Week 9: Treatment of Depression 1 Flashcards Preview

PSYC 412 > Week 9: Treatment of Depression 1 > Flashcards

Flashcards in Week 9: Treatment of Depression 1 Deck (22)
Loading flashcards...
1
Q

CBT Model of Depression

Underlying diathesis-stress model

Cognitive processes to target

Behavioral processes to target

A

Underlying diathesis-stress model

  • Personal diatheses interact with stressful life events to disrupt normal mood
  • Depression maintained by negative cognitive and behavioral processes

Cognitive processes to target
-Depressogenic thinking

Behavioral processes to target

  • Low reinforcement and negative life events
  • Skill deficit
2
Q

Emotional Spirals

A

Depression may begin,
or deepen, as part of a
DOWNWARD
EMOTIONAL SPIRAL

Negative events may 
breed negative moods… 
negative moods, negative 
behaviors … and negative 
behaviors, may produce 
negative thoughts and 
expectations for the future
But, moods do not have 
to just go down. We 
also experience 
UPWARD EMOTIONAL 
SPIRALS.

Positive triggers can start a
chain of pleasant feelings,
events, and thoughts

3
Q

Goal of CBT

A

To bring reactions in line with reality

4
Q

Cognitive Techniques in CBT

A

Goal is to help youths learn how to:

  • Observe their thoughts, feelings, and behavior
  • Consider alternative explanation
  • Solve problems and make rational decisions

Therapy as observation and experiment

  • Assess the accuracy and affective consequences of their thinking
  • Try correcting your thought and see what happens
  • Match developmental level (like adults with adolescents, but not with young kids)
  • Use of concrete examples and cartoons

Young kids typically need more behavioral than cognitive

5
Q

Behavioral Techniques in CBT

A

Keep track of mood and activity

  • How do you feel?
  • What are you doing?

Develop list of rewarding activities

  • Activities that produce pride
  • Activities that produce pleasure
6
Q

What is a good activity?

A

All must be negotiated with client

IN DETAIL

if they will ruminate when walking = not good!
If they will listen to a podcast = good

So you have to be specific as to exactly what they will do

It does not have to be big and in fact, probably helps to start small

7
Q

Behavioral Techniques (2)

Change habits + Obstacles

A
Change habits
Address environmental obstacles
-what will get in the way/how can this be overcome 
-Be specific
Address skill deficits
-Monitor IMPACT and refine plan
8
Q

Antidepressant Medication

A

Developmental differences

  • Many efficacious medications for adults
  • Some do not work at all in children
  • Most do not work as well in adolescents
  • May be due to differences in brain development or metabolism
9
Q

Tricyclic antidepressants

A

Prevent the reuptake of norepinephrine and serotonin in the synapses or by increasing the responsiveness of receptors to these neurotransmitters

No evidence of efficacy in youth

10
Q

Monoamine oxidase inhibitors (MAOIs)

A

MAO is an enzyme that breaks down some neurotransmitters
-MAO inhibitors stop this enzyme thus increasing the level of neurotransmitters in the synapse
-Some mixed evidence of efficacy in teens
-Potentially lethal side effects
-Interacts with foods rich in a particular amino acid (tyramine) and can lead to a potential fatal increase in
blood pressure

Red wine, beer, chocolate, aged/ripened cheese

MUST follow instructions

Not a strong point for adolescents

11
Q

Selective serotonin reuptake inhibitors (SSRIs)

A

Inhibit the reuptake of serotonin so that more is available in the synapse

Similar to tricyclics, but more specifially focused on serotonin

Good evidence for fluoxetine (Prozac) in teens

Tend not to be fatal in overdose

Side effects: agitation, jitteriness, anger, hostility, nausea, stomach cramps

12
Q

Antidepressants for Children and

Adolescents

A

Some SSRIS show some evidence of efficacy

Suggestion of increased risk of suicide

Black-box warning by the FDA

  • Appears on the package insert for medication
  • Warns of serious adverse side effects
  • Most serious warning the FDA gives
  • Named for the black border around the warning
13
Q

Black-Box Warning

A

Began with concern about one drug (Paxil)

FDA requested data from all RCTs involving antidepressants

Nine different drugs, 25 trials

Independent team of experts conducted analyses

Found higher levels of suicidality in patients treated with antidepressants compared to placebos

No deaths from suicides were observed in these trials (+4000 patients)

Similar findings in a follow-up study with more patients

Therefore: Black Box Warning

14
Q

Black Box is a good idea?

