Depression corcoran 2013


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Depression corcoran 2013

  1. 1. Depressive Disorders Jacqueline Corcoran, Ph.D.
  2. 2. Types of Depression • Major depression • Persistent depressive disorder • Disruptive mood dysregulation disorder
  3. 3. Prevalence in Adult • 16.6% of the U.S. population (lifetime)
  4. 4. Co-Morbidity • three-fourths (72.1%) have other lifetime disorders • most common anxiety disorders (59.2%), also substance use disorders. • People who use alcohol to self-medicate may progress to dependence quicker (prevention implication)
  5. 5. Course • Variable depending on risk and protective factors present • 50% have recurrent episodes
  6. 6. Genetic – Environmental Risk • variance explaining the heritability for major depression is significant, in the range of 31% to 42% • serotonin transporter gene is the most studied • Stressful life events may also cause structural changes in brain
  7. 7. Delay in treatment •6-8 years
  8. 8. Suicide Risk • Suicidal or homicidal ideation with intent or plans • History and seriousness of previous attempts (a key factor) • Access to means for suicide and the lethality of those means • Psychotic symptoms • Severe anxiety • Substance use • Conduct problems • Family history of, or recent exposure to, suicide
  9. 9. Treatment • Psychotherapy • Natural treatments • Self-help treatments • Bibliotherapy • Medication
  10. 10. Medication • tricyclic antidepressants • most commonly prescribed antidepressants through the 1980s. • block the reuptake of norepinephrine and serotonin and, to a lesser extent, dopamine • Are as effective as SSRI’s but with more side effects • selective serotonin reuptake inhibitor (SSRI) drugs block serotonin but in general do not interfere with the normal actions of norepinephrine. • The dual serotonin and norepinephrine reuptake inhibitors (SNRIs) do not interfere with other chemicals that are affected by the cyclic antidepressants to cause adverse effects
  11. 11. Youth and Medication • significant improvement in depression compared to placebo but also 80% greater risk of a suicide event, which was defined as suicidal ideation or an attempt. • Prozac (fluoxetine) and Zoloft (sertraline) have shown sufficient efficacy for adolescents, but only Prozac has received sufficient support for children
  12. 12. Youth and Medication • teens need be seen more frequently in the first 3 months after a new prescription is issued • this recommendation is only met in about 30% of cases, and a greater proportion of teens (40%) are not seen even once during this time.
  13. 13. Adults • 50% achieve 50% reduction in symptoms • for adults (after young adulthood) and the elderly, the SSRIs reduce rather than increase risk of suicide
  14. 14. Medication and Psychotherapy • Medication may alter plasticity of brain, allowing psychotherapy to do its work
  15. 15. Critique Serotonin hypothesis critique: •
  16. 16. For more info: Corcoran, J., & Walsh, J. (2012 2nd ed.). Mental Health in Social Work: A Casebook on Diagnosis and Strengths-Based Assessment. Boston: Allyn & Bacon.