depression Flashcards
how many adults experinece depression during their lifetime according to the NCCMH 2010
1 in 10
how many people live with depression globally [WHO,2017]
320 mil
who have a higher lifetime risk for depression [DSM-IV-TR]
women [10-25%] but for men it’s 5-12%
4 risk factors of depression
- hereditary factors
- adverse childhood experiences factors
- sociodemographic factors
- physical disease factor
adverse childhood experinec factors
factors in depression
e.g neglect
sociodemographic factoers
factors in depression
eg gender, economic and educational disadvantage, low levels of close social support
physica; disease factor
factors in depression
associations between physical illness and depression: effects of chronicity and length of illness
DSM-V classification of depression
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.
symptoms of depression according to the DMV-5
- 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
course of depression
- 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]
what is the BioPsychoSocial model
- 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]
social/enviromental factors regarding depression
studies
- 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).
protective factors regarding social/enviro factors in depression
secure parenting, high quality social relationships, engaging in meaningful activities.
the 3 bio theories
- genetic factors
- structural and functional bran differences
- neurochemical factors
genetic factors in depression
- 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)
study regarding Structural and functional differences in brain of non-depressed and depressed participants
- 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).
neurochemical factors regarding depression
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]
what are schemas
- 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.
beck’s negative triad
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]
what is the cognitive model of depression
- early experinces
- core beliefs, attitudes, assumptions [negative cognitive traid]
- triggering event
then leads to endless cycle of thoughts -> feelings -> behaviour -> body sensatiosn
supporting evidence for beck
- 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).
what do behavioural theories suggest
Propose that depression results from a lack of positive reinforcement from pleasurable or meaningful activities (Lewinsohn, 1974)
what do systemic theories suggest
- Suggest that individuals’ experiences cannot be understood in isolation.
- View depression as a problem within the wider family/interpersonal system (Dallos&Draper, 2010).
3 types of interventions for depression
- medication
- physical exercise
- psychological therapies and self-help interventions
exercise intervention for depression
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)
why are exercise interventions effective for depression ?
4 listed
- endorphin hypothesis
- monoaime hypothesis
- distraction hypothesis
- self-efficacy hypothesis
what is the endorphin hypothesis
effectiveness of exercise interventions for depression
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
what is the monoaime hypothesis
effectiveness of exercise interventions for depression
exercise leads to an increase in the availability of serotonin, dopamine, and norepinephrine
But there is limited empirical evidence to support these theories
what is the distraction hypothesis
effectiveness of exercise interventions for depression
exercise serves as a way to distract from worries and neg. thoughts
But there is limited empirical evidence to support these theories
what is the self-efficacy hypothesis
effectiveness of exercise interventions for depression
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
medication for treating depression
- 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]
SSRI’s
- 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.
SNRI’s
SNRI’s inhibit the reuptake of serotonin and noradrenaline
stats regarding use of medication for depression
- 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]
patient preference regarding medication for depression
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]]
what are the psychological therapies for depression
7
- Cognitive Behavioural Therapy
- Behavioural Activation
- Behavioural Couples Therapy
- Mindfulness-Based Cognitive Therapy (for recurrent depression in remission)
- Interpersonal Psychotherapy
- Counselling
- Short-term Psychodynamic Psychotherapy
behavioural activation for depression
- 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.
evidence fro behavioural activation
Meta-analysis of 26 randomised controlled trials looking at the effectiveness of behavioural activation for depression.
Findings:
- Behavioural activation found to be an effective intervention for depression
- Behavioural activation found to be superior to controls and antidepressant medication.
BUT only short-term follow-ups and study quality was low
Couples, family and systemic approaches to treatment
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
evidence for Couples, family and systemic approaches to treatment
- 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)
CBT for depression
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
evidence for CBT for depression
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).
evidence for CBT compared eith cognitive therapy, medication and placebo
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%
mindfulness-based cognitive therapy
- 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.
MBCT evidence
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).
