Treatment of Depression

Psychotherapy Treatment Interpersonal Therapy Cognitive-Behavioral Therapy

Interpersonal Therapy (IPT) short (16 sessions) addresses current rather than past problems addresses following interpersonal difficulties: role loss (grief and mourning) role disputes (incompatible expectations of partner) role transition (change of role) interpersonal deficits (skills education and training) one of most effective therapies for depression, especially mild-moderate symptoms (non-melancholic)

Treatment- Psychological Cognitive Behavioral Treatment (CBT) behavioral activation (make pleasurable behavioral changes) (running, going out with friends) recognize automatic thoughts and negative self-talk use hypothesis testing work on changing negative cognitive distortions develop positive coping styles

Biological Therapies

Antidepressants Tricyclics MAOIs block reuptake of serotonin, norepinephrine, dopamine probably also downregulate sensitivity of receptors especially effective on melancholic depression side effects: drowsiness, blurred vision, tachycardia, weight gain, dry mouth, orthostatic hypotension examples: imipramine (Tofranil) and amitriiptyline (Elavil) inhibit MAO (the enzyme that breaks down, SE, NE, DA more effective with atypical depression usually NOT first line of defense because of side effects (must eliminate tyramine from diet) side effects: chance of hypertension, heart problems examples: phenylzine (Nardil)

SSRIs Antidepressants inhibit reuptake of serotonin usually first drug of choice may have beneficial effects on comorbid disorders including OCD, eating disorders, anxiety disorders, panic disorder fewer side effects: drowsiness or insomnia, maybe weight loss or weight gain, sexual dysfunction less chance of overdose examples: fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil)

9 Treatment Guidelines mild-moderate symptom profile psychotherapy alone: CBT or IPT (may add SSRI) moderate-severe symptom profile (melancholic) SSRI plus psychotherapy ECT for nonresponders seasonal subtype bright light therapy may add SSRI plus psychotherapy

Conclusions depression appears to adhere to the diathesis/stress model, negative life events can trigger the disorder or act as underlying predisposition social, psychological, biological, and genetic factors can predispose a person to depression (causes may work in tandem and are not mutually exclusive) different types of depression may have different causes and respond to different treatments unlike anxiety disorders, combining pharmaceuticals and psychotherapy may enhance effectiveness in treating depression

Carson11 Can We Protect Ourselves from Depression?

Carson12 “Psychological Immunization:” Lessons from Risk-and-Resilience Research Protective Factors self-esteem self-esteem optimistic attitude optimistic attitude emotional regulation skills emotional regulation skills ability to tolerate frustration ability to tolerate frustration ability to self-soothe ability to self-soothe social support system social support system good social skills good social skills married* married* goals for the future goals for the future problem-focused coping style problem-focused coping style flexibility/openness/humor flexibility/openness/humor belong to religious group** belong to religious group**

Carson13 “Psychological Immunization” Against Depression Cognitive Skills Problem-Solving Skills realistic optimism self-acceptance and appreciation world view bigger than self Emotional Regulation Social Skills positive coping strategies stress management problem-solving goal setting making good choices reflective listening assertiveness empathy Self-Care Skills nutrition physical exercise rest moderation

There is evidence that depression is associated with biological changes in the brain, for instance dysregulation of neurochemicals. Do you think that depressed individuals who have committed violent crimes against others (case in point: Andrea Yates, the mother who drowned all five of her children while suffering from depression) should be held morally accountable for their actions? (Note that we will discuss their legal accountability in a future lecture) Question of the Week: Recommended of the Week: Girl, Interrupted starring Winona Ryder Angelina Jolie Brittany Murphy