depression

Question 1

how many adults experinece depression during their lifetime according to the NCCMH 2010

Answer 1

1 in 10

Question 2

how many people live with depression globally [WHO,2017]

Answer 2

320 mil

Question 3

who have a higher lifetime risk for depression [DSM-IV-TR]

Answer 3

women [10-25%] but for men it’s 5-12%

Question 4

4 risk factors of depression

Answer 4

1. hereditary factors
2. adverse childhood experiences factors
3. sociodemographic factors
4. physical disease factor

Question 5

adverse childhood experinec factors

factors in depression

Answer 5

e.g neglect

Question 6

sociodemographic factoers

factors in depression

Answer 6

eg gender, economic and educational disadvantage, low levels of close social support

Question 7

physica; disease factor

factors in depression

Answer 7

associations between physical illness and depression: effects of chronicity and length of illness

Question 8

DSM-V classification of depression

Answer 8

Experiencing five or more symptoms during the same 2-week period and at least one of the symptoms should be either (1) depressed mood or (2) loss of interest or pleasure in almost all activities.

Question 9

symptoms of depression according to the DMV-5

Answer 9

• Weight loss or gain.
• Sleep disturbance (insomnia or hypersomnia).
• Tiredness, fatigue, or low energy.
• Difficulties with thinking, concentration, or making decisions.

also:

• Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• Episode not attributable to physiological effects of a substance or another medical condition.
• Episode not better explained by psychotic disorders.
• No history of manic or hypomanic episode

Question 10

course of depression

Answer 10

• some people experience a single episode of depression and the recover fully
• for others, chronic or recurrent episodes of depression may cause difficulties over the life course
• at least 50% of individuals who recover from a first episode of depression will have one or more additional episodes in their lifetime [Burcussa & Lacuna, 2007]

Question 11

what is the BioPsychoSocial model

Answer 11

• fundamental model that ppl draw on
• idea that different factors interact together to influence us
  1. biological [genetics, physiology, neurology]
  2. psychological [thoughts, emotions, memories]
  3. social [relationships, family, culture, society]

Question 12

social/enviromental factors regarding depression

studies

Answer 12

• Multiple studies show associations between stressful life events and subsequent episodes of depression (Kessler, 1997).
• Poor relationship quality (across all social relationships) has been found to be associated with higher risk of depression (Teo et al., 2013).
• Low SES associated with an increased risk of both onset and persistence of depression(Lorant et al., 2003).

Question 13

protective factors regarding social/enviro factors in depression

Answer 13

secure parenting, high quality social relationships, engaging in meaningful activities.

Question 14

the 3 bio theories

Answer 14

1. genetic factors
2. structural and functional bran differences
3. neurochemical factors

Question 15

genetic factors in depression

Answer 15

• Findings from a meta-analysis of twin studies suggest that 37% of the variance in depression can be accounted for by genetic factors (Sullivan et al., 2000).
• These heritability estimates are higher when clinical samples are recruited, or when diagnosis of depression is ascertained with repeated measurements over time (Menke et al., 2012).
• Linkage studies and genome-wide association studies have yielded conflicting results (Shadrina et al., 2018)

Question 16

study regarding Structural and functional differences in brain of non-depressed and depressed participants

Answer 16

• E.g. Lower activation in brain areas associated with emotional regulation and goal attainment (pre-frontal cortex and anterior cingulate cortex).*
• Differences in areas associated with emotional contextualisation and processing (hippocampus and amygdala) (Davey, 2008).

Question 17

neurochemical factors regarding depression

Answer 17

depression is regularity associated with low levels/different metabolism of the brain neurotransmitters:

• serotonin
• noradrenaline
• dopamine
  rapid uptake of serotonin can be associated with depression [use of SSRI]

Question 18

what are schemas

Answer 18

• Cognitive structures that allow individuals to identify, interpret and organise information.
• Considered to develop in early childhood.
• Individuals with depression have mood-congruent schemas, characterised by themes of loss, failure, worthlessness and rejection.

