Symptoms of Depression
The number and severity of the symptoms can vary from one person to another. Whereas some people experience only a few symptoms, other people experience many. Common symptoms include:
- Persistent sad mood
- Feelings of hopelessness
- Feelings of guilt or worthlessness
- Loss of interest or pleasure in hobbies or enjoyable activities, including sex
- Decreased energy, fatigue, being "slowed down"
- Difficulty concentrating or making decisions
- Problems sleeping
- Appetite and/or weight loss or overeating and weight gain
- Thoughts of death or suicide
- Restlessness or irritability
- Persistent physical complaints such as headaches or chronic pain
Causes of Depression
In some families, major depression appears to occur in each generation. However, there does not have to be a family history of depression for it to occur. People who have low self-esteem, who consistently view themselves and the world with pessimism or who are readily overwhelmed by stress, are also prone to depression. People with medical illnesses such as stroke, a heart attack, cancer, or hormonal disorders often experience depressive symptoms as well. These symptoms may then make the medical condition worse or prolong recovery. A serious loss, difficult relationship, financial problem, or any stressful (unwelcome or even desired) change in life patterns can also trigger a depressive episode. Very often, a combination of factors is involved in the onset of a depressive disorder.
Definitions adapted from Depression, NIH Publication No. 00-3561, May 2002, and Depression (Unipolar) August 2002.
Pertinent websites NIMH: http://www.nimh.nih.gov/health/publications/depression/complete-index.shtml
Community Treatment for Depression Studies
Investigators at the Center for Psychotherapy Research are directing studies focused on treating depression in community settings.
- A Comparison of Cognitive and Dynamic Therapy for Major Depressive Disorder in Community Settings
- The Development of a Therapist Feedback System for Major Depressive Disorder in Community Mental Health
- Development of a Tool to Measure Consumer Preferences in MDD Treatment
- The Mechanisms of Cognitive and Dynamic Therapy in Community Settings
Principal Investigator: Mary Beth Connolly Gibbons, PhD (AHRQ funded)
This five-year, federally funded study seeks to explore the effectiveness of cognitive therapy (CT) and supportive-expressive psychodynamic therapy (SE) for depression in community mental health centers. Although CT has already been shown to be effective in the treatment of depression, very little research has been conducted examining the effectiveness of dynamic therapy, despite the frequency with which various dynamic therapies are implemented in clinical practice. This study will compare the effectiveness of the CT and SE in the treatment of depression in order to assess whether treatment with SE results in comparable alleviation of symptoms.
The specific aims of this study are to:
- Conduct a randomized non-inferiority trial to compare SE and CT for patients with major depressive disorder, and
- Assess the comparative effectiveness of SE and CT on secondary measures of symptoms, patient functioning, and quality of life.
The Development of a Therapist Feedback System for Major Depressive Disorder in Community Mental Health
Principal Investigator: Mary Beth Connolly Gibbons, PhD (NIMH funded)
This study seeks to establish a therapist feedback system to help clinicians better track their patients’ symptoms and outcome over the course of treatment. Although previous research has demonstrated that treatment outcomes improve when therapists receive feedback (regardless of whether that feedback is positive or negative), very few therapists in the community mental health system receive any feedback on the clients they treat. This study aims to increase the ease, efficiency, and frequency of delivering feedback to therapists treating patients for depression by establishing a feedback infrastructure in a community mental health setting and conducting a randomized pilot study exploring treatment outcomes when therapists receive feedback versus no feedback.
The specific aims of this study are to:
- Develop a computerized administration of both the BASIS-24 and the Community Therapist Feedback Questionnaire (CTFQ) that is satisfactory to community consumers of mental health services,
- Develop recovery curves for the BASIS-24 that can be used in the feedback system to identify patients who are not progressing across early treatment sessions,
- Develop the algorithms for the CTFQ report that translate CTFQ subscale scores into clinical text,
- Develop community-friendly reports based on both the BASIS-24 and the CTFQ that can be used to provide therapists with feedback on patients who are potential treatment failures,
- Develop a computerized feedback system in the community mental health center to provide timely feedback reports to therapists, and
- Conduct a pilot randomized study of therapist feedback versus no feedback in the treatment of major depressive disorder in community mental health.
Principal Investigator: Paul Crits-Christoph, PhD (NIMH funded)
The overall goal of this grant is to develop and pilot an instrument that helps guide clinical treatment decisions for people seeking treatment for major depressive disorder in a community mental health setting by incorporating evidence-based practice data that has been customized to the treatment preferences of individual consumers.
The specific aims of this study are:
- To investigate the best (i.e., valid and user-friendly) method of assessing consumer preferences for evidence-based mental health treatment.
- To utilize consumer ratings to evaluate three preferences instruments for their clarity, difficulty, reasonableness, and comfort level.
- To determine the ability of each measure to predict time spent in initial treatment in order to ascertain the relative validity and clinical usefulness of the instruments.
The Mechanisms of Cognitive and Dynamic Therapy in Community Settings
Principal Investigator: Paul Crits-Christoph, PhD (NIMH Funded)
The study seeks to examine the mechanism of action of cognitive therapy and supportive-expressive psychodynamic therapy in a community mental health setting in regards to major depressive disorder. The study will be appended to a recently funded comparative effectiveness study of these two psychotherapies. Studies of the mechanism of CT have rarely used an alternative psychotherapy as a comparison group; no fully adequate and comprehensive test of these potential mediators has been done to date. In the parent effectiveness study, patients are randomly assigned to receive 16 weeks of CT or SE therapy, with measures of depressive symptoms, functioning, and quality of life completed monthly. Within this study, a self-report measure of self-understanding of interpersonal patterns, a self-report measure of dysfunctional attitudes, a rater-scored measure of compensatory skills, and a computerized task that assesses underlying cognitive schemas will be administered to the same set of patients. Results of this study might have implications for the potential modifications of these treatments to enhance effectiveness and for the dissemination of evidence-based treatments to the community mental health setting.
The specific aims of this study are to:
- To potentially identify how both CT and SE therapy work in community settings
- To test hypotheses about variables that are proposed to be important to the mechanism of CT, as potential mediators of symptom change in CT for MDD in community settings. The three potential mediator variables are: change in dysfunctional attitudes, change in underlying depressogenic schemas, and change in compensatory skills. The extent to which mean changes in these mediator variables are specific to CT, and the extent to which the relation between the mediators and symptom change is specific to CT, will be investigated by comparing effects to those found in an alternative psychotherapy (SE therapy).
- To test the hypothesis that change in self-understanding of interpersonal patterns is a mediator of symptom change for SE therapy for MDD in community settings. The specificity of the effects, relative to CT, will also be examined.
- To examine the proposed mediator variables for CT and SE therapy in relation to change in functioning and quality of life.
To learn more about our current treatment programs, research protocols, or to ask specific questions about the Center, please call us at 215-349-5222.