Depression

Beck initially set out to test the Freudian notion that depression is a consequence of “anger turned inward” (rage directed the introjected parent for not gratifying infantile desires) but soon came to conclude that no such unconscious motivation existed and that instead depressed patients actually believe that they were unlovable or inadequate. He developed a treatment that he named cognitive therapy that is as efficacious as and more enduring than antidepressant medications. It stands as the most often tested and most widely practiced treatment for depression.     

Depression

Abstract— The theory of clinical depression presented here integrates etiological factors, changes in specific structural and cellular substrates, ensuing symptomatology, and treatment and prevention. According to this theory, important etiological factors, such as stress, can suppress the production of new neurons in the adult human brain, thereby precipitating or maintaining a depressive episode. Most current treatments for depression are known to elevate brain serotonin neurotransmission, and such increases in serotonin have been shown to significantly augment the ongoing rate of neurogenesis, providing the neural substrate for new cognitions to be formed, and thereby facilitating recovery from the depressive episode. This theory also points to treatments that augment neurogenesis as new therapeutic opportunities.     

Depression

Patients with myocardial infarction who suffer from a depression are at increased risk of dying of a subsequent heart attack or some other complication of coronary artery disease (CAD). A considerable body of research has provided evidence that a major depression, which is found in 16 to 23 percent of patients with CAD, but also subliminal depressive symptoms are independent risk factors for an unfavourable outcome of CAD. However, it is not yet clear whether depression is a causal risk factor having impact on the course of the heart disease or merely a prognostic marker that allows predicting the outcomes of interest, without any causal influence on them. Several pathways between depression and CAD have been discussed. These include behavioral mechanisms such as low compliance with both medical treatment and life style recommendations as well as neurobiological links. Much attention has been paid to the hypothalamic-pituitary-adrenocortical and sympathomedullary hyperactivity found in depression. Other possible links include diminished heart rate variability, stress-induced ischemia, platelet activation, and immunological dysregulation. To resolve the issue whether depression is a causal risk factor or only a prognostic marker, experimental studies are needed to evaluate interventions aimed at improving depression and test whether mortality is subsequently reduced. Such studies brought in the past mixed results. Whereas comprehensive intervention programs including risk factor management have produced a reduction in both coronary morbidity and mortality, a recent multicenter study providing either cognitive-behavioral therapy or usual care to depressed patients with CAD could not demonstrate a survival benefit among the participants of the intervention. Finally, results of evaluation studies regarding integrated disease management programs for patients with comorbid depression are presented.     

Multiple Depression

The subject of this paper is the problematisation of depression in today's mental health care. It is based on a study of the professional discussion on depression in Finland from the mid-1980s to the 1990s. The ways in which Finnish mental health experts define the object of depression treatment bring out an ambivalence that stems from the discrepancy between two parallel but incongruent notions of what depression is: the psychopharmacological and the psychotherapeutic. The analysis of the discussion demonstrates how clinical and practical rationales of today's mental health care are formed in the space between the two poles. Two tendencies of these rationales are also pointed out: first, the DSM paradigm of depressive illness inclines to become problematic and to dissolve in the actual practices. Second, they insinuate emphasis on antidepressant medication and overall neuropsychiatric approach in the treatment of depressive disorders, although in an ambivalent way.     

Lao Depression Inventory

There are no measurement tools that accurately measure depression among Lao refugees. The overall purpose of this research was to complete the development and validation procedures for the Lao Depression Inventory (LDI). The study consisted of 216 Ethnic Lao refugees. A clinical interview and 164 true/false questions were administered to identify specific items which could identify depression among the Ethnic Lao people. All items were administered in both English and Lao. Overall, 78 of the 164 items differentiated groups of depressed and nondepressed Lao at the .01 level. Results of validation procedures showed that a 30-item scale had an accuracy rate of 89% in identifying the presence of depression in the validation group; the hit-rate for the same items and cutoff was 92% in the cross-validation group. Potential uses of the scale are discussed.     

抑郁症的隐喻

抑郁症作为一类精神疾患其隐喻由来已久,精神病学与心理学对该病认识的不断深入,相互运作并将抑郁症置于异化之中,社会文化等诸因素强化了病患扭曲的认同感。从社会、文化功能的角度探讨隐喻对抑郁症病患心理的消极影响,旨在丰富我国抑郁症研究的医学社会学内容。     

Lao Depression Inventory

There are no measurement tools that accurately measure depression among Lao refugees. The overall purpose of this research was to complete the development and validation procedures for the Lao Depression Inventory (LDI). The study consisted of 216 Ethnic Lao refugees. A clinical interview and 164 true/false questions were administered to identify specific items which could identify depression among the Ethnic Lao people. All items were administered in both English and Lao. Overall, 78 of the 164 items differentiated groups of depressed and nondepressed Lao at the .01 level. Results of validation procedures showed that a 30-item scale had an accuracy rate of 89% in identifying the presence of depression in the validation group; the hit-rate for the same items and cutoff was 92% in the cross-validation group. Potential uses of the scale are discussed.     

Defense Mechanisms in Mania,Bipolar Depression and Unipolar Depression

The present study compared the use of defense mechanisms in ten bipolar manic, ten bipolar depressed and ten unipolar depressed patients. The defense mechanisms were assessed by two methods: TAT stories scored by Defense Mechanism Manual and Defense Mechanism Rating Scale ratings of psychodynamic interviews. The severity of symptoms was assessed by Beck Depression Inventory for depressed patients and Young’s Manic Rating Scale for manic patients. Both bipolar manic and depressed groups used the defense mechanism of denial, borderline level defenses and immature defenses significantly more than the unipolar depression group. The manic group showed greater dependence on narcissistic level defenses as compared to the other two groups. Positive relationships were found between severity of manic symptoms and the defense mechanisms of denial as well as the narcissistic level defenses. The bipolar depression group also used more action level defenses as compared to the unipolar depression group. The unipolar depression group scored higher on the defense mechanism of identification and adaptive level defenses as compared to the manic group. A negative correlation was found between the severity of depressive symptoms for unipolar depression group and the defense mechanism of identification. The neurotic level defenses were used most frequently by unipolar depression group, followed by the bipolar depression group and manic group. Some of these findings are in consonance with the psychoanalytic understanding of mania and depression.     

