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Criteria for diagnosing depression (5/2-1N)
- At least 5 of the listed symptoms in the same 2 week period
- 1 symptom must be depressed mood/loss of interest
- or pleasure
- Noticeable change in functioning
Symptoms of depression:
- Weight loss/gain, or a decrease/increase in appetite.
- Insomnia/hypersomnia nearly every day.
- Psychomotor agitation (restlessness)
- Fatigue/loss of energy nearly every day.
- Feelings/worthlessness/excessive /inappropriate guilt nearly every day
- Diminished ability to think/concentrate, or indecisiveness
- Thoughts of death, recurrent suicidal ideation, suicide attempt or plan
- Depressed mood (or irritability in children /adolescence) most of the day, nearly every day.
- Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly everyday.
Restriction on diagnosing depression:
- The disturbance is not due to organic factors
- Or a normal reaction to death.
- Delusions or hallucinations for as long as two weeks in the absence of prominent mood symptoms.
Some organic factors which prevent a diagnosis of depression:
- Drug Abuse
- Drug side effects
- Neurological disorders (stroke or syphilis)
- Nutrition/vitamin B12 deficiency
3 characteristics of depression:
- (1) Alteration in mood
- (2) a cluster of signs and symptoms of alterations in biological functioning (sleep, appetite, psychomotor changes)
- (3) psychological changes in cognition, suicidal ideation, guilt, apathy and fatigue lasting two weeks+.
2 Categories in of Depression in the DSM 5:
- Major Depression- single episode
- Major Depression- Recurrent
Severity and other characteristics of the diagnosis:
- Severe- w/o or w/ psychotic features
- Partial Remission
- Full Remission
Major depression, recurrent
Is made if there have been two or more episodes of major depression
- Diagnosed if the client presents:
- Significant/ marked impairment in functioning
- Excessive symptoms
Do women or men present a greater lifetime risk for depression?
- Women: 10%-15%
- Men: 5%-12%
At what age is the first major depressive episode likely to occur before?
Before age 40, in half of all cases
What percentage of people had significant depressive symptoms before they were diagnosed?
How long does a untreated episode of depression typically last?
- 6-13 months
- Treated episodes: about 3 months
Why is it important for clients to stay on their meds, esp for the first 3 months?
Withdrawal of antidepressants sooner than three months will often lead to the re-emergence of depressive symptoms.
Is there a correlation between socioeconomic status and occurrence of depression?
Are major depression rates increasing in young people?
Some evidence suggests that the incidence of depressive illness is increasing among those 20 or younger
Who many people with depression think about suicide?
About 2/3 of all people suffering from depression contemplate suicide.
How many people with major depression commit suicide?
About 10-15% commit suicide
How many of those suffering from depression also suffer from anxiety?
What is the most common symptom reported by those suffering from depression?
- Almost all people suffering from depression report low energy.
- And, 80% complain of not being able to sleep.
Which demographic suffers the highest rates of depression compared to the general population?
- Older adults.
- Prevalence data suggest that anywhere between ¼ and ½ of older adults may suffer from depression.
- This population also has the highest rate of undetected and untreated depression.
What happens with depressive episodes as the disorder goes on?
- Episodes generally become more frequent and last longer
- Over a 20 year period, the mean number of episodes is 5 or 6.
How many patients with an initial dx of major depression go on to experience mania and thus get a bipolar dx?
About 5-10% of patients with an initial dx of major depressive disorder have a manic episode within 6 to 10 years after the first depressive episode.
Is depression chronic or benign?
- Major depressive disorder is not benign, but tends to be chronic with relapse, especially without treatment.
- Men are more likely than women to follow a chronic course.
What are the rates of recovery for hospitalized clients?
- If hospitalized for a first major episode have about a 50% chance of recovery in the first year.
- But, the percentage of patients recovering after hospitalization decreases over time
Relapse rates for depression
- 25% of patients released from the hospital relapse in the first six months
- 30-50% within the first two years
- 50-75% over five years.
- The incidence of relapse is lower in patients who continue with prophylactic psychopharmacological treatment.
Treatment refractory depression.
20% of people who suffer from depression do not respond to current treatment.
Positive prognostic indicators (MAS)
- Mild episodes
- Absence of psychotic symptoms
- Short hospital stay
Psychosocial indicators of a good prognosis (HSS)
- History of solid friendships
- Stable family functioning
- Generally sound social functioning for 5 years preceding illness
Other positive indicators of recovery for depression (ANA)
- Absence of co-morbidity,
- No more than one hospitalization
- Absence of personality disorders.
Negative predictors of recovery for depression (ADH):
- Anxiety disorder symptoms
- Drug and alcohol abuse
- History of more than one depressive episode
Biological Theories of Depression (GINN)
- Genetic causation
- Inherited general affective temperament + psychosocial factors
- Neurotransmitters deficiencies
- Neuroendocrine dysregulations
Support for genetic causes of depression (FTF):
- Major depression tends to run in families
- Twin and adoption studies provide scientific evidence.
- First-degree relatives of persons with major depression are 2 to 10 times more likely to develop depression
Support for neurotransmitter causes of depression
- The proof for this idea is that 60-70% of patients treated with anti-depressant medication get better.
- All of these medications affect several neurotransmitters at once.
behavioral theories of depression
- Learning theory
- Learned helplessness
Learning theory and depression
- Disruption of established patterns of behavior which result in loss of pleasurable reinforcement.
- Or people not learning behaviors which lead to pleasurable reinforcers.
Learned Helplessness and depression
- Suggests that depression occurs in response to situations the individual cannot control.
- An individual experiences very unpleasant feeling and expends energy developing behaviors that stall having to experience the painful feelings
Cognitive theories of depression
- Focus on distorted/maladaptive patterns of thinking.
- This thinking involves negative, catastrophic attributions and expectations
- Patterns are learned primarily from primary relationships.
Standard of care for people suffering from major depression is (CTM)
- Cognitive-behavioral or problem-solving intervention.
- Time-limited 12-16 weeks
- Medication if symptoms reach moderate or severe level
Medications for Treating Depression
- Medication is widely used to treat depression.
- SSRI medications are the most frequently used in the treatment of depression- Prozac 1988
- 10 or 20 mg capsules
- Typical starting dose is 20 mg in the morning with food
- Four weeks to reach its therapeutic level.
- Symptom relief can be seen in 1-3 weeks (evaluation of progress in 4-6 weeks)
- dosage can be moved up to as high as 60 or 80 mg if needed after 4-6 wks.
5 common effective SSRIs (CLPPZ)
- Prozac, and
- Newer anti-depressants
Other disorders treated by SNRIs and SSRIs (AT-OCD)
- Obsessive-compulsive disorders
When do to a suicide risk assessment
- Any report of depressive symptoms immediately gets a red flag to do a suicide assessment.
- Not assessing the risk of suicide can potentially be catastrophic.
Tips for interacting with suicidal clients
- Assume that a suicidal person contacting you has mixed feelings and is asking for your help
- Reach out and support that part of the person that wants life.
- Ask simple and direct questions.
- Do not judge or condemn.
- Determine whether they have worked out a specific plan.
- Determine how lethal the method of choice.
Questions to ask a suicidal person- Past history
- Have you attempted suicide in the past?
- What kind of help did you receive?
- Was it helpful?
How to asses individual and social factors influencing someone's motivation to commit suicide (WADRA)
- What has happened recently to get them to think of suicide?
- Ability to cope with stress
- Do they have anyone to rely on during a time of crisis?
- Role of alcohol and drugs in lessening control
- Ask if family is available and supportive