Mood disorders iii chapter 7 march 12 2014 psyc 2340 abnormal psychology brett deacon ph d
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Mood Disorders III (Chapter 7) March 12, 2014 PSYC 2340: Abnormal Psychology Brett Deacon, Ph.D. Or, Everything You Ever Wanted to Know about Antidepressant Medications. Announcements. Exam #2 handed back Midterm grades turned in. From Last Class. Genetic influences on depression

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Mood Disorders III (Chapter 7) March 12, 2014 PSYC 2340: Abnormal Psychology Brett Deacon, Ph.D.

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Mood Disorders III(Chapter 7)March 12, 2014PSYC 2340: Abnormal PsychologyBrett Deacon, Ph.D.


Or, Everything You Ever Wanted to Know about Antidepressant Medications


Announcements

  • Exam #2 handed back

  • Midterm grades turned in


From Last Class

  • Genetic influences on depression

  • Chemical imbalance theory

    • Popularity

    • Accuracy

    • Effects on depressed individuals


Treatments for Depression

  • Cognitive therapy

    • Supported by large body of evidence

    • Directly targets errors in thinking

    • Teaches patients to:

      • 1. Identify thinking errors

      • 2. Dispute them

      • 3. Generate more accurate ways of thinking

      • 4. Generate practical solutions to problems


Treatments for Depression

  • Behavioral activation

    • Increases contact with reinforcing events

    • Equal to or more effective than cognitive therapy (Jacobson et al., 1996; Dimidjian et al., 2006)

  • Interpersonal psychotherapy

    • Addresses problematic relationship functioning associated with depression

  • Physical exercise

  • “Antidepressant” medications


Comparison of Four Depression Treatments

  • Dimidjian et al. (2006)

  • Compared Paxil, placebo, cognitive therapy, and behavioral activation during 8 weeks of treatment for 241 depressed patients

  • Examined low vs. high severity patients separately

    • Why?


Comparison of Four Depression Treatments

  • Dropout rates:

    • Cognitive therapy = 13.3%

    • Behavioral activation = 16.3%

    • Paxil = 44.4%

  • For “low severity” participants, Paxil was not significantly more effective than placebo pill

    • Placebo was 85.7% as effective as Paxil on self-reported depressive symptoms and 85.6% as effective on clinician-rated symptoms


Cognitive therapy vs. Behavioral Activation vs. Antidepressants: Long-Term Maintenance of Gains After Treatment Discontinuation

Dobson et al., 2008


Psychotherapy vs. Antidepressants: Long-Term Cost-Effectiveness

Dobson et al., 2008


Adverse Effects of Antidepressants

  • Drug-induced treatment resistance and chronic depressive symptoms

  • Long-term use of antidepressant medication, even when immediately beneficial, may produce a state of “tardive dysphoria” in 30% to 50% of patients characterized by loss of drug efficacy with symptom exacerbation, increased risk of relapse, and diminished and potentially irreversible responsiveness to subsequent drug treatment (El-Mallakh et al., 2011; Fava, 2003; Fava & Offidani, 2010)


Prior Antidepressant Exposure and Treatment Response (Leykin et al., 2007)


Medication vs. Psychotherapy for Depression: A Summary

  • Antidepressants are as effective as psychosocial treatments in the short term for mild, moderate, and severe depression

  • The small advantage of antidepressants over placebo is the same with psychotherapy – what does this mean?

  • Psychotherapy is far more effective in preventing relapse

  • Psychotherapy is less expensive (vs. brand name antidepressants)

  • Psychotherapy is preferred by patients

  • More patients refuse or drop out of pharmacotherapy; psychotherapy has no adverse physical effects

  • Psychotherapy is difficult to access and not used by many


60 Minutes Story on Antidepressants

  • http://www.youtube.com/watch?v=Zihdr36WVi4


Antidepressants in the News

  • Fallout from the 60 Minutes story on the placebo effect in antidepressants

  • http://ww2.psych.org/MainMenu/Newsroom/NewsReleases/2012-News-Releases/60-Minutes-Segment-on-Antidepressants-Irresponsible-and-Dangerous.aspx?FT=.pdf

  • http://www.huffingtonpost.com/dr-harold-koplewicz/placebo-effect_b_1332416.html

  • http://www.madinamerica.com/2012/02/the-american-psychiatric-associations-response-to-60-minutes-evidence-based-response-or-propaganda/

  • http://www.psychologytoday.com/blog/the-skeptical-sleuth/201202/cbs-60-minutes-news-treating-depression-sorting-through-the-confu-0

  • http://www.psychologytoday.com/blog/the-skeptical-sleuth/201203/irving-kirsch-d-j-vu-all-over-again

  • http://www.psychologytoday.com/blog/who-we-are/201203/demonizing-kirsch-will-get-us-nowhere

  • http://www.psychologytoday.com/blog/our-empathic-nature/201203/the-media-war-anti-depressants


Drug Treatments for Mood Disorders

  • Antidepressant medications

  • CDC study: http://www.cdc.gov/nchs/data/databriefs/db76.htm

  • Key findings include:

    • Eleven percent of Americans aged 12 years and over take antidepressant medication.

    • More than 60% of Americans taking antidepressant medication have taken it for 2 years or longer, with 14% having taken the medication for 10 years or more.


Many Americans Take Antidepressant Medications

Overall

average

CDC, 2011


Drug Treatments for Mood Disorders

  • Newer generation antidepressants (e.g., SSRIs)

    • First SSRI was Prozac (1987)

2010

1990


Basis of Prozac’s FDA Approval

  • A note about FDA requirements for approval

  • 5 Prozac studies involving 1,132 depressed patients

  • Each trial lasted between 4 - 8 weeks

  • The trials included a 1- to 2-wk washout period during which patients were given placebo, prior to random assignment. Those whose scores improved 20% or more were excluded from the study prior to random assignment.

  • Replacement of patients who investigators determined were not improving after 2 weeks was allowed in three Prozac trials.

  • Many patients were given a sedative medication to minimize adverse effects.

  • Investigators coded suicide attempts as “overdose” to minimize apparent adverse effects.

  • Depressive symptoms were measured only using the clinician-rated Hamilton Rating Scale for Depression. Self-report symptoms were not assessed.


Basis of Prozac’s FDA Approval

  • 3 trials showed a statistically significant advantage of Prozac vs. placebo; 2 did not

  • Averaged across all trials:

    • Average improvement with Prozac = 8.30 points on HAM-D

    • Average improvement with placebo = 7.34 points on HAM-D

  • 89% of drug effect duplicated with placebo

  • The FDA approved Prozac for adults in 1987


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