Lecture 16

Treatment of depression

cognitive, behavioural

The CBT model of depression asserts that depression is maintained by negative ______ and ______ processes

• thinking

• events

• deficits

CBT for depression acts on 2 processes:

• Cognitive

  • Depressogenic ______

• Behavioural

  • Low reinforcement and negative life _______

  • Skill _____

• Way that depression may begin or deeper

• Negative events → negative moods → negative behaviours → negative thoughts and expectations for the future

What’s a downward emotional spiral?

reaction

The ultimate goal of CBT is to bring people’s _______ in line with the event

• Observe

• alternative

• Solve, rational

Cognitive techniques in CBT helps youth learn how to:

• ______ their thoughts, feelings, and behaviour

• Consider ______ explanations

• ______ problems and make ______ decisions

• track

• rewarding

• habits

• plan

Behavioural techniques in CBT:

• Keeping ______ of mood and activity

• Developing a list of ______ activities

• Changing everyday ______

• Monitoring the impact and refining the ______

• lower

• lower

  • challenging

  • parents

Meta-analysis on CBT efficacy in children and adolescents:

• Sub-clinical depression at baseline → 63% ______ risk depression at follow-up

• Clinical depression at baseline → 45% _____ risk post-treatment

• 2 predictors of positive outcomes:

  • Combination of behavioural activation + thought ______

  • Involving ______ in intervention

symptoms

In low and middle income countries, CBT with adolescents worked well to reduce depressive _______, compared to economic interventions, interpersonal and integrated therapy that had weaker effects

not

There are many efficacious antidepressant medications for adults with depression, but these do _____ work necessarily in children/adolescents

Tricyclic antidepressants	Target norepinephrine + serotonin No evidence of efficacy in youth
Monoamine oxidase inhibitors	Increase the level of neurotransmitters in the synapse Mixed evidence of efficacy in teens Lethal side effects
Selective serotonin reuptake inhibitors	Target serotonin Good evidence of efficacy in teens Many negative side effects (agitation, anger, hostility, nausea…)
Serotonin and norepinephrine reuptake inhibitors	Target serotonin and norepinephrine May lead to increased risk of suicide?

What are the 4 types of antidepressant medications and their functions/descriptions?

• Serious warning issued by the FDA present on medication packages

• Warns of serious adverse side effects

What’s a black-box warning?

increased

Adolescent suicide rates in the US ______ for the first time in 2004, after many years of decrease

• suicidal

• decrease, increase

Recent studies:

• Didn’t find higher rates of _____ ideation in youth treated with Prozac compared to placebo

• After black-box warnings and media coverage of antidepressants:

  • There was a _____ in antidepressant use and a _______ in psychotropic drug poisonings for adolescents

  • There was a _____ in antidepressant use, a ______ in suicide attempts, and _______ differences in suicides in young adults

  • There was a _____ in antidepressant use and _______ change in attempted/completed suicides

risks, benefits

With SSRIs, we must ultimately balance the ______ (increased suicidal ideation) and the ______ (avoiding the risk of suicidal ideation if depression is left untreated)

Stimulants

What are the most common prescriptions for preschoolers with depression?

promising

Preliminary evidence of parent-management training focused on depression is ______

• Therapy

• fluoxetine

• monitored

Treating depression in preschoolers:

• _______ is recommended as the first approach

• If symptoms are severe and persist, ______ (Prozac) has the best risk/benefit profile in older children and is recommended as the first choice in preschoolers

• If medication is used, it must be closely _____ by a child psychiatrist