Depression EXSS 3070 Lecture Notes

Flashcards for key vocabulary and concepts from the Depression EXSS 3070 Lecture.

Mental Illnesses

Health conditions involving changes in emotion, thinking or behavior, associated with distress and/or problems functioning in social, work or family activities.

Mental Illness (DSM-5 Criteria)

A behavioural or psychological syndrome or pattern that occurs in an individual, reflects an underlying psychobiological dysfunction, resulting in clinically significant distress or disability.

ICD

International Classifications of Diseases, created by the World Health Organization, used in most countries, comprises 17,000 diagnostic categories and 100 000 medical diagnostic index terms

DSM-5TR

Diagnostic and Statistical Manual of Mental Disorders, created by the American Psychiatric Association, the most popular classification of mental disorders for mental health professionals. Contains a listing of diagnostic criteria for every psychiatric disorder recognized by the U.S. healthcare system

Mood

A conscious state of mind or predominant emotion; a prevailing attitude.

Affective Disorder

A psychological disorder characterised by the elevation or lowering of a person’s mood, and interferes with an individual’s daily life

Depression

A mental disorder characterized by feelings of sadness, loss of interest or pleasure, and can lead to a variety of emotional and physical problems.

Bipolar Disorder

A mood disorder that causes unusual shifts in mood, energy, activity levels, concentration, and the ability to carry out day-to-day tasks

Mania

A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy

Depression

The leading cause of disability and ill health worldwide

Causes of Depression

External life stressors + Internal medical illness and/or treatments + Past bad experiences + Personality patterns of thinking + High anxiety + Chemical changes + Family (inherited) disposition.

Neurobiological Hypotheses of Major Depressive Disorder (MDD)

Genetic vulnerability + Altered HPA axis activity + Deficiency of monoamines + Dysfunction of specific brain regions + Neurotoxic and neurotrophic processes + Reduced GABAergic activity + Dysregulation of glutamate system + Impaired circadian rhythms

Classes of Antidepressants

Selective serotonin reuptake inhibitors (SSRIs) + Serotonin-noradrenaline reuptake inhibitors (SNRIs) + Tricyclic antidepressants (TCAs) + Monoamine oxidase inhibitor (MAOIs)

Treatments for Mood Disorders

Medications, Psychological interventions, Physical treatments

Professionals involved in Diagnoses/Referrals of Mental Health Disorders

General Practitioners, Psychologists, Psychiatrists, Neurologists, Other medical professionals

Professionals involved in Management/Prevention of Mental Health Disorders

Medical practitioners/ specialists, Allied health practitioners, Psychologists, Behaviourial therapists, Counselors, Social workers, Art therapists, Exercise Physiologists

Exercise and Depression

Strong evidence demonstrates that moderate-to-vigorous physical activity reduces the risk of developing major depression. It also reduces the symptoms of depression among individuals with and without clinical levels of depression.

Aerobic Dose for Managing Depression

Low dose = 7 kcal/kg/week (3 or 5 days per week) NOT EFFECTIVE. Public Health Dose = 17.5 kcal/kg/week (3 or 5 days per week) = EFFECTIVE

High Intensity PRT vs. Low intensity in treating Depression

High Intensity PRT reduces depression significantly more than Low Intensity PRT or referral to GP for Usual Care

Effective PRT intensity for Depression

80% 1RM or 15-18 on Borg Scale, 3 d/wk

Proposed Mechanisms of Exercise Benefit in Depressive Illness

Mastery, self-efficacy + Internal locus of control + Self-esteem + Sense of purpose, eudaimonic happiness + Reduction in catabolic/inflammatory profile + Increase in anabolic/neurotrophic factors + Hippocampal and cortical neurogenesis, functional and cognitive enhancement + Reduction in pain/frailty/mobility impairment + Treatment of co-morbid illness + Improved fitness

Reference

Australian & New Zealand Journal of Psychiatry, 55(1)

Mental Health Outcomes Likely to Improve with Exercise

Decrease symptoms of depression, anxiety, stress and schizophrenia + Decrease social isolation + Improve sleep quality + Increase engagement with treatment and service utilisation + Reduce cravings and withdrawal in substance use disorders (SUD) and alcohol addiction + Increase self-esteem + Improve quality of life

Physical Health Outcomes likely to Improve with Exercise

Weight management (weight loss, maintenance and prevention of weight gain) + Reduce the risk of chronic disease (i.e. cardiovascular disease, metabolic syndrome & T2DM) + Improved psychosocial function i.e. activities of daily living, social and occupational functioning + Contribute to longer life expectancy through improvement in cardiovascular fitness and reduction in cardiometabolic risk

Exercise Guidelines for Depression

There are no ACSM guidelines/position stand for exercise prescription for depression. There is a, ESSA consensus statement related to exercise for mental health

What an AEP can do

AEPs can provide access to interventions using assertive outreach strategies to engage with individuals in the community + Conduct and promote regular physical health screening and metabolic monitoring + Conduct exercise and functional capacity assessments + Design and implement accessible group exercise programs to encourage and enable higher levels of participation

What does ESSA say AEPs can do?

Provide basic healthy eating advice in the absence of a dietitian + Provide in-service training for the mental health workforce on the implementation of exercise and physical activity in mental health settings + Consult with mental health clinicians and GP’s on the most effective strategies to improve the health of clients + Conduct information and training seminars on the role of physical activity in mental health for people with mental illness, their carers, friends and family

Exercise Prescription Guidelines in Depression

Aerobic and anaerobic exercises are effective in decreasing depressive symptoms and enhancing mood + Increasing lifestyle physical activity is important + Group vs individual? + Supervised vs unsupervised? + Frequency

Important data to collect at initial assessment and prior to exercise prescription

Pre-exercise Assessment and Exercise Prescription Considerations

Practical Issues in Implementation of Exercise for MH Disorders

Stability of symptoms + Co-diagnoses + Other treatments + Setting/Supervision + Modality + Measurement of outcomes

Suggested questions for clinicians to screen for cognitive impairment in mood disorders

Screen for Potential Cognitive Problems especially in Older Adults

Monitor ALL psychological and medical co- morbidities

Alcohol AUDIT-C questionnaire + PSQI for insomnia + PHD-9 or GDS for depression + PTSD checklist + GAD-7 for anxiety

Important for AEPs to consider

AEPs need to know relative risk of weight gain/metabolic disease and psychotropic medication classes when assessing clients

Barriers to effective lifestyle intervention

Understand, Assess and Overcome Barriers to Implementation

Addressing lack of motivation for exercise in mental health settings

Adopt an empathic, person-centered approach that gives individuals a central role in determining the type of activities offered

Strategies for Encouraging Individuals Who Are Experiencing Mental Distress to Adopt and Maintain a Physically Active Lifestyle

Provide strategies on how to cope if planned physical activity cannot be completed Regular + ly discuss client preferences and goals + Incorporate activities that will allow the client to be challenged and successful + Help connect clients to various physical activity resources + Regularly check-in with a client about progress toward their goals

Negative predictors of exercise adaptation in depression

Suicidal tendency + Psychosis + Mania + Medical conditions making exercise difficult + Hospitalization or surgery in the past month + Changes in antidepressant medication/dosing over the past month

Many studies are now investigating the delivery of MH interventions via telehealth platforms

TeleHealth for exercise delivery in MH ?