KIN354 Lecture Notes - Lecture 7: Suicidal Ideation, Tricyclic Antidepressant, Pharmacotherapy
7 – DEPRESSION AND EXERCISE
⎯ Truncated range of emotion
⎯ Cannot experience happiness authentically but present functionally
⎯ They may experience anxiety symptoms, such as panic attacks
o However, they may not have a panic disorder
o It may not lead to avoidance
o People might also generally become anxious, can be selectively socially anxious
o Since they don’t derive much pleasure from it, people who were moderately social will withdraw from
their social activities
⎯ Suicidality is high, depressed people find themselves on the topic of death often
o Pre-occupied with death, severe injuries, searching for info (modern manifestations)
⎯ Thinking about suicide is different from taking steps to commit, which is different from actually committing
⎯ The vast majority of people who are depressed have suicidal ideation that they do not act on
o A subset of these people may prepare for suicide (may or may not have full intent to commit)
o Some people actually go through with it
⎯ The rate of suicide is much higher in people who have diagnosed or present, undiagnosed depression
Exercise
⎯ Depression is one of the most common, and can be debilitating
⎯ Exercise has an important role in the treatment and prevention of depression
⎯ Primary prevention: open to all
o Get involved with intervention with the absence of any symptoms
o Prevent the initial experience of depression
⎯ Secondary prevention: intervention that occurs when there is initial identification of depression
o Intervene when someone is at risk
o Experiencing symptoms but no diagnosable condition
⎯ Treatment/tertiary prevention: this is more in line with treating people who have diagnosed depression
Primary Prevention
Cairney et al., 2009
⎯ National Population Health Survey (NPHS) Canadian
Study of those 65 and older.
o Examined 6-year prospective data.
[N=1,327]
o Time lag association between changes in
activity level and changes in emotional
distress
o More psychological distress could be indicative of people who have depression
⎯ Increases in distress is the independent variable
o It correlated with people who reduced their activity level
⎯ People who were initially mildly sedentary and became moderately sedentary became more distressed
o The reverse is also true
⎯ The association between reduced activity and increase likelihood of reporting depressive symptoms was
important
⎯ A mediational analysis also showed that there were some intervening factors:
o Physical health
â–Ş Could be responsible for decreased activity and possible depressive symptoms
o Self-esteem/mastery
▪ People’s global evaluation of their own self-worth
o Other unknown factors
⎯ Given that decreased activity gave rise to increased depressive symptoms, what was responsible for that
increase?
o Self-esteem (39%) accounted for the rise the most
o People in this age range (>65 yo) had lower self-esteem and this generated symptoms of distress
Current Treatment Options
⎯ Pharmacotherapy is the frontline treatment
because it is easy to administer and tackles
many issues
o SSRIs improve depressive and anxiety
symptoms
o Tricyclic antidepressants increase risk
for discontinuation syndrome
(unpleasant side effects)
⎯ Psychotherapy is comparable in efficacy to
pharmacotherapy
⎯ rTMS is current approved as a second-line
treatment in Canada
o i.e. your symptoms have not
improved from the first line
treatments
⎯ Aerobic exercise?
o Is it a legitimate treatment?
Why Exercise?
⎯ We have two front-line treatments that work moderately well
⎯ Why this?
o It has beneficial effects that may be comparable to other options.
â–Ş The magnitude of effects is comparable to front-line treatments
o It can be continued indefinitely
â–Ş Though it has been argued that pharmacotherapy and psychotherapy can continue indefinitely,
it does not happen this way and it is not always advisable
o It may have many positive spinoffs for physical health (beyond the mental health benefits).
o It does not require $$$ (or at least, its comparatively very inexpensive).
o Does not require endurance of stigma or disclosure of Dxstatus.
o May be the most “acceptable” option.
Depression: What is it?
⎯ Part of the “mood disorders” group of psychiatric conditions
o Belongs to the same group as anxiety disorders
⎯ Characterized by:
o Sad or flat emotionality
â–Ş Tends to be pervasive
o Recurring negative thoughts about one’s self, others, the future.
o Suicidal thoughts very common; actual attempts less so, but still a significant concern.
o Withdrawal from others
o Loss of interest in activities that were previously enjoyable
⎯ Without treatment, depression can last years, or in fact never fully improve.
o Tends to be episodic
o Even without treatment, they may recover, though full functionality never returns
⎯ With treatment, increases the chances of fuller return to function.
⎯ Depression tends to be recurrent
o If they have one episode, they are likely to have another
o The severity will always vary
Types of Depression
⎯ Unipolar
o Dysthymia
â–Ş A lower grade depression that is more persistent
â–Ş Rather than being episodic with a big crash, the person is at a low
â–Ş Has normal responsiveness and social engagement (i.e. mildly depressed but functional)
▪ Never really “snap out of it”
â–Ş Not as heavy as MDD but persistent over time
o MDD
â–Ş Most common manifestation
â–Ş With or without psychotic features
• A subset of people experience hallucinations or delusions, they may act bizarre
â–Ş Likely to have multiple episodes
• Treatment for the first episode (esp. with CBT) can help prevent/reduce the severity of
the later episodes
Document Summary
Cannot experience happiness authentically but present functionally. They may experience anxiety symptoms, such as panic attacks: however, they may not have a panic disorder. It may not lead to avoidance: people might also generally become anxious, can be selectively socially anxious, i(cid:374)(cid:272)e the(cid:455) do(cid:374)"t de(cid:396)i(cid:448)e (cid:373)u(cid:272)h pleasu(cid:396)e f(cid:396)o(cid:373) it, people (cid:449)ho (cid:449)e(cid:396)e (cid:373)ode(cid:396)atel(cid:455) so(cid:272)ial (cid:449)ill (cid:449)ithd(cid:396)a(cid:449) f(cid:396)o(cid:373) their social activities. Suicidality is high, depressed people find themselves on the topic of death often: pre-occupied with death, severe injuries, searching for info (modern manifestations) Thinking about suicide is different from taking steps to commit, which is different from actually committing. The rate of suicide is much higher in people who have diagnosed or present, undiagnosed depression. Depression is one of the most common, and can be debilitating. Exercise has an important role in the treatment and prevention of depression. Primary prevention: open to all: get involved with intervention with the absence of any symptoms, prevent the initial experience of depression.
