in children of depressed mothers compared to the general population.
Does the correlation between mothers’ and children’s depression indicate the direction of causation?
No
Correlation does not imply causation; both mothers’ and children’s depression may influence each other.
What is a possible bidirectional process theorized in the relationship between a mother’s depression and a child’s mood?
Child’s negative mood escalates in counterpoint with negative parenting
This vicious cycle can worsen both the child’s and the mother’s mental health.
List some conceivable explanations for the correlation between mothers’ and children’s depression.
- Genetic bond
- Prenatal experiences
- Impact on mother-child interactions
- Family life disruption
- Attachment bond security
- Observational learning
These factors can contribute to the transmission of depressive symptoms from mothers to their children.
True or False: Fathers’ depression has been shown to have a stronger statistical association with children’s depression than mothers’ depression.
False
Statistically, mothers’ depression is more closely associated with children’s depression.
Why might mothers’ depression have a greater impact on children’s depression compared to fathers’ depression?
Mothers are more involved in daily child-rearing activities
This increased contact exposes children to their mothers’ moods and behaviors more frequently.
What is one explanation for why depression may disrupt mothers’ parenting more than fathers’ parenting?
Fathers tend to maintain a more stable, playful style of interaction
Even when depressed, fathers may interact with children in a less affected manner compared to mothers.
Fill in the blank: A mother’s depression may affect the quality of general family life, disrupting family _______.
harmony
This disruption can have wider implications for the family dynamics and the emotional environment.
How can children learn aspects of depression from their mothers?
Through observational learning
Children may mimic the behaviors and emotional expressions they observe in their mothers.
What is the relationship between maternal depression and child attachment?
Maternal depression is associated with insecure child-parent attachment, which can lead to depression in children.
The insecure attachment may develop due to the way depressed mothers relate to their children.
How does a child’s self-image relate to their attachment with their mother?
A positive, secure relationship leads to a self-image of being worthy of love, while a relationship characterized by rejection leads to a self-image of being unlovable.
This development occurs during the toddlerhood period as children gain self-awareness.
What did Toth et al. (2009) find regarding mothers’ depression and children’s self-representation?
Mothers’ depression was linked to insecure infant-mother attachment, and children’s self-representations at age 4 were correlated with the insecurity of that attachment.
This highlights the impact of maternal mental health on child development.
What methodological issues were present in early research on parenting and depression?
Early research relied on self-reported questionnaires or interviews, which may have inherent bias.
This can lead to questionable results regarding the feelings of depressed parents about their parenting.
What did Lovejoy et al. (2000) conclude about depressed mothers’ behavior?
Depressed mothers exhibit a lack of positive behaviors and high rates of negative behaviors towards their children.
The meta-analysis synthesized findings from forty well-designed studies.
What were the findings of McLeod, Weisz, and Wood (2007) regarding parenting and child depression?
The correlation between parenting and children’s mood disorders was significant, but parenting measures explained only 8% of the variance in child outcomes.
This suggests that parenting is one of many causal agents in child depression.
Fill in the blank: Child abuse and neglect are known to lead to _______ in children and adolescents.
[depression]
What is the kindling hypothesis in relation to child maltreatment?
The kindling hypothesis suggests that maltreatment increases sensitivity to stress, leading to depression with less stress required to trigger episodes.
This heightened sensitivity is theorized to be due to chronic abuse or neglect affecting physiological processes.
What does equifinality mean in the context of depression?
Equifinality refers to how individuals with different risk and protective factors can end up with the same outcome, such as depression.
This concept helps understand the complexity of mental health outcomes.
What are the effects of peer victimization on children’s mental health?
Peer victimization is a common pathway to depression among children and youth, with correlations found in several studies.
Victims often experience significant emotional distress and may face suicidal ideation.
True or False: Bully-victims are often the most depressed individuals.
True
What did studies differentiate between in terms of bullying?
Direct bullying (physical aggression) and indirect bullying (manipulating relationships, spreading rumors).
The different forms of bullying have varying impacts on mental health outcomes.
What is the relationship between school connectedness and depressive symptoms?
A sense of membership and belonging in the school community is related to self-reported depressive symptoms.
Alienation from school may occur independently of parent attachment issues.