A

Other types of studies have shown that use of antidepressants is
associated with decreased suicidality

Epidemiological data: Prevalence of anti-depressant use and of suicidality
-Indicates that as use of antidepressants goes up, suicidality goes down

Note that adolescent suicide rates in the US increased for the first time in 2004, after many years of decrease

Speculation that this was, in part, due to adolescents not being treated for depression

More Recent Studies

Obtained complete longitudinal data from RCTs for Prozac (fluoxetine) from the drug companies and the Treatment for Adolescents with Depression (TADS) study

Built on previous studies by including additional data

Examined association between treatment group and clinician ratings of suicidal ideation

Did not find higher rates of suicidal ideation in youth treated with Prozac compared to placebo

15
Q

Study on the effects of black box warning

A

Investigated whether warnings and media coverage were
associated with decreased use of anti-depressants and
increased suicides

Obtained data from 11 health care organizations in the United States

Identified people who were prescribed an antidepressant

Identified suicide attempts

Psychotropic poisoning

Poisoning by drugs is most common method of suicide attempt leading to hospitalization

As an indicator of suicide, poisoning by psychotropic drugs is highly specific

But, will be an underestimate of suicide attempts

Identified completed suicides

16
Q

Study on the effects of black box warning

Results

A

Drop in use

Increase in suicide attemts after black box warning

No change in completed suicides

17
Q

Study on the effects of black box warning

Young adults and adults

A

Young adults (18 to 29)

  • Same pattern as adolescents
  • Decrease in use of antidepressants
  • Sharp increase in suicide attempts
  • No differences in suicides

Adults (30 to 64)

  • Also saw a decrease in antidepressant use
  • No change in attempted suicides or completed suicides
18
Q

Antidepressant Use in Children and Adults

A

Evidence on whether the SSRIs increase suicidal ideation in children
is characterized as mixed

Balancing risk and benefit

Possible increase of suicidal ideation due to taking SSRI

Risk of suicidal ideation of depression is left untreated

Some evidence that some SSRIs (e.g., Prozac) may confer
acceptable benefit:risk ratio for adolescents

19
Q

Treating Depression in Preschoolers

What is known about treatments now

A

Diagnosis of depression in preschoolers is very new

Not much is known about effective treatments

As of 2017, no large-scale studies had investigated the safety and efficacy of antidepressant medication in children younger than 7
years of age

In general, very limited data on use of psychiatric drugs with
preschoolers

3-9/1000 U.S. preschoolers treated with psychiatric meds in the 1990s

Most common prescriptions are for stimulants (ADHD I imagine)

20
Q

Parent management training for depression

A

Luby and colleagues have developed a version of parent management training that focuses on helping parents learn to manage their children’s moods

Includes helping children experience positive affect

First RCT for preschool depression examined this treatment

Preliminary evidence suggests that it is promising

21
Q

Treating Depression in Preschoolers

Current guidelines

A

Therapy is recommended as the first approach

If symptoms are severe and persist (therapy does not work), fluoxetine (Prozac) has the best risk/benefit profile in older children and is recommended as the first
choice in preschoolers

If medication is used, must be closely monitored by a child psychiatrist

22
Q

Summary

A

CBT and SSRIs are both evidence-based treatments for depression in
older children and adolescents

Evidence that for youth, SSRIs may be associated with increased suicidal ideation, and this risk must be balanced against the potential clinical benefits

For preschoolers, limited work examining efficacy and safety of antidepressant medications

Therapy recommended as the first approach

Decks in PSYC 412 Class (47):