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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- Go to article: Dysthymia and Major Depression: Distinct Conditions or Different Stages Along a One-Dimensional Continuum?
Dysthymia and Major Depression: Distinct Conditions or Different Stages Along a One-Dimensional Continuum?
Until recently researchers have discussed whether dysthymia and major depression represent distinct conditions or rather different stages along a one-dimensional continuum. This study addresses this question by examining the belief systems of normal, dysthymic, and depressed participants. We explored participants’ beliefs and differentiated between positive and negative as well as between core and peripheral beliefs. Normal participants showed fewer negative beliefs and negative peripheral beliefs than the dysthymic group, whereas normal participants had more positive beliefs and positive core beliefs as well as fewer negative core beliefs than the depressed group. The hypothesized one-dimensional continuum could not be demonstrated for the belief systems. Instead, the data point to the conclusion that our idea of a one-dimensional continuum reaching from normal to dysthymic to depressed was too simple. Apparently, the differences in the belief systems reported here are related to the chronic character and severity of the mood disorder.
- Go to article: The Relationship of Cognitive Style and Attachment Style to Depression and Anxiety in Young Adults
This study examined the associations between attachment style and cognitive style and depression and anxiety symptomatology. Using a college sample of 167 participants, the tripartite model of depression and anxiety (Clark & Watson, 1991) was employed to examine whether the construct of negative affectivity could account for the previously reported relationships between insecure attachment style and negative cognitive style and both depression and anxiety. Negative cognitive style and insecure attachment were found to be significantly associated with both depression and anxiety symptomatology. Although negative affectivity effectively accounted for the relationships between negative cognitive style and both depression and anxiety and could explain the relationship between insecure attachment and anxiety, it failed to account for the association between insecure attachment and depression. In addition, negative cognitive style and insecure attachment appeared to be independently and uniquely associated with negative affect, rather than forming a mediational relationship.
- Go to article: Childhood Emotional Maltreatment, Cognitive Vulnerability to Depression, and Self-Referent Information Processing in Adulthood: Reciprocal Relations
Childhood Emotional Maltreatment, Cognitive Vulnerability to Depression, and Self-Referent Information Processing in Adulthood: Reciprocal Relations
Previous work has established a relationship between reports of childhood emotional maltreatment and cognitive vulnerability to depression, as well as an association between cognitive vulnerability and self-referent information-processing biases. Findings from this study of individuals at low (LR) and high (HR) cognitive risk for depression revealed a relationship between reports of childhood emotional maltreatment and current information processing biases. Specifically, individuals with greater childhood emotional maltreatment exhibited more negative self-referent information processing. Moreover, cognitive risk mediated the relationship between childhood emotional maltreatment and these information-processing biases. Testing an alternate model, information-processing biases also mediated the relationship between childhood emotional maltreatment and cognitive risk.
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.
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.
- Go to article: Consumer Advertising of Psychiatric Medications Biases the Public Against Nonpharmacological Treatment
Consumer Advertising of Psychiatric Medications Biases the Public Against Nonpharmacological Treatment
In the United States, aWntidepressant medications are heavily promoted through direct-to-consumer advertising, which is regulated by the Food and Drug Administration (FDA). Advertisements for selective serotonin reuptake inhibitors frequently contain information inconsistent with the scientific evidence on the treatment of depression with antidepressants. The information presented serves to promote the use of antidepressants by biasing the public against nonpharmacological treatment of depression. While the FDA enforces regulations requiring fair and balanced presentation when comparing one medication to another, there appears to be no action taken against pharmaceutical companies that distort scientific evidence in order to disparage nonmedical approaches to depression.
- Go to article: Stability and Change of Sociotropy and Autonomy Subscales in Cognitive Therapy of Depression
Sociotropy and autonomy have been demonstrated to be a diathesis for depression as well as predictors of treatment outcome. There are few studies, however, that have investigated whether these vulnerability factors change with cognitive therapy (CT) and are associated with outcome in CT. Also, it appears that the autonomy construct may have both positive and negative content and it is important to examine these two aspects of autonomy in treatment. In this study, depressed outpatients (N = 149) were followed from intake to the 12th session of CT. The treatment outcome variables included depression (Beck Depression Inventory), hopelessness (Beck Hopelessness Scale), and sociotropy and autonomy (Sociotropy-Autonomy Scale [SAS]). Using a repeated measures analysis, depression symptoms and hopelessness decreased significantly over time. Both subscales of sociotropy, preference for affiliation and fear of criticism and rejection, were positively associated with depression at intake, and decreased significantly over time in those who responded to treatment. However, independent goal attainment, one subscale of autonomy, increased significantly over sessions and was associated with treatment response. The second subscale of autonomy, sensitivity to others’ control, demonstrated no change. The results suggest that independent goal attainment may be an indicator of psychological health. Implications for future research using the SAS and its subscales in treatment and vulnerability research are described.
- 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.
This article traces the origins of intrusive thoughts in depression, devoting special attention to how misguided attempts to gain mental control can ironically fuel unwanted thoughts. A review of the research highlights the ways in which cognitive biases, stress, and thought suppression can contribute to the development and maintenance of depression. The article concludes with a consideration of the implications for treatment.