Mood disorders in youth, specifically depression and bipolar disorder, have been increasingly prevalent. Treatment standards for youth essentially reflect those intervention strategies used with adults; however, there are serious concerns as to the effectiveness and safety of these interventions. Moreover, with growing pressures to use “evidence-based” treatments, clinicians are compelled to critically examine the literature to determine the most effective treatment course. This article examines current treatment approaches for mood disorders in youth and scrutinizes the justification for using psychotropic medications as a “front-line” intervention.
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Background: Treatment of depression with a single pharmaceutical agent often does not work, and several agents may be tried or combined to increase efficacy. Augmentation involves the addition of one or more medications to an existing antidepressant monotherapy to enhance mood and overall antidepressant response. Approximately 22% of individuals with unipolar depression are prescribed augmentation strategies. This study examined the effectiveness of augmentation strategies. Methods: A Medline search of studies published before January 1, 2007 was conducted to assess the extent of published data on the most frequently prescribed augmentation strategies. Studies with completed original data, sufficient efficacy data, and participants diagnosed with unipolar depression were included. Letters to the editor, preliminary data, data only presented at conferences, and small uncontrolled case reports were excluded. Results: 13 studies contained sufficient data to calculate an effect size. Mean estimated effect size of all 13 studies calculated with random effects was 0.1782 with a 95% confidence interval of −0.2513−0.6076. Conclusions: There are minimal published data examining antidepressant augmentation, and augmentation is a minimally effective treatment option.
This article outlines a theory of depression and the rudiments of a treatment plan. It builds upon my earlier study of interviews in a mental hospital and the work of the psychologist Helen Block Lewis. Theory: Recursive shame-based spirals may be the basic mechanism of both clinical depression and extreme violence. Shame–fear, shame–shame, and shame–anger spirals are described. Hypotheses: depression may result from a shame–shame spiral or when the anger in shame–anger spirals is directed in, recursively, without limit. Similarly, violence can result if the anger in the shame–anger spiral is directed out. These ideas lead to a proposal for treatment of depression focused on social bonds and hidden emotions. In this connection, possible effects of antidepressants on emotion are also discussed.
- Go to article: Is Social Anxiety Making Us Depressed?: A Social Evolutionary Hypothesis for Why SSRIs Work
In the developed world, the use of selective serotonin reuptake inhibitors (SSRIs) has skyrocketed since 1988, when Prozac was first released in the United States. Biomedical psychiatry’s explanation for their success is an unsubstantiated hypothesis that claims SSRIs treat a chemical imbalance in people who suffer from low levels of the neurotransmitter serotonin. Using social evolutionary theory, this article provides an alternative hypothesis for why SSRIs work for some people. SSRIs’ success is attributed to their capacity to adapt people to the increased status anxiety occurring in developed nations grappling with the effects of unprecedented global competition. Biomedical psychiatry is depicted as adjusting patients to prevailing social norms rather than contributing to mental health.
- Go to article: Exposure to SSRI Antidepressants In Utero Causes Birth Defects, Neonatal Withdrawal Symptoms, and Brain Damage
Exposure to SSRI Antidepressants In Utero Causes Birth Defects, Neonatal Withdrawal Symptoms, and Brain Damage
Pregnant mothers should avoid taking SSRI antidepressants—they are hazardous to the developing fetus, cause withdrawal symptoms in the newborn baby, and induce biochemical and morphological abnormalities in the brain. If pregnant mothers need help with sad or anxious feelings, they should seek counseling or psychotherapy, especially family therapy involving the child’s father, as well as other sources of emotional support.
Among the huge accumulation of psychological books offered in libraries and book stores, a relative few volumes stand out in an otherwise deluge of self-help exhortations, and discuss the psychotherapeutic process itself. Of that small portion, most consist of self-congratulatory case histories from professional therapists. Few volumes come from patients. The author, a long-term psychotherapy patient, briefly summarizes lessons gained in one of the most difficult processes a human can endure. The essay criticizes the current emphasis on psychotropic medication and equates anesthetizing unpleasant emotions, particulary depression, to shooting the messenger. Unpleasant emotions, like physiological pain, act as the body’s signals that something needs attention. Drugging them into insensitivity in the belief that they stem from unbalanced chemistry cures nothing. The argument offers an admittedly more difficult alternative that preserves the natural signal functions of depression, anxiety, and fear.
The present study explored the relationships between metacognitions, negative emotions, and procrastination. A convenience sample of 179 participants completed the following questionnaires: General Procrastination Scale, Decisional Procrastination Scale, Meta-cognitions Questionnaire 30, Penn State Worry Questionnaire and Hospital Anxiety and Depression Scale. A cross-sectional design was adopted and data analysis consisted of correlation and multiple regression analyses. One dimension of metacognitions was found to be positively and significantly correlated with behavioral procrastination. Four dimensions of metacognitions were found to be positively and significantly correlated with decisional procrastination. Positive and significant relationships were also observed between anxiety, depression and behavioral procrastination; and between anxiety, depression, worry, and decisional procrastination. Multiple regression analyses indicated that depression and beliefs about cognitive confidence independently predicted behavioral procrastination, and that depression and positive beliefs about worry independently predicted decisional procrastination. These preliminary results would seem to suggest that metacognitive theory may be relevant to understanding procrastination.
- Go to article: On the Integration of Cognitive-Behavioral Therapy for Depression and Positive Psychology
Cognitive-behavior therapy (CBT) has received extensive empirical support as an efficacious intervention for the acute treatment of major depressive disorder and the prevention of depressive relapse. Nevertheless, many patients do not respond favorably to CBT, and the specific active ingredients of CBT remain unclear. With its emphasis on identifying and cultivating individual strengths, however, positive psychology appears to have considerable potential to enhance the efficacy of CBT and to help clarify the processes that mediate its salubrious effects. We outline existing areas of conceptual and technical overlap between CBT and positive psychology, and discuss how CBT may be extended and improved through the incorporation of positive psychological principles.
The current study examined the factorial categorization of 12 depression-related constructs in a sample of seventh graders. For this purpose, different vulnerability factors, as well as depressive symptoms, were assessed, including depressogenic inferential styles about the self, consequences, and causes; dependency; self-criticism; distraction; problem solving; rumination; self-esteem; and social support. Separate exploratory factor analyses by sex revealed that symptoms of depression consistently loaded onto a separate factor from vulnerability constructs. Generally, girls and boys displayed similar factor structures, as indicated by separable factors tapping coping, self-view, and pessimism. Additionally, there were noteworthy sex differences. Girls, but not boys, displayed a pattern suggesting the development of a coping style encompassing social support.
In depression, negative beliefs are coupled with profound physical weakness. Specifically, the belief that one is incapable of altering events in order to prevent expected negative outcomes or bring about positive outcomes leads to bodily symptoms characterized by low energy, slow motor movement, and delays in the initiation of movement. The purpose of this article is to present a theoretical model describing the causal mechanisms that link these cognitive and somatic elements of depression. We propose that (a) the inability to alter events is conceptualized metaphorically as motor incapacity; (b) as part of this conceptualization, the experience of motor incapacity is mentally simulated; and (c) this simulation leads to both subjective feelings of lethargy and peripheral physiological changes consistent with motor incapacity.