This document summarizes information about depressive disorders including types of depression, prevalence, comorbidity with other disorders, course, genetic and environmental risk factors, delay in treatment, suicide risk factors, and treatment options. It discusses that major depression affects 16.6% of Americans in their lifetime. Treatment includes psychotherapy, natural remedies, self-help, and medication. Medications discussed are SSRIs, SNRIs, and older tricyclic antidepressants. Risks and benefits of antidepressant medication are described for both youths and adults.

1. Depressive Disorders
Jacqueline Corcoran, Ph.D.

2. Types of Depression
• Major depression
• Persistent depressive
disorder
• Disruptive mood
dysregulation
disorder

3. Prevalence in Adult
• 16.6% of the U.S. population (lifetime)

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. Course
• Variable depending on risk
and protective factors
present
• 50% have recurrent episodes

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. Delay in treatment
•6-8 years

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. Treatment
• Psychotherapy
• Natural treatments
• Self-help treatments
• Bibliotherapy
• Medication

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. 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. 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. 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. Medication and Psychotherapy
• Medication may alter plasticity of brain,
allowing psychotherapy to do its work

15. Critique
Serotonin hypothesis critique:
•http://www.youtube.com/watch?v=obJjrP5wtRM

16. For more info:
http://www.jacquelinecorcoran.com/
Corcoran, J., & Walsh, J. (2012 2nd
ed.). Mental
Health in Social Work: A Casebook on Diagnosis
and Strengths-Based Assessment. Boston: Allyn
& Bacon.