Depression:

What is it & What are my

Treatment Options?

Presented by:

Elizabeth Nikol, LCSW, ACT

Sr. Integrated Behavioral Health Clinician

SMG Behavioral Health & Cognitive Therapy Center

January 8th, 2015

Agenda

• What is Depression?

• Statistics

• Types of Depression

• Consequences of Depression

• The Neurotransmitter’s Role in Depression

• Medication Options

• The Role of Our Thoughts in Depression

• Cognitive Therapy

• Q&A

Statistics – National Institute of Mental Health

(NIMH) and the Center for Disease Control

(CDC)

• In a 12 month period, 9.5% of adults suffer with some form

of depression

• 45% of these are classified as severe

• Only 50% of these people seek treatment

• Ages 45 – 64 have the highest incidence, but average age of

onset is 30

• Women are more likely to suffer from some form of

depression

• Other risk factors: Less education, those previously

married, the unemployed.

Statistics: Robert Leahy, PhD

“Beat the Blues”

• 1 in 5 people will experience depression in their

lifetime

• 20% are still depressed two years after onset

• 59% of those with depression also suffer with

anxiety

• 24% have substance abuse disorders

• Depressed people are 30 times more likely to

commit suicide

What is Depression?

According to the American Psychiatric Association:

• Depressed mood or extreme sadness

• Loss of pleasure or interest in most things that you usually enjoy

• Significant weight loss or gain

• Difficulty sleeping (too much or too little)

• Feeling either restless or slowed down

• Being tired all the time

• Having feelings of worthlessness or guilt

• Difficulty thinking or concentrating

• Repeated thoughts of death or dying

(Needs to be for at least 2 weeks & nearly every day)

Difference between Sadness and

Depression

• Sadness lasts for a short period of time, whereas

depression can last for weeks or months at a time.

• Sadness usually does not impact a person’s ability to

function productively, whereas depression can.

• Sadness is often times realistic in thought pattern,

whereas depressed thoughts can be distorted and

unrealistic.

• Depression involves feelings of hopelessness and

helplessness.

• Depression is an illness

Other Types of Depression

• Adjustment Disorder with Depressed Mood

• Bipolar I and II

• Postpartum Depression

• Dysthymia

• Seasonal Affective Disorder (SAD)

• Pre-menstrual Dysphoric Disorder (PMDD)

Why Does Someone Become

Depressed?

• Physical (Biochemical/Genetics)

• Behavioral

• Cognitive

• Situational or Environmental

Consequences of Depression

Higher rates of work absences and disability

Increase rate of disease and physical symptoms (i.e.

headaches, back pain, gastro issues, etc.)

Less productivity at work and home

Poor lifestyle choices

Relationship difficulties

Suicide

“So, you’re telling me I have a

chemical imbalance?”

3 Neurotransmitters Likely Involved in Depression

• Dopamine

• Serotonin

• Norepinephrine

Medications

• SSRI’s: Celexa, Lexapro, Prozac, Luvox, Paxil,

Zoloft

• SNRI’s: Effexor (Venlafaxine) , Pristiq (also

Venlafaxine), Cymbalta

• Dopamine-Norepinephrine Reuptake Inhibitors:

Wellbutrin (Bupropion)

• Mood Stabilizers: Lamictal, Abilify, Seroquel

Electroconvulsive Therapy (ECT)

• Used to be called "electroshock" therapy

• Electrodes are placed to the head, and a seizure is

induced

• Causes change the brain chemistry and can relieve severe

depression symptoms

• Considered for patients with major depressive disorder

with a high degree of symptom severity (catatonia,

psychotic symptoms, etc) and functional impairment

• Also selected for emergencies, such as a when someone

is refusing to eat, is nutritionally compromised or

actively suicidal and not responding to other

interventions.

Other interventions

• Bright Light Therapy: mostly used for SEASONAL

AFFECTIVE DISORDER, but is beginning to be

introduced in other forms of depression and for

those who are unable to tolerate medication for a

variety of reasons.

