Lecture 10: Depression

Question 1

Depression prevalence and impact

Answer 1

• Depression 12-month prevalence is about 6% of population
• Mood disorders (including depression) have a lifetime prevalence rate of 20% in NZ
• Rates higher than women
• Greater prevalence in industrialised countries than in developing countries
• Can occur at any age - but median is 30

Question 2

Impacts of depression

Answer 2

• Depression is leading cause of disability worldwide and is a major contributor to overall global burden of disease
• > 300 million people of all ages suffer from depression

Question 3

Major Depressive Disorder

Answer 3

DSM-5 diagnosis:
- Five or more following symptoms have been present during some 2 week period and represent a change from previous functioning:
= Depressed mood*
= Diminished interest or pleasure in all or almost all activities*
= Significant weight loss or reduction in appetite
= Insomenia or hypersomnia
= Psychomotor agitation or retardation
= Fatigue or loss of energy
= Feelings of worthlessness or guilt (feeling of regreat)
= Diminished ability to think, concentrate, indecisiveness
= Recurrent thoughts of death, suicidal ideation
* Must have one of other of these
- Children may have irritable rather than depressed mood

Question 4

Persistent Depressive Disorder (Dysthymic Disorder)

Answer 4

DSM-5 diagnosis:
- Depressed mood for most of day or for more days than not for at least 2 years (or 1 year for children)
- Plus 2 (or more ) of following symptoms:
= poor appetite or overeating
= Insomnia or hypersomnia
= Low energy or fatigue
= Low self-esteem
= Poor concentration/difficulties making decisions
= Feelings of hopelessness

Question 5

Why are rates increasing?

Answer 5

• There is less stigma associated with acknowledging depression
• Modern life is more stressful
• We have reinterpreted ordinary sadness as depression

Question 6

Biological explanations/aetiology

Answer 6

• Genetic: family history 2-3 times more likely to experience depression
• Neuro-chemical explanations suggest lack of monoamines responsible for depression
  = but simple serotonin hypothesis has been largely debated
• Is depression a response to chemical imbalance or life events?
• Serotonin transporter gene not linked to depression
• Stressful life events alone predict likelihood of depression

Question 7

Biological Intervention

Answer 7

• Anti-depressants prescribed to 1 in 9 in NZ adults (1 in 7 women)
• Tri-cyclic anti-depressants and more recent ‘Prozac’ - Selective Serotonin Reuptake Inhibitors and now ‘dual action’ anti-depressants Serotonin and Norepinephrine reuptake inhibitors
• Some claim are no more effective than placebos - except for severe depression = other disagree

Question 8

Study of 1829 NZ antidepressant users: (Read et al., 2014)

Answer 8

• 62% reported sexual difficulties
• 60% reported feeling ‘numb’
• 52% feeling ‘not like myself’
• 39% feelings of suicidality
• 42% reported reduction in positive feelings
• 55% reported withdrawal effects
  Positive experiences (54%)
  Negative (16%)
  Mixed (28%)

Question 9

Psychodynamic explanations

Answer 9

• Early experience of loss, rejection by caregiver
• Ambivalent feelings towards caregiver
• Negative feelings conflict with need for care and love
• Anger turned inward (defence mechanism of introjection)
• Leads to self hatred

Question 10

Psychodynamic intervention

Answer 10

• Explore early experiences
• Help client to identify habitual defences
• Develop insight
• Has a broader focus than just symptoms of depression - looks at quality of relationships etc.

Question 11

Humanistic (client-centred) explanations

Answer 11

• Limited experience of UPR
• Lacked the env. needed to develop awareness of organismic (real) self
• Discrepancy between real and ideal self

Question 12

Humanistic interventions

Answer 12

• Provide a facilitating env. with empathy, UPR, genuineness
• Allows client to explore their own feelings without judgement
• Provides opportunity for them to discover who they are and what they need
• Tends not to be focused specifically on depression but rather dev. of an authentic, self actualised client

Question 13

Behavioural explanations

Answer 13

• Seligman: Learned helplessness - repeated experience of lack of control over aversive stimulus produces helpless response
• Treatments aimed at shifting inactive behavioural patterns combined with CBT

Question 14

Behavioural interventions

Answer 14

• Pleasant Activity scheduling

- Mood activity schedule to identify depression lifting activities (score depression on 0-100%)

Question 15

Cognitive explanations

Answer 15

• Beck negative cognitive triad = negative beliefs about self, others, world

Question 16

Cognitive interpretations

Answer 16

Challenging negative beliefs

• Use thought records to challenge negative beliefs
• Keep a record of depressed thoughts and associated events
• Monitor associated feelings and behaviours
• Challenge depressed thoughts through socratic questioning or experiment
• Replace with rational/helpful thoughts

Question 17

Family therapy explanations

Answer 17

• Individual psychological problems seen as a function of family difficulties
• Focus on problems in family structure, roles, communication etc.

Question 18

Family therapy interventions

Answer 18

• Family therapy for family with child suffering from depression
• Couple therapy for relationship problems resulting in depression for one or
  both partners
• Mother-infant therapy to improve attachment

Question 19

ACT explanations

Answer 19

• Depression involves fusing with thoughts about the past and worries about the future and ruminating on these

Question 20

ACT interventions

Answer 20

• Notice thoughts.
• Use mindfulness to defuse
  from thoughts and bring self back to
  present.
• Increase self compassion and acceptance

Question 21

Maori model explanations

Answer 21

• Effects of colonisation, historical trauma

- Loss of connection to culture, iwi and whenua (land)

Question 22

Maori model interventions

Answer 22

• Reconnection with culture.

- Adaptations of other models to be suitable for Maori

Question 23

Suicide statistics

Answer 23

• New Zealand has the highest rate of male youth suicide and third highest rate of female youth suicide amongst 27 high income
  countries (Patton, 2012)
• Suicide is one of the leading causes of death for young people under the age of 25 in NZ
• Gender paradox: Women are more likely to attempt suicide than men, men are more likely to complete
• Study of reasons New Zealand youth give for suicide inescapable difficulties, constant pressure, emotional distress, a cry for help

Question 24

Suicide risk assessment

Answer 24

• An important consideration in the treatment of depressive disorders
• Some issues to consider in a suicide risk assessment:
  = Mental health problem (especially mood disorders)
  = Active or passive intention
  = Chosen method
  = Access to method
  = Previous history
  = Alcohol or drug use

Question 25

What to do if you think someone is

suicidal

Answer 25

• Take them seriously
• Listen to them without judging
• Do not leave them alone
• Do not agree to secrecy
• Speak with a responsible adult/professional
• Call 111 if you think there is immediate risk
• Phone or take them to your local hospital
• Youthline
• Lifeline