Depression II

Question 1

What do most theories about the development of depression involve?

Answer 1

Cognitive vulnerability x stressful life events = depression.

Question 2

In schema theory, life is constantly being interpreted through a negative lens. How does this support one of the main risk factors of Major Depression?

Answer 2

Constantly interpreting life in a negative way provides more and more evidence to support negative schema. Thus, a person is more likely to have a depressive relapse (% increase after each episode).

Question 3

Interpersonal relations are considered very important in the causation/maintenance of depression. What are some ways a person with depression might reduce contact from friends?

Answer 3

Having limited eye contact, lowered speech, lack of reaction/interest in other people. Regularly disclosing negative information, displaying negative facial expressions.

Question 4

How does Stress-Generation Hypothesis interpret the control people have over life events?

Answer 4

While there are some life events that are out of our control, there are many under our influence. Depressive people tend to generate more negative life events that are dependant on how they behave (job loss, relationship breakdown, etc.).

Question 5

Theories on the cause/maintenance of depression show that depression is insidious, whereby it ___ .

Answer 5

Maintains and exacerbates itself, each time becoming stronger and stronger.

Question 6

What was the first effective treatment for depression and when/what for was it introduced?

Answer 6

Electroconvulsive Therapy (ECT) was first introduced in 1938 to treat schizophrenia.

Question 7

How does ECT work? What is its course and how effective is it?

Answer 7

It works by applying a brief electrical current to the brain that induces a temporary seizure. After 6-10 treatments mood will normally lift. It is 85% effective for those with severe depression.

Question 8

Are there side effects for ECT? How often is it used and is it effective in the long-term (after the course is finished)?

Answer 8

The main side-effect is short term memory loss. It is only used sparingly, as a last resort for those with severe depression because we still don’t know how it works. Relapse after treatment is common.

Question 9

What treatment for Major Depression came after ECT? What do they have in common?

Answer 9

Three waves of drug treatments. They are equally effective and once stopped, relapse usually occurs within 6-8 months.

Question 10

What was the first wave of drug treatment? When was it introduced and what for?

Answer 10

Monoamine Oxidase Inhibitors (MAOIs) was introduced in 1956 to treat tuberculosis.

Question 11

What was the second wave of drug treatment? When was it introduced and what for?

Answer 11

Tricyclic Medications were introduced in the early 1960s to treat psychosis.

Question 12

What was the third wave of drug treatment? When was it introduced?

Answer 12

Selective Serotonin Reuptake Inhibitors (SSRIs) were first introduced in the 1980s.

Question 13

How do Monoamine Oxidase Inhibitors (MAOIs) work?

Answer 13

They break down/block Monoamine Oxidase A & B, increasing the availability of Serotonin and Norepinephrine.

Question 14

How do Tricyclic Medications work?

Answer 14

They block the reuptake of Serotonin and Norepinephrine.

Question 15

How do SSRIs work? What are two similar but alternative medications?

Answer 15

SSRIs block the reuptake of Serotonin, there are also SNRIs (Serotonin and Norepinephrine Reuptake Inhibitors) and NDRIs (Norepinephrine and Dopamine Reuptake Inhibitors).

Question 16

What are some serious side effects when prescribing MAOIs? What needs to be avoided when taking MAOIs?

Answer 16

Blocking MAO-A & -B cause serious side effects, such as hypertension, the patient must avoid Tyramine (beer, red wine, cheeses). Taking this medication increases the likelihood of death.

Question 17

What should be considered when prescribing MAOIs?

Answer 17

Only prescribing MAOIs that inhibit MAO-A, as inhibiting MAO-B is more risky.

Question 18

What are some minor side effects of Tricyclic Medications and what is a big risk that needs to be considered/monitored?

Answer 18

They are anti-cholinergic drugs so induce dry mouth, blurred vision, tremor, etc. Around the 10th-14th day, the risk of suicide increases, as the vegetative symptoms lift first but mood is still low.

Question 19

Tricyclic Medications are a type of drug that is risky when prescribing to depressed people, what kind of drug is that?

Answer 19

They are cardiotoxic, meaning they can be used for suicidal overdose.

Question 20

Although there are lots of negative effects with most anti-depressant drugs (particularly Tricyclic Medications and MAOIs) they are still widely used. Why is that?

Answer 20

Because sometimes they are the only drug that produces a positive response.

Question 21

SSRIs are the drug of choice at present - why is that?

Answer 21

They have the same efficacy but produce fewer side effects than other drugs.

Question 22

What are some of the side effects of SSRIs?

Answer 22

Insomnia, agitation, nausea, sexual dysfunction (inorgasmia).

Question 23

How long does it take for anti-depressant medications to kick in?

Answer 23

14-21 days.

Question 24

Which psychological treatment for depression has the most evidence for effectiveness? And how does it work?

Answer 24

Cognitive Behavioural Therapy (CBT). It addresses cognitive biases (but is not positive thinking) by creating more realistic/rational interpretations of events/the self/the world.

Question 25

What are two behavioural components of Cognitive Behavioural Therapy?

Answer 25

Behavioural Experiments - testing new hypotheses to prove that negative ideas are false.
Behavioural Activation - getting patient to revisit activities they used to love and then challenge negative thoughts about them.