Fill in the blank: Maltreatment by peers is a common pathway to _______ among children and youth.
[depression]
What role does parental rejection play in child depression?
Parental rejection is a significant factor in the development of child depression.
Excessive parental control may also contribute, but its role is less clear.
What psychological implications are associated with near-universal access to the internet?
Increased prevalence of depression
The internet can lead to avoidance of interpersonal contact and aimless activities.
How can the internet be beneficial for individuals feeling awkward in establishing relationships?
It allows for interpersonal relationships to be formed in an anonymous environment
Physical cues of awkwardness are often not involved.
What is a potential negative effect of electronic communication according to Kraut et al. (1998)?
It may increase depression by substituting lower-quality social interactions for higher-quality ones.
What correlation was found in the Youth Internet Safety Survey (2005) regarding youth and internet use?
Youth with depressive symptoms use the internet more frequently and disclose personal information more extensively.
What did Gross (2004) find regarding internet use and psychological adjustment in high school students?
No significant correlations between internet use and measures of psychological adjustment.
What is the purpose of the online therapeutic program MindGym?
To deliver psychotherapy for depression to young people.
What is hopelessness theory as described by Abramson, Metalsky, and Alloy (1989)?
It includes three depressive thinking styles: permanence of negative events, disastrous consequences, and feelings of being irreparably flawed.
What does personality theory by David Zuroff suggest about vulnerability to depression?
Personality profiles such as dependency, self-criticism, and excessive need for approval increase vulnerability to depression.
What is a schema according to Beck’s theory?
A stored body of knowledge that influences understanding and reactions to situations.
What does response-styles theory by Nolen-Hoeksema propose about coping with depressive symptoms?
Habitual responses determine the intensity and duration of depressive episodes.
What significant finding did Abela and Hankin (2008) report regarding hopelessness theory in children?
Twenty-three out of twenty-seven studies confirmed that hopelessness predicts depression in the presence of stressful life events.
What percentage of adults diagnosed with major depressive disorder reported a major depressive episode during their adult years according to Fombonne et al. (2001)?
About two-thirds.
How many children and adolescents treated for depression in mental health clinics will make a suicide attempt by early adulthood?
One-third.
What is the main focus of most prevention programs for depression?
Cognitive-behavioral theory.
What did the meta-analysis by Stice et al. (2009) reveal about prevention programs?
They deliver significant reductions in subsequent depression symptoms.
What type of participants were found to achieve higher success rates in prevention programs?
Populations known to be at high risk for depression.
Fill in the blank: Cognitive-behavioral content has been most often used in direct efforts at _______.
[preventing depression]
What potential preventive interventions could also be effective aside from dedicated programs?
Reduction of child maltreatment or bullying in schools.
What is the primary aim of cognitive-behavioral therapy?
Improving distorted thinking
Cognitive-behavioral therapy focuses on helping clients recognize and change negative thought patterns.
How is cognitive-behavioral therapy typically delivered?
Individually or in groups
What is a common feature of each cognitive-behavioral therapy session?
A clear agenda and a homework assignment
How many sessions does cognitive-behavioral therapy typically require for meaningful change?
Twelve to sixteen sessions
What do cognitive-behavioral treatments aim to help clients understand?
How their thinking leads to feeling miserable
What distinction did Meichenbaum make in cognitive-behavioral treatments?
Cognitive-behavioral treatments vs. cognitive-hyphen-behavioral treatments
What does Beck’s traditional approach focus on?
Correction of maladaptive schemata and beliefs
What additional components does Lewinsohn’s approach to cognitive-behavioral therapy include?
- Relaxation training
- Direct instruction in social skills
- Working on the client’s schedule of pleasant activities
What role do parents often play in cognitive-hyphen-behavioral treatments for children?
Modifying the troubled child’s environment or routine
What is the estimated effect size of cognitive-behavioral treatment for depression in childhood and adolescence?
About one standard deviation
According to meta-analyses, what percentage of treatment group members experience success with cognitive-behavioral therapy?
70–75 percent
True or False: Recent studies have shown larger effect sizes for cognitive-behavioral therapy compared to earlier research.
False
What average effect size did Weisz, McCarty, and Valeri report in their meta-analysis?
