Depression Webinar

In class today we listened in on a Webinar about depression by Dr. Stringaris. A webinar is exactly what it sounds like, a seminar on the web. Webinars are a very common thing for people to tune into, especially when their profession involves constant new discoveries of new information like scientists and nurses. 

Stringaris starts the webinar discussing some evolutionary theories of depression:
Protection from negative outcomes, Psychic Pain, A way to change one's own environment and protection from infections.

To find out if someone has depression are if if five or more of the following symptoms have been present during the same time:

• Depressed mood
• Diminished interest in pleasure
• Significant weight loss
• Insomnia or oversleeping
• Agitation or retardation
• Fatigue or loss of energy nearly every day
• Feelings of worthlessness of excessive or inappropriate guilt (may be delusional) nearly every day
• Recurrent thoughts of death (not fear of dying) but suicidal thoughts

Adolescents and Depression:

Suicide is one of the main causes of death in adolescents, adolescents with major depression are 30 times more likely to die of suicide.

Aetiology of Depression

Genes: 30-50% of the liability to depression is due to genetic factors. 

Gene-environmental correlation: Increased genetic liability for lifetime traumas

Gene-environmental interaction: different genotypes respond to environmental variability in different ways

Development and Depression:

Girls are more likely to develop depression during puberty possibly due to the changes in the body and also hormonal changes. 

Girls who experience puberty earlier are more likely to develop depression possibly to hormones,  being so young, being subjected to stress and being exposed to girls who are order and are experiencing adult things. 

Continuities, homotypic:

Childhood depression does not predict adult depression

Anxiety: early on anxiety precedes depression though the links are bidirectional by mid-late adolescence

Alcohol: probably and internalizing pathway to depression

ODD/CD: the strongest predictors of later depression

Behavior Problems and depression:

40% of depressed young adults have had serious disruptive problems during development

Early onset and persistence show the highest depression risk in girls 

Neurology of Depression

Depression is probably a heterogeneous syndrome,

It is useful to think of two core abnormalities

Negative Bias and missing the positive: 

More common to spot the negative or misinterpret a neutral face as sad or angry

People who suffer from depression are more likely to pick up the negative and show an increase of negativity in the amygdala in the brain. Missing the positive, a depressed person may be more likely to miss something positive in their environment like a smile, antidepressants seem to help with this. 

Disrupted Hedonic Processing:

Anticipatory anhedonia: Someone with depression may not think they deserve anything like an award, depression is being unable to see why something might be rewarding

In the brain, processing an award in an area of the brain, it is important in the path of genesis in depression, they are much more likely to become depressed.

Diagnosis

Parents focus on the irritability/oppositionality

Teachers focus on the academics

Person cannot bring themselves to talk about is, patients can be perplexed 

Awareness is key in diagnosis, knowing that adolescence is a peak period 

Screening is only appropriate in samples that are relatively high risk

Diagnosis should also address:

Presence of manic symptoms

Underlying medical causes (e.g. anemia, thyroid disease) 

Risk assessment! (have they cut before, have they tried to kill themselves, etc.)

Treatment

the downstream effect of genes and environment

Medical treatment and psychological targets behavior feelings and thoughts

The first line treatment of depression is simple:

Pharmacology

serotonin reputake inhibitors (SRI's)

fluovetine, serttaline, citalopram

Psychological therapy:

cognitive behavior therapy (CBT)

inter person therapy (IPT)

In mild cases, start with CBT/IPT if you have access to trained therapists

About 60% of young people respond to antidepressant but 50% also respond to the placebo possibly because related to the severity of the depression, the higher the severity of the depression, the lower the response to the treatment.

Antidepressants offer a good risk benefit ratio:

Numbers needed to treat: 10

Numbers needed to harm: 112

 This is important in the context of the suicidality debate and the black box warning.