1-11 of 11 Results

  • Keywords: depression x
Clear all

Article

Felipe B. Schuch and Brendon Stubbs

Depression is a leading cause of global burden affecting people across all ages, genders, and socioeconomic groups. Antidepressants are the cornerstone of treatment, yet treatment response is often inadequate. While some psychological interventions such as cognitive behavioral therapy can also help alleviate depressive symptoms, alternative and complimentary treatment options are required. In particular, therapeutic interventions that also address the greatly increased levels of obesity and cardiovascular disease among people with depression may offer added value. With the rising burden of premature mortality due to cardiovascular disease in people with depression and promising evidence base for physical activity to improve depressive symptoms, it is important to review the role, benefits, and underlying neurobiological responses of exercise among people with depression. There has been a growing body of evidence to suggest that higher levels of physical activity reduce a person’s risk of incident depression. It appears that lower levels of cardiorespiratory fitness increase an individual risk of depression, suggesting that physical activity and physical fitness have a key role in the prevention of depression. Moreover, exercise can improve depressive symptoms in those with subthreshold depressive symptoms and major depressive disorder. Despite the effectiveness of exercise, the optimal dose and frequency are yet to be fully elucidated. Nonetheless, exercise appears to be well accepted by people with depression, with relatively low levels of dropout from interventions, particularly when supervised by qualified professionals with expertise in exercise prescription. Various barriers to engaging in exercise exist and motivational strategies are essential to initiate and maintain exercise. A number of hypotheses have been postulated to determine the antidepressant effect of exercise; however, most are based on animal models or models elucidated from people without depression. Therefore, future representative research is required to elucidate the neurobiological antidepressant response from exercise in people with depression. Physical activity interventions targeting fitness should be a central part of the prevention and management of depression. In particular, physical activity interventions offer a viable option to prevent and address cardiometabolic abnormalities and cardiovascular disease, which account for a significant amount of premature deaths in this population and are not addressed by standard pharmacological and psychological therapies.

Article

In clinical practice with older adults, depression is a common presenting problem and is usually interwoven with one or more life problems. These problems are often the focus of psychotherapy. Interpersonal Psychotherapy (IPT) is a highly researched and effective treatment for depression in adults and older adults. IPT is time-limited, and as an individual psychotherapy it is usually conducted over 16 sessions. IPT focuses on one or two of four interpersonally relevant problems that may be a cause or consequence of depression. These include: role transitions (life change), interpersonal role disputes (conflict with another person), grief (complicated bereavement), and interpersonal deficits (social isolation and loneliness). The four IPT problem areas reflect issues that are frequently seen in psychotherapy with depressed older people.

Article

Despite high rates of mental illnesses, older adults face multiple barriers in accessing mental health care. Primary care clinics, and home- and community-based senior-serving agencies are settings where older adults routinely receive medical care and social services. Therefore, integration of mental health care with existing service delivery systems can improve access to mental health services and reduce the unmet mental health needs of seniors. Evidence suggests that with innovative components mental health provided in collaboration with primary care providers with or without co-location within primary care clinics can improve depression and anxiety. Home-based models for depression care are also effective, but more research is needed in examining home-based approaches in late-life anxiety treatment. It is noteworthy that integrative models are particularly helpful in expanding the reach in underserved communities: elders from minority and low-income backgrounds and homebound seniors.

Article

Åsa Jansson

Depression is defined in diagnostic literature as a mood disorder characterized by depressed mood, loss of interest or pleasure in activities, significant changes in weight, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness or excessive guilt, difficulty concentrating, and suicidal ideation and/or attempts. Research suggests a link between depressed mood and monoamine depletion, elevated cortisol, and inflammation, but existing laboratory evidence is inconclusive. Current treatments for depression include selective serotonin reuptake inhibitors (SSRIs), cognitive behavioral therapy (CBT), and lifestyle changes; however, more severe forms of the disorder can require other medication, sometimes in combination with electroconvulsive therapy (ECT). Disagreement persists over how to define and classify depression, in part due to its ambivalent relationship to melancholia, which has existed as a medical concept in different forms since antiquity. Melancholia was reconfigured in 19th-century medicine from traditional melancholy madness into a modern mood disorder. In the early 20th century, melancholia gradually fell out of use as a diagnostic term with the introduction of manic-depressive insanity and unipolar depression. Following the publication of DSM-III in 1980 and the introduction of SSRIs a few years later, major depressive disorder became ubiquitous. Consumption of antidepressants have continued to rise year after year, and the World Health Organization notes depression as the leading cause of disability worldwide. At present, internationally recognized systems of classification favor a single category for depressive illness (alongside a circular mood disorder, bipolar I and II), but this view is challenged by clinicians and researchers who argue for the reinstatement of melancholia as a separate and distinct mood disorder with marked somatic and psychotic features.

