Depression in Teens Webinar
Why is there depression?
Some evolutionary theories of depression:
- Protection from negative outcomes
- Psychic pain (analogous to bodily pain)
- A way of changing one's own environment
Standard definition of Major Depressive Disorder
- Depressed mood most of the day, nearly every day
- diminished interest in or pleasure in all or most activites
- significant weight loss when not on diet
- insomnia or too much sleep
- psychomotor agitation or retardation
- fatigue or loss of energy nearly every day
- feelings of worthlessness or excessive guilt
- diminished ability to think or concentrate
- recurrent thoughts of death
Symptoms cause significant distress in social, occupational
Epidemiology of depression
- adolescents with major depression are up to 30 times more likely to die from suicide
- In its severe form it affects about 9% of adolescents
- Second leading cause of years lived in disability
Aetiology of depression
Genes and environment:
- Genes: 30-50% of the liability to depression is due to genetic factors
- Gene- environment correlation: increased genetic liability for lifetime traumas
- Gene- environment interraction: responding differently to situations of stress
- Traumatic life event increases probability in depression for certain family members
- Interplay between environment and genetic makeup in depression
Development and depression
Sex and Pubertal effects on depression
- Difference in cognitive processing
- Greater exposure or sensitivity to psychosocial
- Hormonal mechanisms- girls who start menstrual cycle earlier are more likely to have depression
Continuities, homtypic:
- Childhood depression does not predict adult depression
- Anxiety- early on anxiety precedes depression
- Alcohol- an "internalising" pathway to depression
- OCD
Behavior problems and depression
- 40% of depressed young adults have had serious disruptive problems
- What exactly explains the transition between irritability and depression?
Neurobiology of depression
- Depression is probably a heterogeneous syndrome
- Negativity bias and missing the bias
- People who suffer from depression are more likely to pick up the negative
- Miss positive parts of life due to negativity caused by depression
- Money is People who don't expose effort to get a reward
- Unable to see why something rewarding is positive
- Processing reward in brain is important but people who have depression have low activity in this area
- Does treatment change reward processing?
- Can we target our treatments on reward processing
Diagnosis
- Diagnosis will take longer of parents focus of irritability and oppositionality
- Teachers focused on academic performance
- Cannot bring oneself to speak about it
- (In ex) Christina only diagnosed after she took first overdose
- Awareness is key to diagnosis
- Screening only in high risk situations
- Diagnosis should address: presence of manic problems, underlying medical causes, risk assessment
Downstream effects of genes and environment
- Medications and psychological treatment are trying to target behavior, feelings, and thoughts
Treatments
- Pharmocology
- Psychological therapy: CBT and IPT
- in mild cases start with psychological treatment
- Combining may be better
- 60% of young people respond to an antidepressant
- 50% respond to placebo
- The higher the severity of depression the lower the placebo response
- 10 antidepressant needed to treat person and 112 needed to harm ( important when talking about suicidality)
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