Where do depressed people go first? Katon and Walker 1998
Where do depressed people go first? Katon and Walker 1998
41 % initially go to physician with complaints of feeling ill
37 % report pain, 12 % report general fatigue and tiredness
Treatments for Unipolar Depression
Only about 40 % of people with mood disorders receive minimally adequate care
In one study of the depressed poor, only 2/3 said that they had ever received the diagnosis (Bazargan et al 2005)
Second most prescribed class of meds (behind blood pressure)
Second most prescribed class of meds (behind blood pressure)
3 of the 12 most prescribed meds are antidepressants (Gitlin, 2002)
74 % of those who are depressed take meds alone or with therapy. In 1990, that was 37 % . Today 60 % receive therapy. In 1990, that was 71 % (Boyles, 2002).
Will meds help us all?
Knutson et al 1998—Gave nondepressed volunteers antidepressants—noted improvements in negative symptoms like hostility and fear, but did not increase positive feelings like happiness and excitement
First class—MAOIs—developed in 1950s
Monamine oxidase inhibitors—Parnate, Marplan—dev. as tx for TB, but people became less depressed
Fewer serious side effects but—drowsiness, dry mouth, constipation, decreased sex drive, nausea, tremors, blurred vision, can occas. stimulate mania, increase effects of both when taken with alcohol, fatal in overdose
ECT—severely depressed at imminent risk; 6-12 sessions every other day, varying levels of amnesia persist; can be useful in the elderly. Effective for 50-80 % who do not respond to meds
ECT—severely depressed at imminent risk; 6-12 sessions every other day, varying levels of amnesia persist; can be useful in the elderly. Effective for 50-80 % who do not respond to meds
Bright light therapy—originally just for SAD, but may help with other types of depression
Transcranial magnetic stimulation—brief, intensive pulsating magnetic transmissions
Noninvasive, done in awake patients
May be more effective than antidepressants without side effects of ECT
Cognitive-behavioral and behavioral activation therapy
Focuses on here and now problems
Teaches people how to evaluate their beliefs and automatic thoughts
Equally or more effective than antidepressants
More effective at preventing relapse
Modified CBT may work for bipolar
Interpersonal therapy
Not as extensively studied or used
Also effective
Focuses on current relationship issues, trying to help person understand and change maladaptive interaction patterns
Modified for bipolar to stabilize daily life
Family and marital therapy
Unipolar—focus on reducing marital discord is effective
Bipolar—focus on reducing ee and increasing coping effective in preventing relapse
Cognitive, interpersonal and biological are all effective.
Cognitive, interpersonal and biological are all effective.
Elkin et al 1994, 1989—compared the three with a placebo. Among those who completed tx, sx were almost completely eliminated, compared with 29 % of those on placebo. Drug therapy was faster, but may not prevent relapse as well.
Cognitive and interpersonal are not relapse-proof. As many as 30 % of those who respond to these methods may relapse. Continuation or maintenance approaches may help.
Behavior therapy alone is not as effective as the other types of tx.
Psychodynamic tx is also less effective.
Combo of meds and therapy is modestly more effective.
ECT acts more quickly than meds, but is equally effective.
Myths about suicide
Myths about suicide
People who discuss suicide won’t do it
Suicide is committed without warning
Only people of a certain class commit suicide
Religion prevents suicide (devoutness may, though)