.34
What issue did Weisz, McCarty, and Valeri identify in many studies reviewing cognitive-behavioral therapy?
Missing long-term outcome data
What was a significant problem in Lupita’s case study regarding her family?
Her parents’ constant quarreling and her father’s bipolar disorder
What homework assignments did Lupita complete during her therapy?
- Daily mood thermometer
- Diary of positive and negative thoughts
During which sessions did Lupita learn to set specific goals for her life?
Sessions 5–8
What was emphasized in the final consolidation phase of Lupita’s therapy?
Learning to communicate effectively and assert wishes
What cultural context is emphasized in Lupita’s case study?
Familismo
What was added to the CBT manual used in Puerto Rico to address cultural needs?
A standard, manualized family intervention
What is the established efficacy of cognitive-behavior therapy attributed to?
Empirical orientation and well-designed studies of its effects
What is ‘bona fide therapy’?
Therapy based on an established theoretical model and documented methods
How many studies on bona fide therapy were included in Spielmans, Pasek and McFall’s review?
Twenty-three studies
What types of bona fide therapies were found to be more effective than placebo groups?
- CBT
- Interpersonal therapy
- Parent training
- Behavior therapy
- Social skills training
What was the result of the systematic comparison between CBT and interpersonal therapy?
Both were effective with no significant difference
What does interpersonal psychotherapy focus on?
The interpersonal relationships of the depressed individual at the time of onset
When was pharmacotherapy for mood disorders first developed?
Since the 1950s
What is the typical research design used to evaluate the effectiveness of psychotropic medication?
Randomized clinical trial
What does ‘double-blind’ mean in the context of clinical trials?
Neither the participant nor the evaluator knows if the participant is receiving active medication or placebo
What ethical consideration applies when conducting clinical trials with children?
It may be unethical to prescribe placebo medication to a child in need of care
What is known about the placebo effect in adolescents and children?
They exhibit substantial responses to placebos, especially in depression treatment
What are tricyclic antidepressants known to affect?
- Noradrenergic system
- Serotonergic system
Why are tricyclic antidepressants considered less than optimal for children?
Their effectiveness rate is not much higher than placebo and they have substantial side effects
What are SSRIs and when did they largely replace first-generation antidepressants?
Selective serotonin reuptake inhibitors; replaced in the past 25 years
How do SSRIs reduce depression?
By increasing the levels of serotonin in the synapse
What is the most commonly used SSRI for child and adolescent depression?
Fluoxetine
How many prescriptions for SSRIs to young people were there in the U.S. by 2002?
Three million prescriptions
What percentage increase in suicidal ideation was found in young people taking SSRIs?
2%
What was the impact of warnings about SSRIs on prescriptions for antidepressants to young people?
Dropped by 58 percent
What was the change in the percentage of cases not receiving any psychological therapy while on medication after the SSRIs warnings?
Dropped from 43% to 14%
Fill in the blank: The effectiveness of psychotropic medication is typically evaluated using a _______.
randomized clinical trial
True or False: Tricyclic antidepressants have fewer side effects compared to SSRIs.
False
What are the concerns regarding the use of medications in children and adolescents?
Children and adolescents may respond to medications differently than adults
Their physiological response to antidepressants may not be the same due to immature neurotransmitter systems.
What is the most widely used homeopathic medicine for the treatment of depression?
St. John’s wort
It is the most frequently prescribed medication for adolescent depression in Germany.
What are the concerns related to the effectiveness of St. John’s wort?
Limited data confirming its effectiveness and potential interactions with other medications
It may help with mild to moderate depression.
Why is there interest in combining pharmacological interventions with psychotherapy?
Concerns about the safety of SSRIs and the potential for medication relapse
Long-term use of medication in young people may not be advisable.
What factors must be considered when designing research to evaluate combined therapies?
- Large sample size
- Long-term and short-term effects
- Outcomes beyond relapse
- Dosage issues
- Timing of treatments
What was the outcome of the Treatment for Depressed Adolescents (TADS) study?
Combined treatment was superior to medication alone with a 73% success rate
Cognitive-behavioral therapy was not significantly more effective than placebo.
What did the longer-term results of the TADS study reveal?
