Beck Depression Inventory

1
Beck Depression Inventory
Sadness
0 I do not feel sad
1 I feel sad
2 I am sad all the time
and cannot snap out of it
3 I am so sad or unhappy that I cannot stand it
Self-dislike
0 I do not feel disappointed in myself
1 I am disappointed in myself
2 I am disgusted with myself
3 I hate myself
2
Beck Depression Inventory
Crying Spells
0 I don't cry any more than usual
1 I cry more now than I used to
2 I cry all the time now
3 I used to be able to cry but now I cannot
cry even though I want to
Work Difficulty
0 I can work about as well as before
1 It takes extra effort to get started
at doing something
2 I have to push myself very hard to do anything
3 I cannot do any work at all
3
Symptoms of Depression
Emotional
Sadness
Anhedonia
Crying
Irritable
Guilt
Loss of Affectionate Feelings
Cognitive
Self-Devaluation/Negative Self-Image
Concentration Difficulties
Indecisive
Suicidal Thoughts
4
Symptoms of Depression
Motivational
Agitation or Retardation
Indecisive
Increases with Severity
Physical
Loss of Appetite
Weight Loss
Difficulty Sleeping
Weakness and fatigue
Loss of Interest in Sex
More Susceptible to Physical Illness
5
Lifetime Prevalence Rates of Major Mental
Disorders
6
Depression Risk factors

• Sex Depression is approximately twice as common
  in women than men
• Age Depression occurs most frequently in young
  adults
• Education Higher prevalence of depression in
  people with less than a college education
• Socioeconomic class More frequently present
  among members of lower socioeconomic status
• Reference Blazer et al, 1994

7
Causative Theories of Depression

• Cognitive theories
• Negative thought processes as causative factors
  in depression
• Cognitive-Behavioral theories
• Uncontrolled aversive events give rise to learned
  helplessness
• Biological Theories
• Abnormal biological processes, possibly
  inherited, give rise to depression

8
"Being Alone on a Friday Night"
A. Doesn't bother me because I figure I'll
have a date next weekend for sure.
B. Upsets me and makes me feel lonely.
C. Upsets me and makes me start to imagine
endless days and nights by myself.
D. Doesn't bother me because one Friday
night alone isn't that important,
probably everyone has spent nights alone
9
Becks Negative Triad TheoryAn example of a
cognitive theory

• Depressed individuals have acquired negative
  schemata or beliefs (Negative triad theory)

10
Becks Negative Triad TheoryAn example of a
cognitive theory

• Depressed individuals have acquired negative
  schemata or beliefs (Negative triad theory)
• These negative beliefs bias and distort thinking
  in such a way that the individual misperceives
  reality

11
Biological Theories of Depression

• Some evidence for heritability of depression
  (although genetic factors do not appear to be as
  influential as in other disorders)
• The advent of various pharmacological compounds
  that appear to aid in the treatment of depression
  provide insight into possible neurochemical
  causes of depression

12
Prevalence of antidepressants Annual sales for
GlaxoSmithKline
Reference GlaxoSmithKline online quarterly report
13
Marketing of Antidepressants Direct-to-consumer
advertising
Reference Rosenthal et al, 2002 (NEJM)
14
How effective are antidepressants? Comparison
with Placebo
Reference Kirsch et al, 2002 (Prevention and
Treatment)
15
Patterns of Depression
Recovery without
1/2
(40)
Recurrence
16
Patterns of Depression
Recovery without
1/2
(40)
Recurrence
Recovery with
Recurrence (50)
3
17
Patterns of Depression
Recovery without
1/2
(40)
Recurrence
Recovery with
Recurrence (50)
3
Chronic (10)
18
Vulnerability to Depression
Intimate Relationship
Part-time or Full-time Job
Serious Religious Commitment
19
CHANGING DEPRESSION
Overall
Almost all get better
Happy prospects for a sad disease
(Solomon Snyder, "The Troubled Mind")
20
CHANGING DEPRESSION
ECT
Overall
Almost all get better
Effective for 75-90
Happy prospects for a sad disease
Side effects
Advantages
(Solomon Snyder, "The Troubled Mind")
Rx of choice
Suicidal
Extreme malnutrition
Severely depressed
21
CHANGING DEPRESSION
ECT
Overall
Almost all get better
Effective for 75-90
Happy prospects for a sad disease
Side effects
Advantages
(Solomon Snyder, "The Troubled Mind")
Rx of choice
Suicidal
Extreme malnutrition
Antidepressants
Severely depressed
MAO Inbibitors
Tricyclics -
Disadvantage - 1-3 weeks
Advantage - Prevention of relapse
22
CHANGING DEPRESSION
Overall
ECT
Almost all get better
Effective for 75-90
Happy prospects for a sad disease
Side effects
Advantages
(Solomon Snyder, "The Troubled Mind")
Rx of choice
Suicidal
Extreme malnutrition
Antidepressants
Severely depressed
MAO Inbibitors
Tricyclics -
Therapy
Disadvantage - 1-3 weeks
Severe - Some recommended
(Cognitive)
Advantage - Prevention of relapse
Moderate - Method of choice
23
Types of Depression
Exogenous
Endogenous
Genetics
Precipitating Event
Retardation
Agitation
Rxn to Environment
Less Responsive
Anhedonia or Melancholia
More Severe
Less Severe
Drugs/ECT
Psychotherapy
24
EXOGENOUS
ENDOGENOUS
SAD
GRIEF




