Depression is a widespread and serious disorder that affects over 340 million people worldwide. It is the leading cause of disability in the United States. While medication and cognitive behavioral therapy are both empirically supported treatments for depression, CBT has been shown to have advantages over medication in long-term outcomes, with lower relapse rates in the 1-6 year range following treatment. Additionally, CBT has lower dropout rates compared to medication treatment and does not carry the risk of side effects that many antidepressant medications do. However, in reality, most depressed individuals in the U.S. receive either no treatment or medication treatment alone.

1. Depression:
What to do if it Strikes You
Diane Spangler, Ph.D.
Department of Psychology

2. Depression is a Serious, Widespread Disorder
• Approximately 16% of persons will experience
major depression during their lifetime
• 340 million persons worldwide currently meet
criteria for clinical, unipolar depression
• Depression is ranked as the 4th highest public
health concern by the World Health
Organization. It is expected to be ranked 2nd
by 2010.
• Depression is the leading cause of disability in
the United States.

3. Depression is Recurrent
• If untreated, 85% of persons who have
one episode of depression will have
another episode within 10 years
• Median number of depressive episodes
per person is 4
• 25% have 6 or more episodes

4. Recognizing Depression
Adult Child
• Sad mood • Irritability
• Loss of interest/pleasure • Facial expression
• Appetite changes • Decreased play
• Sleep changes • Decreased sociability
• Fatigue • Lethargy
• Worthlessness • Low self-esteem
• Concentration diminished • Accident proneness
• Indecision • Attachment problems/
• Helplessness separation
• Hopelessness
• Withdrawal
• Suicidal thoughts

5. What to do if it strikes you?
Seek Treatment!
But not just any treatment

6. Empirically Supported Treatments
• Medication* (Anti-depressants)
– Neurochemical change
• Cognitive-Behavioral Therapy* (CBT)
– Cognitive change
– Behavioral change
• Interpersonal Psychotherapy (IPT)
– Relationship change

7. Response: Post-treatment
• Findings from single studies comparing the
short-term efficacy of CBT and MEDS are
mixed
• Some studies show CBT and MEDS to be
similar in outcome at post-treatment. Some
show CBT superior to MEDS.
• The most recent and well-done meta-
analyses find that CBT is more effective than
MEDS in acute outcome (Beck & Butler, 2001;
Gloaguen et al., 1998)

8. Response: Long-term
• CBT shows clear advantages in long-
term outcome over medication
• Following CBT treatment, likelihood of
relapse and recurrence is significantly
reduced

9. CBT vs. MED: Long-term Outcome
90
80
70
% DEPRESSED
60
50
CBT
40
MED
30
20
10
0
1 YEAR 2 YEARS 6 YEARS

10. Additional Considerations
• Efficacy: Short and Long-term
• Drop-out rates:
– MEDS (40%)
– CBT (10%)
• Side Effects
– Side effects for meds are common
• Weight gain, loss of libido, sleep disruptions, dizziness, nausea,
constipation, blurred vision, fatigue, agitation
– Some side effects mimic/worsen depressive symptoms
– Some AD meds are lethal in overdose & used to commit
suicide by depressed persons
– AD meds are the most common agent used in suicide by
poisoning
– AD meds linked to serious health problems (cardiovascular
disease; breast cancer; sudden death in children)
• AD meds are not recommended for women who are trying to
become pregnant, currently pregnant or nursing

11. Additional Considerations
• Combination Treatment
• Subtypes of Depression
• Availability/Access to Treatment
– For a list of certified cognitive therapists go to:
www.academyofct.org
• Cost
– Time/Effort to Administer
– Length of Treatment Regimen
– Insurance Coverage

12. What Actually Happens in the Real World?
• 50% of depressed persons in the U.S.
receive no treatment at all
• Of those who seek treatment, the
majority receive medication only

13. Self-Care for Depression
• Stay Engaged Behaviorally
– Exercise
– Social contact/support
– Hobbies/Interests
– Sleep
– Novelty

14. Self-Care for Depression
• Decenter from depressive rumination
– Thought restructuring
• Feeling Good by David Burns
– Mindfulness
• The Mindful Way Through Depression by Mark
Williams et al.

15. “An opportunity to change my life”