Question 19

beck’s negative triad

Answer 19

depression is characterised by a negative cognitive triad:

• a biased view of oneself [I am inadequate]
• a biased view of the world in general [no one cares about me]
• a biased view of the future [I’ll never be good at anything]

Question 20

what is the cognitive model of depression

Answer 20

1. early experinces
2. core beliefs, attitudes, assumptions [negative cognitive traid]
3. triggering event
   then leads to endless cycle of thoughts -> feelings -> behaviour -> body sensatiosn

Question 21

supporting evidence for beck

Answer 21

• Studies using eye-tracking have found that individuals with depression pay more attention to negative information (sad faces) and less attention to positive information (happy faces) (Duque & Vazquez, 2015).
• Depressed individuals recall more negative information than positive information in memory tests (Mathews & MacLeod, 2005).
• Depressed individuals exhibit a bias to interpret ambiguous information as negative (Mathews & MacLeod, 2005; Orchard et al, 2015).

Question 22

what do behavioural theories suggest

Answer 22

Propose that depression results from a lack of positive reinforcement from pleasurable or meaningful activities (Lewinsohn, 1974)

Question 23

what do systemic theories suggest

Answer 23

• Suggest that individuals’ experiences cannot be understood in isolation.
• View depression as a problem within the wider family/interpersonal system (Dallos&Draper, 2010).

Question 24

3 types of interventions for depression

Answer 24

• medication
• physical exercise
• psychological therapies and self-help interventions

Question 25

exercise intervention for depression

Answer 25

on a multinational scale, depression has been found to be associated with low levels of physical activity [Stubbs et al., 2016]

exercise interventions for depression include:

• aerobics
• fitness
• yoga
• dance

Findings from a systematic review of meta-analyses suggest that exercise interventions may be effective at decreasing depressive symptoms across all age groups (Hu et al., 2020)

Question 26

why are exercise interventions effective for depression ?

4 listed

Answer 26

1. endorphin hypothesis
2. monoaime hypothesis
3. distraction hypothesis
4. self-efficacy hypothesis

Question 27

what is the endorphin hypothesis

effectiveness of exercise interventions for depression

Answer 27

exercise leads to the release of β-endorphins, which are associated with positive mood and well-being

But there is limited empirical evidence to support these theories

Question 28

what is the monoaime hypothesis

effectiveness of exercise interventions for depression

Answer 28

exercise leads to an increase in the availability of serotonin, dopamine, and norepinephrine

But there is limited empirical evidence to support these theories

Question 29

what is the distraction hypothesis

effectiveness of exercise interventions for depression

Answer 29

exercise serves as a way to distract from worries and neg. thoughts

But there is limited empirical evidence to support these theories

Question 30

what is the self-efficacy hypothesis

effectiveness of exercise interventions for depression

Answer 30

exercise may enhance self-efficacy as it provides the opportunity for individuals to have meaningful mastery experiences

But there is limited empirical evidence to support these theories

Question 31

medication for treating depression

Answer 31

• depression can be alleviated in some cases by drugs that raise the levels of serotonin and noradrenaline
• older versions of antidepressant medications:
  
  • tricyclic drugs
  • monamine oxidase inhibitors
• newer versions of antidepressant medications
  
  • SSRIs [Selective Serotonin Reuptake Inhibitors]
  • SNRIs [Serotonin-noradrenaline reuptake inhibitors]

Question 32

SSRI’s

Answer 32

• SSRIs are thought to work by increasing the availability of serotonin in the brain.
• Serotonin is a neurotransmitter - it carries signals (or messages) between neuron’s in the brain.
• After carrying a message, serotonin is usually reabsorbed by the neuron’s (reuptake).
• SSRIs inhibit this reuptake of serotonin, which means that there is more serotonin available to pass signals between nearby neuron’s.

Question 33

SNRI’s

Answer 33

SNRI’s inhibit the reuptake of serotonin and noradrenaline

Question 34

stats regarding use of medication for depression

Answer 34

• most common treatment offered for depression
• 83 million prescriptions of antidepressant in the uk in 2021/22 [NHS business services authority]
• approximately 17% of the uk adult population are prescribed antidepressant meds [public health England]

Question 35

patient preference regarding medication for depression

Answer 35

a meta-analysis of patient preferences found that individuals prefer psychological treatment to pharmacological treatment for depression [3x more likely to express a preference for psychological treatment]]

Question 36

what are the psychological therapies for depression

7

Answer 36

• Cognitive Behavioural Therapy
• Behavioural Activation
• Behavioural Couples Therapy
• Mindfulness-Based Cognitive Therapy (for recurrent depression in remission)
• Interpersonal Psychotherapy
• Counselling
• Short-term Psychodynamic Psychotherapy

Question 37

behavioural activation for depression

Answer 37

• focuses on activity scheduling to help people with depression to reengage with pleasurable and meaningful activities, so that they can be positively reinforced.
• Planned activities are timetabled to promise engagement and reduce behavioural and cognitive avoidance.
• Encouragement to introduce small changes and build up to long-term goals.