NEUROTIC
PSYCHOTIC
Impairment
Cause
25
EXOGENOUS
ENDOGENOUS
SAD
GRIEF




NEUROTIC
PSYCHOTIC
Impairment
Cause
Environment
Early childhood
Genetic Predisposition
Change
26
EXOGENOUS
ENDOGENOUS
SAD
GRIEF




NEUROTIC
PSYCHOTIC
Impairment
Cause
Environment
Early childhood
Genetic Predisposition
Change
None/Self-help
Therapy
Drugs
27
Efficacy and safety of antidepressants for
children and adolescents Menkes, et al, British
Medical J.
28
The magnitude of benefit is unlikely to be
sufficient to justify riskingthose harms
(side-effects), so confidently recommending these
drugs as a treatment option, let alone as first
line treatment, would be inappropriate.
29
"Been Looking for a Job Unsuccessfully for
Awhile."
What was one cause of this event?
30
"Been Looking for a Job Unsuccessfully for
Awhile."
What was one cause of this event?
1. Is the cause something about you or other
people?
1 2 3 4 5 6 7
2. In the future will this cause be present
again?
1 2 3 4 5 6 7
3. Does the cause influence this or all
situations?
1 2 3 4 5 6 7
4. How important is this event if it happened to
you?
1 2 3 4 5 6 7
31
"Been Looking for a Job Unsuccessfully for
Awhile."
What was one cause of this event?
Depressive Attributional Style
1. Is the cause something about you or other
people?
Internal
1 2 3 4 5 6 7
2. In the future will this cause be present
again?
Stable
1 2 3 4 5 6 7
3. Does the cause influence this or all
situations?
Global
1 2 3 4 5 6 7
4. How important is this event if it happened to
you?
1 2 3 4 5 6 7
32
Cognitive Style and Depression
Learned Helplessness
(Seligman)
Initial Formulation
At first

Stress Anxiety
If control unattainable
Stress Depression
Attribution Theory
Attribution Theory and Negative Event Interaction
33
Types of Depression
Exogenous
Endogenous
Genetics
Precipitating Event
Retardation
Agitation
Rxn to Environment
Less Responsive
Anhedonia or Melancholia
More Severe
Less Severe
Drugs/ECT
Psychotherapy
34
"Been Looking for a Job Unsuccessfully for
Awhile."
What was one cause of this event?
35
"Been Looking for a Job Unsuccessfully for
Awhile."
What was one cause of this event?
1. Is the cause something about you or other
people?
1 2 3 4 5 6 7
2. In the future will this cause be present
again?
1 2 3 4 5 6 7
3. Does the cause influence this or all
situations?
1 2 3 4 5 6 7
4. How important is this event if it happened to
you?
1 2 3 4 5 6 7
36
"Been Looking for a Job Unsuccessfully for
Awhile."
What was one cause of this event?
Depressive Attributional Style
1. Is the cause something about you or other
people?
Internal
1 2 3 4 5 6 7
2. In the future will this cause be present
again?
Stable
1 2 3 4 5 6 7
3. Does the cause influence this or all
situations?
Global
1 2 3 4 5 6 7
4. How important is this event if it happened to
you?
1 2 3 4 5 6 7
37
Cognitive Style and Depression
Learned Helplessness
(Seligman)
Initial Formulation
At first

Stress Anxiety
If control unattainable
Stress Depression
Attribution Theory
Attribution Theory and Negative Event Interaction