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.