Depression corcoran 2013
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Transcript of Depression corcoran 2013
Depressive DisordersJacqueline Corcoran, Ph.D.
Types of Depression
• Major depression • Persistent
depressive disorder • Disruptive mood
dysregulation disorder
Prevalence in Adult
• 16.6% of the U.S. population (lifetime)
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)
Course
• Variable depending on risk and protective factors present• 50% have recurrent episodes
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
Delay in treatment
•6-8 years
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
Treatment
• Psychotherapy• Natural treatments• Self-help treatments• Bibliotherapy• Medication
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
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
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.
Adults
• 50% achieve 50% reduction in symptoms
• for adults (after young adulthood) and the elderly, the SSRIs reduce rather than increase risk of suicide
Medication and Psychotherapy
• Medication may alter plasticity of brain, allowing psychotherapy to do its work
Critique
Serotonin hypothesis critique:
•http://www.youtube.com/watch?v=obJjrP5wtRM
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.