Other interventions (con’t)

• Transcranial Magnetic Stimulation (TMS)

– Uses transcranial pulsed magnetic fields

– No seizure, but molecular changes are suspected

to occur

– Jury is still out on this as well, but some people

are doing it

– Does not require surgery

Other Medical Conditions That

Mimic Depression – Need to Rule Out

• Thyroid condition

• Cardiac condition

• Anemia

• B12 or Folic Acid deficiency (certain vitamin

deficiency)

• Viral infections (eg. Lyme disease, Influenza post-

viral infection)

Criteria used to determine when

medication is needed

• Mild vs. Moderate vs. Severe Depression

• Psychosocial or interpersonal issues

• Previous response to medication (combination

necessary?)

• Effectiveness

• Side effects

Length of time for treatment

• After 4-8 weeks a patient should begin to notice

moderate improvement

• Once a patient is feeling the symptom that brought

the patient in for treatment, one counts 9-12

months from that day of treatment relief for the

possibility of tapering off the medication.

• If a person has more than one episode of Major

Depression, the recommendation is for that

individual to remain on medication to prevent

relapse and recurrence.

Risk Factors for Recurrence of Major

Depressive Disorder

• Prior History of multiple episodes of MDD

• Persistence of depression symptoms after

recovery of the episode

• Presence of additional psychiatric issues

(substance abuse, panic or anxiety disorders)

• Presence of a chronic general medical

condition

Other Conditions Requiring Psychiatric

Evaluation and Intervention

• Post-Partum Depression (and Peri-Partum Depression)

oA patient with a known diagnosis of depression

should, whenever possible, have a planned pregnancy

and in consultation with a Psychiatrist understand the

risks of being on medication while pregnant.

o If one can be off all medication prior to conception,

that should be done in consultation and with careful

monitoring throughout pregnancy.

oHowever, there are times when a woman may need to

be on medication while pregnant and all the

risks and fetal effects should be reviewed.

Therapeutic Interventions:

Cognitive Behavioral Therapy (CBT)

• Pioneers: Aaron Beck and Albert Ellis

• Negative thinking encourages and continues depression and anxiety

• These thought processes help to engage self defeating behaviors

• Together the therapist and patient work to evaluate thinking, make changes where necessary and problems solve

• New behaviors are created

• Effectiveness confirmed in numerous studies

• Short-term treatment

Negative Cognitions

• Self

• Others

• The future

Cognitive Distortions

• Mind reading

• Fortune Telling

• Catastrophizing

•All or Nothing Thinking

• Discounting the Positive

• Negative filtering

• Shoulds

• Personalizing

• Unfair comparisons

• Emotional Reasoning

Thought Record & Socratic Questions

• What evidence/facts do I have that supports my

thought?

• What evidence/facts do I have that counters my

thought?

•Alternative explanations?

• What are the advantages of thinking this way?

• What are the disadvantages of thinking

this way?

Thought Record & Socratic Questions

• What is the worst that could happen? Could I live

through it?

• What would I tell a friend with the same thought?

• Is this thought a cognitive distortion?

• What would I like to think instead?

Behavioral Activation

• Depressed people act depressed

• Few activities that are pleasurable or achievement

oriented

• Track activities for one week

• Score 1 – 10 for pleasure (P), achievement (A) and

depression (D)

• As pleasure and achievement go up, depression

goes down

• Activity scheduling

Mindfulness

•A way of experiencing the world based in Buddhist

tradition

• Fully aware

• Staying in the present moment

• Observing thoughts without judging them

•Actively change relationship to the thoughts

• Watch them come about and then actively move away

• Move away from doing and focus on being

• Experiential Exercise

Resources• Mind Over Mood – Dennis Greenberger & Christine Padesky

• The New Feeling Good – David Burns, MD

• Beat the Blues Before They Beat You – Robert L. Leahy

• Overcoming Depression Once Step at a Time – Michael Addis & Christopher Martell

• The Mindful Way Through Depression – Zindel Segal, Mark Williams, John Teasdale & Jon Kabat-Zinn

• SMG Behavioral Health and Cognitive Therapy Center: http://www.summitmedicalgroup.com/service/Behavioral-Health-and-Cognitive-Therapy-Center/

• Academy of Cognitive Therapy website: http://www.academyofct.org

• Mindfulness Center of NJ: http://www.mindfulnessnj.com

• APPS!