Question 38

evidence fro behavioural activation

Answer 38

Meta-analysis of 26 randomised controlled trials looking at the effectiveness of behavioural activation for depression.

Findings:

1. Behavioural activation found to be an effective intervention for depression
2. Behavioural activation found to be superior to controls and antidepressant medication.

BUT only short-term follow-ups and study quality was low

Question 39

Couples, family and systemic approaches to treatment

Answer 39

Based on the idea that problems occur within systems rather than within individuals.

Therapeutic approaches focus on relationship dynamics within a couple or family.

• Communication
• Closeness
• Conflict
• Functioning

Question 40

evidence for Couples, family and systemic approaches to treatment

Answer 40

• Couples therapy found to be as effective at reducing depressive symptomatology as CBT, with a recovery rate of 37% (though low sample size; Bodenmann et al., 2008
• A review of the evidence of family therapy for depression suggests that the findings are mixed. However, there is a moderate level of evidence that family therapy was more effective than no treatment/waiting list (Henken et al., 2007)

Question 41

CBT for depression

Answer 41

focus on working with the clients to identity and evaluate potentially unhelpful thoughts and beliefs

• keeping diaries of significant events associated with changes in mood, thoughts and behaviour
• testing out beliefs using ‘behavioural experiments’
• practicing more helpful, more realistic ways of thinking

Therapy may be quite brief (6-8 sessions) for mild-moderate problems, problems, longer longer (16-24 sessions) for more severe or complex difficulties

Question 42

evidence for CBT for depression

Answer 42

adults

• a review/meta-analysis of 34 RCTs found CBT had a significant effect on depressive symptoms for adults in primary care. CBT found to be more effective than controls [Santoft et al., 2019]

online CBT

• A review of 33 studies (29 RCTs) found online CBT to be effective in reducing depression scores. Effect sizes were comparable to treatment with standard psychological treatment and treatment with antidepressant medication (Saddichha et al., 2014).

children and adolescents

• Systematic review and meta-analysis of 31 studies found that CBT was effective at reducing depressive symptoms, both immediately at the end of treatment and at follow-up (ranging from 17-39 weeks). After receiving CBT, youth experiencing clinical depression had 36% more chance of recovery compared to control groups (Oud et al., 2019).

Question 43

evidence for CBT compared eith cognitive therapy, medication and placebo

Answer 43

De Rubeis et al., 2005

Compared cognitive therapy and antidepressant medication in the treatment of moderate-severe MDD.

240 participants randomly assigned to one of three groups:

1) Antidepressant medication (n = 120)

2) Cognitive therapy (n = 60)

3) Placebo (n = 60)

Response rates at 8 weeks

Medication: 50%

CT: 43%

Placebo: 25%

difference between CT and medication success response wasn’t significant

Response rates at 16 weeks

Medication: 58%

CT: 58%

Question 44

mindfulness-based cognitive therapy

Answer 44

• Mindfulness refers to the ability to have an awareness of thoughts, feelings, bodily sensations, while also being accepting and non-judgemental of these experiences (Bishop et al., 2004).
• The theory behind MBCT suggests that it is not the content of negative thoughts and beliefs that causes distress, but how individuals respond to these negative thoughts and beliefs.

Question 45

MBCT evidence

Answer 45

for the prevention of relapse

• A systematic review of six RCTs (n=593) found that MBCT reduced the risk of recurrence by 34% as compared to control groups (treatment as usual or placebo). For individuals with ≥3 previous episodes of depression, the risk was reduced by 43% (Piet & Hougaard, 2011)

for current depression

• A systematic review of 13 RCTs (n=1046) found that, at post treatment, MBCT was found to be as effective as other therapies (e.g. CBT) at reducing depressive symptoms and more effective than control conditions. Results at follow-up were less conclusive, but did suggest that MBCT was comparable to other therapies (Goldberg et al., 2019).