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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 2014 psyc 2340 abnormal psychology brett deacon ph d

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

Or everything you ever wanted to know about antidepressant medications

Or, Everything You Ever Wanted to Know about Antidepressant Medications



  • Exam #2 handed back

  • Midterm grades turned in

From last class

From Last Class

  • Genetic influences on depression

  • Chemical imbalance theory

    • Popularity

    • Accuracy

    • Effects on depressed individuals

Treatments for depression

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 depression1

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

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 treatments1

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

Mood disorders iii chapter 7 march 12 2014 psyc 2340 abnormal psychology brett deacon ph d

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

Psychotherapy vs. Antidepressants: Long-Term Cost-Effectiveness

Dobson et al., 2008

Adverse effects of antidepressants

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

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

Medication vs psychotherapy for depression a summary

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

60 Minutes Story on Antidepressants


Antidepressants in the news

Antidepressants in the News

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








Drug treatments for mood disorders

Drug Treatments for Mood Disorders

  • Antidepressant medications

  • CDC study:

  • 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

Many Americans Take Antidepressant Medications



CDC, 2011

Drug treatments for mood disorders1

Drug Treatments for Mood Disorders

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

    • First SSRI was Prozac (1987)



Basis of prozac s fda approval

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 approval1

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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