Lecture 7 Depression Treatment

Question 1

Only effective treatment of MD prior to 1950

Answer 1

Electroconvulsive Therapy

Question 2

Procedure of ECT

Answer 2

• apply brief electrical current to brain
• results in temporary seizures
• a course of 6-10 treatments administered

Question 3

Pros and cons of ECT

Answer 3

Pros:

• effective for severe depression (85%+)
• still used in people not responsive to other treatments
• few side effects

Cons:

• relapse common
• STM loss
• uncertain why/how ECT works

Question 4

1st wave of drugs

Answer 4

Monoamine Oxidase Inhibitors (MAOIs)

introduced in 1956 (iproniazide)

14-21 days to effect

MAO breaks down serotonin/norepinephrine, MAO inhibitors block MAO A and B

Question 5

side effect of MAOIs

Answer 5

hypertension -> stroke if not on strict diet

Must avoid Tyramine (beer, red wine, cheeses)

Ideally should inhibit MAO-A only

still used: Parnate (tranylcypromine), Nardil (phenelzine)

Question 6

2nd wave of drugs

Answer 6

Tricyclic medications

introduced in 1960s (imipramine) for psychosis

14-21 days to effect

block presynaptic reuptake of serotonin and norepinephrine

still widely used

Question 7

side effects of tricyclic medications

Answer 7

Vegetative symptoms lift first: increased suicide risk between 10th-14th day

negative side effects: dry mouth, blurred vision, tremor, emotional blunting, drowsiness, anxiety, confusion, restlessness, dizziness, muscle twitches, weakness, nausea, vomiting, constipation, memory

cardiotoxicity

Question 8

3rd wave of drugs

Answer 8

selective serotonin reuptake inhibitors (SSRIs)

introduced in 1980s (prozac)

all waves of drugs are equally effective, only difference is side effects

more specifically block reuptake of serotonin, only act on serotonin so less side effects

drugs of choice at present

Question 9

side effects of SSRIs

Answer 9

fewer and less serious

insomnia, agitation, nausea, sexual dysfunction

Question 10

other 3rd wave drugs

Answer 10

serotonin and norepinephrine reuptake inhibitors (SNRIs)

norepinephrine and dopamine reuptake inhibitors (NDRIs)

Question 11

Cognitive Behavioural Therapy

Answer 11

addresses cognitive biases in thinking (NOT positive thinking)

behavioral components: behavioral activation, behavioural experiments

outcomes comparable to drug therapy, lower relapse rates vs drug treatment alone (29 vs 60%)

Question 12

Interpersonal Psychotherapy (IPT)

Answer 12

not dealing with depression, dealing with interpersonal world
target beginning / exacerbation of depression: Interpersonal/role disputes
Role transitions
Interpersonal deficits

Question 13

Mindfulness-based cognitive therapy (MBCT)

Answer 13

specifically developed to reduce relapse (after 1 episode 50%, 3 episodes 90%)

as effective as prophylactic treatment with maintenance antidepressant medication

notice and distance from mild depressive thoughts (easier and easier to trigger depression)

mechanism: reduces rumination (my thoughts are simply symptoms, divert attention to something else), increases self compassion, increases meta-awareness

Question 14

prevelance of depression in children

Answer 14

<1% preschool

2-3% school-age

15-30% adolescence (14-18)

risk rises greatly in late adolescence

Question 15

gender difference in depression

Answer 15

female:male 2:1

dramatic difference emerge during early-to-mid adolescence

Question 16

cognitive diathesis-stress model

Answer 16

Beck: negative schema

Seligman: helplessness, negative attributions

Cognitive style + negative events -> depression

predict depression from 12-14 years

Question 17

critical time for major depression

Answer 17

mid adolescence because:

negative cognitive styles consolidated

increased stress during adolescence

Question 18

why increase especially in females

Answer 18

possible: reporting difference, self-medication in males, hormonal difference

higher stress exposure:

• sexual victimisation (16-19 peak age of rape)
• body image concerns (80% girls)
• interpersonal negative events
• vicarious stress in social network

higher negative cognitive style

different coping responses to stress
-rumination vs distraction/problem-solving

Question 19

causes of depression in preadolescents

Answer 19

negative cognitive styles in children

negative events -> cognitive style -> depression

role of depressed parent: model depressive behaviour, non-contingent responsiveness (most important risk factor, 4-5 times more risk)

emotional abuse, neglect

Question 20

medication treatment for preadolescence depression

Answer 20

TGA: no SSRIs or antidepressants currently approved in Australia for treatment in children/adolescence

fluoxetine and escitalopram approved by FDA in USA

Australia guidelines:

• fluoxetine only in moderate/severe MDD
• when psychological therapy not effective
• must occur in context of ongoing management plan: close monitoring of symptom severity and adverse effects + protocol in place for managing suicidal thinking

Question 21

treatment for preadolescent

Answer 21

CBT derived from adult approaches

prevention:
-psychoeducation and CBT
-universal prevention: given to all students
-indicated prevention: aimed at children or adolescents with high scores on symptom scales
-selective prevention: target high risk groups
e.g.children of depressed parents
programme effective on ST, but effect dissipate after 4 months
booster sessions result in higher LT effectiveness