Article

Kim Van Orden, Caroline Silva, and Yeates Conwell

Suicide in later life is a significant public health problem around the world—a problem that will increase in magnitude in the coming years with the impact of population aging. Adults age 70 and older have higher suicide rates than younger groups worldwide in both lower-income and higher-income countries. While suicide rates tend to increase with age, suicide in later life is not an expected or normative response to stressors that accompany the aging process. Instead, a constellation of risk factors places an older adult at elevated risk for suicide. These factors can be remembered as the Five D’s: psychiatric illness (primarily depression); functional impairment (also called disability, often associated with dependency on others); physical illness (particularly multiple comorbid diseases); social disconnectedness (including social isolation, loneliness, family conflict, and feeling like a burden); and access to lethal (deadly) means. The greatest risk occurs when multiple domains of risk converge in a given individual. Approaches to prevention can address the Five D’s. Given that older adults are reluctant to seek out mental healthcare and that standard primary care practice cannot easily provide it, models of primary care-based integrated care management for mental disorders, including in older adulthood, have been developed, rigorously tested, and widely disseminated. These models play an important role in suicide prevention by integrating treatment for physical and mental illness. Upstream, selective prevention strategies that target disconnectedness—such as engaging older adults as volunteers—may serve to reduce disconnectedness and thereby reduce suicide risk. Universal prevention strategies that involve growing the geriatric workforce may address disability by increasing older adults’ access to medical and social service providers with expertise in improving physical, cognitive, and social functioning, as well as improving quality of life. Addressing ageism and building age-friendly communities that use strategies to integrate older adults into society and promote social participation hold promise as universal prevention strategies. Ultimately, effective suicide prevention strategies for older adults must focus on improving quality of life as well as preventing suicide: strategies such as psychotherapy and medication for psychiatric disorders must be supplemented by prevention strategies for older adults give at all ages in addition to treating psychiatric disorders and suicidal thoughts is needed to address the problem of suicide in later life.

Article

Aaron L. Slusher and Edmund O. Acevedo

Physical activity is essential for optimal human functioning. However, the emergence of modern lifestyle conveniences has contributed to the increased prevalence of sedentary behavior. As a result, the psychobiological nature of physical activity and the positive impact of physical activity on body and brain communication has prompted investigators to utilize a breadth of research strategies and techniques to identify physical activity regimes, associated mental health benefits, and the plausible mechanisms that explain the mental health adaptations. Furthermore, investigators have provided evidence supporting a number of mechanisms that at least partially explain the psychological adaptations to acute (a single bout) and chronic (long-term) physical activity intervention. Through these efforts, the observed efficacy of physical activity as a potential therapeutic intervention strategy to ameliorate the most prevalent mental disorders (i.e., anxiety, depression, bipolar disorder, and schizophrenia), and to enhance mental illness-related and age-related impairments of cognitive function has received some attention in the literature and will likely lead to clarity and confidence for clinical use.

Article

Progressive neurological disorders are incurable disorders with gradual deterioration and impacting patients for life. Two common progressive neurological disorders found in late life are Parkinson’s disease (PD) and motor neuron disease (MND). Psychological complications such as depression and anxiety are prevalent in people living with PD and MND, yet they are underdiagnosed and poorly treated. PD is classified a Movement Disorder and predominantly characterized by motor symptoms such as tremor, bradykinesia, gait problems and postural instability; however, neuropsychiatric complications such as anxiety and depression are common and contribute poorly to quality of life, even more so than motor disability. The average prevalence of depression in PD suggest 35% and anxiety in PD reports 31%. Depression and anxiety often coexist. Symptoms of depression and anxiety overlap with symptoms of PD, making it difficult to recognize. In PD, daily fluctuations in anxiety and mood disturbances are observed with clear synchronized relationships to wearing off of PD medication in some individuals. Such unique characteristics must be addressed when treating PD depression and anxiety. There is an increase in the evidence base for psychotherapeutic approaches such as cognitive behavior therapy to treat depression and anxiety in PD. Motor neuron disease (MND) is classified a neuromuscular disease and is characterized by progressive degeneration of upper and lower motor neurons is the primary characteristic of MND. The most common form of MND is Amyotrophic lateral sclerosis (ALS) and the terms ALS and MND are simultaneously used in the literature. Given the short life expectancy (average 4 years), rapid deterioration, paralysis, nonmotor dysfunctions, and resulting incapacity, psychological factors clearly play a major role in MND. Depression and suicide are common psychological concerns in persons with MND. While there is an ALS-specific instrument to assess depression, evaluation of anxiety is poorly studied; although emerging studies suggesting that anxiety is highly prevalent in MND. Unfortunately, there is no substantial evidence-base for the treatment of anxiety and depression in MND. Caregivers play a major role in the management of progressive neurological diseases. Therefore, evaluating caregiver burden and caregiver psychological health are essential to improve quality of care provided to the patient, as well as to improve quality of life for carers. In progressive neurological diseases, caregiving is often provided by family members and spouses, with professional care at advanced disease. Psychological interventions for PD carers addressing unique characteristics of PD and care needs is required. Heterogeneous clinical features, rapid functional decline, and short trajectory of MND suggest a multidisciplinary framework of carer services including psychological interventions to mitigate MND. A Supportive Care Needs Framework has been recently proposed encompassing practical, informational, social, psychological, physical, emotional, and spiritual needs of both MND patients and carers.

