1. Depression: What to do if it Strikes You Diane Spangler, Ph.D. Department of Psychology

2. Depression is a Serious, Widespread Disorder Approximately 16% of persons will experience major depression during their lifetime 340 million persons worldwide currently meet criteria for clinical, unipolar depression Depression is ranked as the 4 th highest public health concern by the World Health Organization. It is expected to be ranked 2 nd by 2010. Depression is the leading cause of disability in the United States.

3. Depression is Recurrent If untreated, 85% of persons who have one episode of depression will have another episode within 10 years Median number of depressive episodes per person is 4 25% have 6 or more episodes

4. Recognizing Depression Sad mood Loss of interest/pleasure Appetite changes Sleep changes Fatigue Worthlessness Concentration diminished Indecision Helplessness Hopelessness Withdrawal Suicidal thoughts Irritability Facial expression Decreased play Decreased sociability Lethargy Low self-esteem Accident proneness Attachment problems/ separation Adult Child

5. What to do if it strikes you? Seek Treatment! But not just any treatment

6. Empirically Supported Treatments Medication* (Anti-depressants) –Neurochemical change Cognitive-Behavioral Therapy* (CBT) –Cognitive change –Behavioral change Interpersonal Psychotherapy (IPT) –Relationship change

7. Findings from single studies comparing the short-term efficacy of CBT and MEDS are mixed Some studies show CBT and MEDS to be similar in outcome at post-treatment. Some show CBT superior to MEDS. The most recent and well-done meta- analyses find that CBT is more effective than MEDS in acute outcome (Beck & Butler, 2001; Gloaguen et al., 1998) Response: Post-treatment

8. Response: Long-term CBT shows clear advantages in long- term outcome over medication Following CBT treatment, likelihood of relapse and recurrence is significantly reduced

9. CBT vs. MED: Long-term Outcome % DEPRESSED

10. Additional Considerations Efficacy: Short and Long-term Drop-out rates: –MEDS (40%) –CBT (10%) Side Effects –Side effects for meds are common Weight gain, loss of libido, sleep disruptions, dizziness, nausea, constipation, blurred vision, fatigue, agitation –Some side effects mimic/worsen depressive symptoms –Some AD meds are lethal in overdose & used to commit suicide by depressed persons –AD meds are the most common agent used in suicide by poisoning –AD meds linked to serious health problems (cardiovascular disease; breast cancer; sudden death in children) AD meds are not recommended for women who are trying to become pregnant, currently pregnant or nursing

11. Additional Considerations Combination Treatment Subtypes of Depression Availability/Access to Treatment –For a list of certified cognitive therapists go to: www.academyofct.org Cost –Time/Effort to Administer –Length of Treatment Regimen –Insurance Coverage

12. What Actually Happens in the Real World? 50% of depressed persons in the U.S. receive no treatment at all Of those who seek treatment, the majority receive medication only

13. Self-Care for Depression Stay Engaged Behaviorally –Exercise –Social contact/support –Hobbies/Interests –Sleep –Novelty

14. Self-Care for Depression Decenter from depressive rumination –Thought restructuring Feeling Good by David Burns –Mindfulness The Mindful Way Through Depression by Mark Williams et al.

15. “An opportunity to change my life”