 List TEN goals that you have.  Complete TEN sentences starting with “I am….” DO NOW!

{ Affective Disorders DEPRESSION

Symptomology

 Client must present one A list symptom and at least 4 others:  A LIST SYMPTOMS:  Depressed mood  Loss of interest in activities that used to be enjoyed  B LIST SYMPTOMS:  Insomnia/hypersomnia  Appetite change  Loss of energy  Feeling worthless  Difficulty concentrating  Suicidal thoughts Symptomology

 Major Depressive Disorder  what we normally think of!  Dystemia  ‘lite’ depression  Seasonal Affective Disorder (S.A.D.)  winter =   Bipolar Disorder-  ½ depression, ½ mania.. Different types! TYPES

 AT RISK POPULATIONS  2-3x more common in women  15% of the population is depressed at one point in their lifetime  Higher in lower economic bracket  Higher in Jewish males (= to women)  17 million Americans a year  PROGNOSIS  Reccurent in 80% of those who experience at least one depressive episode  Average of 4 episodes Prevalance Rates

 Role of Genetics  Moffit (2006): followed NZ subjects from Recorded life stressors. Looked at LONG vs SHORT serotonin transporter gene (5-HTT)  Depression after 4+ stressful experiences in 5 years:  33% with short gene depressed  17% with long gene depressed  So… Long gene works BETTER!  Role of Neurotransmitters  ↓ serotonin = ↑ chance of depression  Role of Hormones  Diathesis Stress Model  Stress releases the hormone CORTISOL, which is linked with depression  Vulnerability (genes, prenatal effects) + STRESS = ↑ chance of depression Biological Etiology (Cause)

 Role of Cognitions  Thoughts of hopelessness, pessimistic thinking, low self esteem.  Depresses cognitions, cognitive distortions, and irrational beliefs produce disturbances in mood.  Alloy (1999)   Followed Americans in their twenties. Thinking style was tested and students were placed into positive or negative thinking groups   After 6 years, only 1% of those in the positive thinking group had developed depression, 17% of the negative thinking group Cognitive Etiology

ThoughtsActionsFeelings

 Role of Culture  Individualistic Cultures: value the individual over the group  Symptoms: sad, hopeless, worthless, loss of interest  Collectivist Cultures: value the group/whole over the individual  Symptoms: headache, tired, stomachache, backache Sociocultural Etiology

Drug Therapy  Types of medication  Mood stabilizers- help even out highs/lows  Antidepressants- help lift the symptoms of depression  Antipsychotics- primarily treat symptoms of mania  Thase (2003)  Meta-analysis of 7 clinical trials looking at remission of depression rates  SSRIs (Prozac) = 35%  SNRI (Effexor) = 45%  Placebo = 25%  Significance: placebo effect almost as effective! We haven’t perfected antidepressants….  Treatment Options: Biological!

 Electroconvulsive Therapy (ECT)  Applies a small amount of electrical current to the brain  Causes mild seizures, which changes brain chemistry  Effective in treating SEVERE depression  Controversial!!  Side effects- confusion and memory loss Treatment Options: Biological!

Cognitive Behavioral Therapy (CBT)  Combines cognitive and behavioral therapy  Goal: change the automatic thoughts that contribute to negative emotions  Cognitive Therapy:  Focuses on how thought affect emotions and behaviors  Behavioral Therapy:  Concentrates on changing a person’s reaction to challenging situations  Hollon (2005)  Patients relapsed when stopped meds = 76%  Patients relapsed when given CBT = 31%  Significance:  CBT helps people learn to COPE  Medicine covers symptoms, doesn’t cure/treat the CAUSE. Treatment Options: Cognitive!