Article

Zella Moore, Jamie Leboff, and Kehana Bonagura

Major depressive disorder, dysthymia, and bipolar disorder are very common diagnoses seen among athletes, and they are serious conditions that can be debilitating if not properly addressed. These disorders warrant careful attention because they can adversely affect multiple domains of an athlete’s life, including athletic motivation, performance outcomes, interpersonal well-being, health, and overall daily functioning. Key foci include the prevalence of, clinical characteristics of, causes of, and risk factors for major depressive disorder, persistent depressive disorder/dysthymia, bipolar I disorder, and bipolar II disorder. Sport psychologists should integrate such important information into their overall case conceptualization and decision-making processes to ensure that athletes and performers at risk for, or struggling with, such mental health concerns receive the most effective, efficient, and timely care possible.

Article

Tipu Aziz and Holly Roy

Deep brain stimulation (DBS) is a neurosurgical technology that allows the manipulation of activity within specific brain regions through delivery of electrical stimulation via implanted electrodes. The growth of DBS has led to research around the development of novel interventions for a wide range of neurological and neuropsychiatric conditions, including Parkinson’s disease, dystonia, chronic pain, Tourette’s syndrome, treatment-resistant depression, anorexia nervosa, and Alzheimer’s disease. Some of these treatment approaches have a high level of efficacy as well as an established place in the clinical armamentarium for the diseases in question, such as DBS for movement disorders, including Parkinson’s disease. Other interventions are at a more developmental stage, such as DBS for depression and Alzheimer’s disease. Success both in clinical aspects of DBS and new innovations depends on a close-knit multidisciplinary team incorporating experts in the underlying condition (often neurologists and psychiatrists); neurosurgeons; nurse specialists, who may be involved in device programming and other aspects of patient care; and researchers including neuroscientists, imaging specialists, engineers, and signal analysts. Directly linked to the growth of DBS as a specialty is allied research around neural signals analysis and device development, which feed directly back into further clinical progress. The close links between clinical DBS and basic and translational research make it an exciting and fast-moving area of neuroscience.

Article

Stirling Moorey and Steven D. Hollon

Cognitive behavioral therapy (CBT) has the strongest evidence base of all the psychological treatments for depression. It has been shown to be effective in reducing symptoms of depression and preventing relapse. All models of CBT share in common an assumption that emotional states are created and maintained through learned patterns of thoughts and behaviors and that new and more helpful patterns can be learned through psychological interventions. They also share a commitment to empirical testing of the theory and clinical practice. Beck’s Cognitive Therapy sees negative distorted thinking as central to depression and is the most established form of CBT for depression. Behavioral approaches, such as Behavioral Activation, which emphasize behavioral rather than cognitive change, also has a growing evidence base. Promising results are emerging from therapies such as Mindfulness Based Cognitive Therapy (MBCT) and rumination-focused therapy that focus on the process of managing thoughts rather than their content. Its efficacy-established CBT now faces the challenge of cost-effective dissemination to depressed people in the community.

Article

Quincy J. J. Wong, Alison L. Calear, and Helen Christensen

Internet-based cognitive behavioral therapy (ICBT) is the provision of cognitive behavioral therapy (CBT) using the Internet as a platform for delivery. The advantage of ICBT is its ability to overcome barriers to treatment associated with traditional face-to-face CBT, such as poor access, remote locations, stigmas around help-seeking, the wish to handle the problem alone, the preference for anonymity, and costs (time and financial). A large number of randomized controlled trials (RCTs) have tested the acceptability, efficacy, and cost-effectiveness of ICBT for anxiety disorders, mood disorders, and associated suicidality. A meta-review was conducted by searching PsycINFO and PubMed for previous systematic reviews and meta-analyses of ICBT programs for anxiety, depression, and suicidality in children, adolescents, and adults. The results of the meta-review indicated that ICBT is effective in the treatment and prevention of mental health problems in adults and the treatment of these problems in youth. Issues of adherence and privacy have been raised. However, the major challenge for ICBT is implementation and uptake in the “real world.” The challenge is to find the best methods to embed, deliver, and implement ICBT routinely in complex health and education environments.