Depression and motivation

Among the characteristic features of depression is a diminishment in or lack of action and motivation. In this paper, I consider a dominant philosophical account which purports to explain this lack of action or motivation. This approach comes in different versions but a common theme is, I argue, an over reliance on psychologistic assumptions about action–explanation and the nature of motivation. As a corrective I consider an alternative view that gives a prominent place to the body in motivation. Central to the experience of depression are changes to how a person is motivated to act and, also as central, are changes to bodily feelings and capacities. I argue that broadly characterizing motivation in terms of bodily capacities can, in particular, provide a more compelling account of depressive motivational pathology.     

细胞因子和抑郁症

在心理神经免疫学领域,越来越多的证据表明神经和免疫之间存在双向交流通路,免疫系统可能在一些心理精神障碍中具有重要作用。“抑郁症的细胞因子假说”认为细胞因子作为神经调质,可能在抑郁症的病因和病理过程中具有重要作用。这个假说得到了很多证据的支持。而在动物身上应用前炎性细胞因子也能够引起与人类抑郁症行为症状非常类似的“病态行为”。研究认为外周细胞因子通过信号传导进入脑内与中枢产生的细胞因子共同作用于下丘脑－垂体－肾上腺轴和5－羟色胺系统,从而导致抑郁症。细胞因子的中枢效应可以解释很多抑郁症状,“抑郁症的细胞因子假说”为探讨抑郁症状的机制和治疗抑郁症提供了一个新的视角     

Codependency and Depression

SUMMARY

The focus of this study was to investigate a correlation between codependency and depression. The instruments that were used for the study were the Beck Depression Inventory (BDI) and The Awareness Activity: How Codependent Are You? Results of this study were based on 149 paired inventories. The individuals who volunteered to complete the inventories were selected from three clinical settings in the New Orleans area; Subjects utilized were adults of both sexes and all ages. There was a strong, positive correlation between the two variables, codependency and depression, of .5966 (p < .00001). When the relationship between codependency and depression was assessed for each of the separate groups, the same trend prevailed across all three groups.

While one cannot conclude from this study that codependency and depression are equal, one may suggest that a relationship exists between them. These findings indicate that if a person reports himself/herself to be highly codependent, he/she is likely to experience an elevated level of depression.     

Depression und Paarbeziehung

The close relationship between depressive disorders and couple relationships has been well proved empirically.Conflicts and problems within the couples'relationship can be a significant trigger for depression. In additition, the quality of the relationship is often markedly impaired by depressive disorders, in many cases far beyond the depressive phase.The couples'relationship also influences significantly the course of depressions, especially when the disorders are not yet chronic.The link between depression and couples'relationship seems to be stronger and more evident for women than for men. Furthermore there seem to be patterns of interaction in couples with a depressed partner, which differ from those in healthy or other clinical comparison groups or distressed couples without depression.These patterns need further exploration with regard to different subgroups of depressed patients and phases of depression.Couples' therapy has been proved to be effective in the treatment of depression on the symptomatic and on the relationship level.Conjoint assessment and counselling sessions with depressed patients and their partners should be conducted regularly.For patients suffering from an ‘anaclitic’,‘sociotropc’form of depression couples' therapy in a more narrow sense is usually indicated. In the treatment of depressives of the ‘autonomous’ ‘introjective’ type partners should be included into treatment for the assessment and the working through of specific conflicts concerning the relationship.     

Psychotherapie bei Depression

Due to significant limitations in mental and physical being, social relationships, and working and functional abilities, prevention and treatment of depressive disorders—predicted to be the most common disorder in 2030—are of particular importance. In the S3 guideline Unipolar Depression, psychotherapy has gained in significance for the acute treatment of unipolar depression. It is noteworthy that psychotherapy is in general recommended as monotherapy or in combination in all degrees of severity of depression. The lasting effects of longer-term psychotherapies are often underestimated. A reflection of the current body of evidence based on the empirical research paradigm and its impact on clinical practice is presented.     

抑郁症的隐喻

抑郁症作为一类精神疾患其隐喻由来已久,精神病学与心理学对该病认识的不断深入,相互运作并将抑郁症置于异化之中,社会文化等诸因素强化了病患扭曲的认同感.从社会、文化功能的角度探讨隐喻对抑郁症病患心理的消极影响,旨在丰富我国抑郁症研究的医学社会学内容.     

Difficulties in the Treatment of Depression During Pregnancy and Postpartum Depression

Treatment with women who become depressed during pregnancy or who develop postpartum depression can be challenging. In certain cases where women have a poor parental representation rooted in a negative relationship with their own mothers, a powerful resistance emerges and can take the form of abandoning the treatment. For women who have a history of abandonment by one of the parents, this particular aspect of the relationship may be repeated. In others, where there is a great deal of anger towards the parent, in spite of conscious wishes to be different, there is an identification with this negative parental image; the new mother feels herself to be a bad mother and flees the treatment as a way to protect the baby. Biological as well as psychological factors present during pregnancy and postpartum depression, as well as the impact of the mother’s depression on the developing infant are described and clinical vignettes are provided to illustrate the main points.