Depression Learning Objectives Biological Modal (aetiology) of depression Beck’s cognitive model of depression Interpersonal psychotherapy for depression Biological Model for Depression Genetic Vulnerability Genes for 5-HT: 5-HT exerts effects on emotions, sleep, circadian rhythm, thermoregulation, appetite, aggression, sexual behaviours, pain sensitivity and sensorimotor reactivity. Deficits in central 5-HT system, such as reduced 5-HT concentrations, impaired uptake function of the 5-HT transporter, altered 5-HT binding and tryptophan depletion have been liked to depression. E.g. 5-HTTLPR In a never depressed person this gene showed amygdala hyperactivity in response to emotion arousing stimuli compared to other groups. Genes that affect the HPA https://www.brainfacts.org/diseases-and-disorders/mental-health/2019/rethinking-serotonins-role-in-depression-030819 Neuroendocrine functioning: Key components are: HPA axis CRH Locus coeruleus -norepinephrine LC-NE systems which include the limbic and cortical pathways bidirectionally interconnect through various neurotransmitter and hormonal circuits. The primary glucocorticoid hormone is cortisol -> cascade functions that are adaptive in acute phases of response to stress and which normally resolve quickly through inhibitory feedback process in the HPA axis. Failure to normalise, due to sustained high cortisol -> promotes illnesses such as depression. Depression is linked to elevated cortisol and related neurohormones. Depressed patients have a slower recovery of cortisol levels in response of psychological stress than controls. Those with abnormal cortisol regulation even after treatment are more likely to replace and generally have poorer clinical prognosis that patients whose cortisol functions returned to normal after treatment. Sustained hypercortisolism damages the stress system, including cells in the hippocampus with generalised effects on the circuits underlying emotional regulation. Causes of this include genetics which are linked to differences in emotional behaviour and glucoritoid response and environmental factors such as those associated with childhood development, prenatal exposure, prenatal and postnatal stress, distruptions of parent-child bond Interpersonal Therapy for Depression Basics Short term focused treatment for depression Focuses on identifying and analysing problematic interpersonal relationships and or life situations For example, unresolved grief or conflicts For example, change in jobs and a geographical move . It is a talk therapy that focuses on improving relationships with others to help relieve mental health symptoms. IPT that addresses interpersonal issues, is at least as effective as short term ant-depressants for mild to moderate forms of clinical depression. Can be used for children, adolescents and adults. Events surrounding interpersonal relationships do not cause depression, but rather depression happens within an interpersonal context and affects relationships and the roles of people within those relationships. Indication Depressive disorders Eating disorders Duration Weekly sessions for 12 to 16 weeks. Techniques Medical model: The disease the patient suffers from for example, depressive disorders is a clinical syndrome distinct from their personality and should be explained similarly to other medical conditions such as anxiety. Identifying connections between the disease manifestation and life events For example, the connection between the death of a loved one and the development of an eating disorder Structure of treatment Time limited 12 to 16 weeks in three phases. Phases of treatment Initial phase 1 to 3 sessions Diagnosis and assessment: Using DSM V or ICD10 to establish a diagnosis Interpersonal inventory: A review of the patient’s relation patterns, intimacy capacity and current relationships. Focus identification Unresolved grief: helping clients move forward from a stressful event such as the death of a loved one Role transition: helps clients manage difficult like transitions such as divorce and retirement Role dispute : helps navigate difficult interpersonal relationships where two parties have differing expectations. Interpersonal deficits Sick role assigement The patient is temporarly acknowledged as being unable to function fully due to depression Treatment agreement The therapist and the patient set goals, emphasizing that resolving interpersonal issues will improve mood Middle phase/core treatment Tailored strategies: Encouraging appropriate mou rning in complicated bereavement Resolving conflicts in role dispute Supporting adjustment to new roles in role transitions Reducing social isolation in interpersonal deficits Skill developing Assertiveness and expressing needs Validating and managing anger Encouraging social engagement and taking interpersonal risks Weekly sessions Reviewing past week’s interpersonal events Reinforcing positive experiences and analysing setbacks Role playing interpersonal scenarios for real life application End phase (last three sessions) Termination preparation Reviewing porgess and reinforcing condifence Therapy as role transition Acknowledging mixed emotions about ending therapy Future planning Discussing maintenance strategies, especially for recurrent MDD, which may include ongoing, but less freuqnet sessions such as monthly check ins. Benefits Helps the patient become more aware of their emotions, thoughts and behaviours and how these impact their relationships and mood. After most people adopt healthier ways of relating to others. Though it cannot male stressful situations disappear but helps the patient in knowing how to respond to them in a more positive way and feel better overall. When combined with a medication such as an anti-depressant, this is more helpful than using anti-depressants alone.