Treatment of Depression

Psychotherapy Treatment

Interpersonal TherapyCognitive-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, especiallymild-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 includingOCD, eating disorders, anxiety disorders, panic disorder

• fewer side effects: drowsiness or insomnia, maybe weight lossor weight gain, sexual dysfunction

• less chance of overdose

• examples: fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil)

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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 canpredispose 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

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Can We Protect Ourselves from Depression?Can We Protect Ourselves from Depression?

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““Psychological Immunization:”Psychological Immunization:”Lessons from Risk-and-Resilience ResearchLessons from Risk-and-Resilience Research

Protective FactorsProtective Factors

• self-esteemself-esteem• optimistic attitudeoptimistic attitude• emotional regulation skillsemotional regulation skills

• ability to tolerate frustrationability to tolerate frustration• ability to self-sootheability to self-soothe

• social support systemsocial support system• good social skillsgood social skills

• married*married*• goals for the futuregoals for the future• problem-focused coping styleproblem-focused coping style• flexibility/openness/humorflexibility/openness/humor• belong to religious group**belong to religious group**

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“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 crimesagainst 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:

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