Clear advantages for the combined group in lower relapse rates and improved functioning
The psychotherapy group eventually showed improvements similar to other treatment conditions.
What are the challenges in implementing combined treatment in clinical care?
Coordination between professionals of different disciplines is often elusive
It is easier for physicians to prescribe medication than to combine it with psychotherapy.
How does physical exercise relate to depression?
Depressed individuals often withdraw from activity, which can exacerbate their condition
Lack of exercise may contribute to sustaining the depressed state.
What did the review by Mead et al. (2008) conclude about prescriptive exercise?
Prescriptive exercise is superior to no treatment
It may be as effective as short-term psychotherapy.
What methodological problems exist in studies on prescriptive exercise?
Lack of long-term follow-up
Many individuals abandon exercise regimens after initial enthusiasm.
What is still unknown regarding prescriptive exercise?
The potential benefits of combining it with other treatments
This remains an area for further research.
What has emerged in the past 30 years regarding childhood and adolescent depression?
It is widespread and treatable
The increase in recognition of childhood depression has led to more effective treatment options.
What are primary and secondary prevention programs in relation to childhood depression?
Cost-effective ways to reduce suffering
These programs aim to prevent the onset of depression and reduce its impact on affected individuals.
What is ‘masked depression’?
Non-apparent depression showing as aggression, anti-social attitudes, or physical complaints
This term is less frequently used now due to objective diagnostic criteria in the DSM.
What are the concurrent prevalence rates of depression in children and adolescents?
1-2% for children and 1-7% for adolescents
What are the cumulative prevalence rates of depression for children under 9 and adolescents?
1%+ for children under 9 and 4-24% for adolescents
What disorders are often comorbid with depression?
- Attention Deficit Hyperactivity Disorder (ADHD)
- Anxiety disorder
At what stage do girls appear more likely to experience depression compared to boys?
Starting at puberty
What factors may contribute to gender differences in depression rates?
- Increased dysphoric mood from negative body image
- Self-denying behavior at puberty
- High levels of anxiety
What has MRI and fMRI technology revealed about depressed children?
They have smaller frontal lobe volumes than non-depressed children
What physiological factors are implicated in depression?
- Poor functioning of amygdala
- Left parietal lobe
- Anterior thalamus
- Right caudate nucleus
- Elevated serotonin and cortisol levels
What does consistently elevated cortisol levels indicate in relation to depression?
High HPA activity and a meaningful predictor of subsequent depression
What does it mean that depressed children are dexamethasone-resistant?
They are resistant to chemicals that suppress HPA activity, leading to elevated cortisol levels
What is a significant predictor of depression related to autonomic nervous system (ANS) activity?
Weaker PNS control of heart activity in depressed adults
What personality features are proximal to depression in children?
- Shyness
- Behavioral inhibition
- Low self-esteem
- Neurotic personality
- Expression of negative emotion
What role does family adversity play in depression?
It is a strong contributor to the development of depression
What can activate genetic predispositions to depression?
Environmental risk factors such as low SES, single-parenthood, or a mother’s emotional distress
How does negative parenting interact with factors leading to child depression?
It can exacerbate the child’s inhibited temperament, stressful life events, and low SES
What is the effect of controlling parents on children from certain cultures?
Greater impact in cultures that do not value filial piety
Which gender may be more prone to depression following child abuse?
Girls
What is the relationship between depression and bullying?
Being bullied or being a bully is linked with depression
What is the role of the internet in relation to depression?
It can both exacerbate and buffer against depression
What theories relate to the cognitive aspects of depression?
- Hopelessness theory
- Personality theory
- Mental schema theory
- Response-style theory
What is a notable consequence of childhood depression?
It often leads to adult depression
What type of therapy has been shown to be effective for depression?
Cognitive-behavioral therapy
What does the Treatment for Depressed Adolescents (TADS) study suggest?
Combining psychotherapy with pharmacology is superior to psychotherapy alone in the long term
What types of antidepressants are mentioned, and which are not optimal for children?
- Tricyclic antidepressants (not optimal)
- SSRIs (substantial individual differences)
Fill in the blank: Primary prevention programs for depression have shown a _______ effect size for depressive outcomes.
moderate