Question 26

What are the outcomes of CBT? How does it compare with drug therapies?

Answer 26

The outcomes are comparable to drug therapies, however 6 to 24 months after stopping CBT or drugs, CBT has a lower relapse rate (29%) compared with medications (60%).

Question 27

Why does CBT have a lower relapse rate than drug therapies?

Answer 27

Because people learn how to stop negative thoughts when they begin to spiral out of control.

Question 28

What does Interpersonal Psychotherapy (IPT) focus on?

Answer 28

IPT deals with interpersonal styles of relating to others, helping people respond to interpersonal disputes in a healthy way.

Question 29

What was Mindfulness-based Cognitive Therapy (MBCT) specifically developed for?

Answer 29

The reduction of depressive relapse.

Question 30

After having 1 depressive episode, what percentage increase is there for another?
What about after 3 episodes?

Answer 30

1 episode = 50%.

3 episodes = 90%.

Question 31

How does Mindfulness-based Cognitive Therapy (MBCT) work?

Answer 31

MBCT works by teaching the patient the NOTICE the arrival of negative thoughts but keep a DISTANCE from them.

Question 32

What does Mindfulness-based Cognitive Therapy (MBCT) reduce (1) and increase (2)?

Answer 32

MBCT reduces rumination, increases self-compassion and the meta-awareness of thoughts.

Question 33

What are the rates of depression in:
Pre-schoolers?
School-age children?
Adolescence (14-18)?

Answer 33

Pre-schoolers: less than 1%.
School-age children: 2-3%.
Adolescence (14-18): 15-30%

Question 34

When does the gender difference in depression diagnosis emerge?

Answer 34

Early-to-middle-adolescence.

Question 35

Why does depression rise so much in adolescence? Which models of depression help explain the phenomena?

Answer 35

The Cognitive Diathesis-Stress Models all indicate that the rise in depression during adolescence is due to a vulnerability to stress, combined with stressful life events.

Question 36

The Cognitive Diathesis-Stress Models are very applicable to depression in adolescent years, why is that? (2 reasons)

Answer 36

Because it is during adolescence that:

1. Cognitive styles are consolidated.
2. There is an increase in stressful events.

Question 37

Major Depression is much more common in young women, what are some variables that might widen the 2:1 ratio? (3)

Answer 37

1. Women report depression more than men.
2. Men tend to self-medicate more with drugs/alcohol.
3. Hormonal differences affect women more.

Question 38

Give 3 environmental factors why young women are more likely to be diagnosed with Major Depression.

Answer 38

• More likely to be victims of sexual abuse.
• More body image concerns (80%).
• More interpersonal negative events + vicarious stress in social network.

Question 39

Give 2 psychological factors why young women are more likely to be diagnosed with Major Depression.

Answer 39

• Higher negative cognitive styles in women (negative interpretations).
• Different coping responses to stress (rumination vs. distraction).

Question 40

In puberty, young women (80%) tend to have more body image concerns than young men, why is that?

Answer 40

Societal expectations goes against the changes women experience during puberty (more body fat/hair, etc.). Whereas societal expectations for men is in accordance with pubescent body changes (taller, more muscular, etc.)

Question 41

What is the model of causation in preadolescent depression? Why is this different to other ages of depression?

Answer 41

Preadolescence depression is not about cognitive style x negative life events = depression.
It is the experience of negative life events that causes negative cognition, which leads to depression.

Question 42

How is the mental health of a child effected when their parent is depressed?

Answer 42

The children of depressed parents are 4-5x more likely to develop depression themselves.

Question 43

Why are children with depressed parents more likely to develop their own depression? (3)

Answer 43

• Children will model their parents depressed behaviours.
• Experience non-contingent responsiveness.
• Depressed parents tend to be more severe/critical on the child.

Question 44

What is non-contingent responsiveness?

Answer 44

It is when a depressed parent fails to consistently respond to their child’s needs. They only respond when they feel they can.

Question 45

In the past, how were depressed children treated? Why has it changed?

Answer 45

Depressed children were treated heavily with medications (mainly SSRIs). This stopped in the mid-2000s as it was understood that anti-depressants are less effective for children and have serious side effects (increase in suicide ideation/attempts).

Question 46

What are the current Australian Guidelines for treated children with anti-depressant medications?

Answer 46

Only Fluoxetine to be used for those with moderate/severe MDD, when therapy has been ineffective.
Must be closely monitored and used in an ongoing management plan.

Question 47

What is the best approach for treating childhood depression? And what two elements does it entail?

Answer 47

Prevention utilising psychoeducation and CBT.

Question 48

What are three methods for helping prevent childhood depression?

Answer 48

1. Universal prevention: educate all children in schools.
2. Indicated prevention: aimed at children with high scores on symptom scales.
3. Selective prevention: target ‘high risk’ groups (e.g. children of depressed parents).

Question 49

Are the programs aimed at preventing childhood depression effective? Give detail.

Answer 49

They are helpful in the short-term, but effects tend to dissipate after 4 months.
Booster sessions can result in effectiveness for up to 6 years.