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C H A P T E R
31
Depression
Barbour, Hoffman, and Blumenthal
Chapter 31
Definition
A term often used to refer to varying levels of
psychological distress, ranging from
dysphoric mood state to the diagnosis of a
clinical disorder such as major depressive
disorder (MDD).
Summary of DSM-IV Diagnostic
Criteria for Major Depressive Episode
Five (or more) of the following symptoms are
present during the same 2 wk period and
represent a change from previous functioning
(note that at least one of the symptoms must
be either number 1 or number 2).
1.Depressed mood most of the day, nearly every
day
2.Diminished interest or pleasure in all or most
activities
3.Significant change in weight or appetite
(continued)
Summary of DSM-IV Diagnostic
Criteria for Major Depressive Episode
(continued)
4. Insomnia or hypersomnia
5. Psychomotor agitation or retardation
6. Fatigue or loss of energy
7. Feelings of worthlessness or guilt
8. Diminished ability to think or concentrate
9. Recurrent thoughts of death or suicide
Note. The symptoms cause clinically significant distress or impairment, are not
caused by the effects of a substance or general medical condition, and are
not better accounted for by bereavement or another psychiatric disorder.
Scope
• ~17% of adults suffer or have suffered from
MDD sometime during their lifetime
• 80% of those meeting criteria for MDD
classified as having moderate to severe
episodes
• Women > men; Latinos and African
Americans generally < than Caucasians
• Economic burden of depression exceeds
$44 billion
Pathophysiology of Depression
• Interaction between genetics and
environment; both neurochemical
(deficiencies of norepinephrine, serotonin,
dopamine) and behavioral factors involved
• Associated with autonomic nervous system
dysregulation, increased inflammation,
platelet reactivity, and endothelial
dysfunction
• Negative evaluations of self (self-efficacy,
self-worth)
Clinical Considerations
• Gold standard for the diagnosis of
depression is structured interview
administered by mental health professional.
• Typical screening tools include Beck
Depression inventory, Hospital Anxiety and
Depression Scale
(continued)
Clinical Considerations (continued)
• Signs and symptoms include hopelessness,
suicidal ideations, poor self-worth, fatigue,
loss of interest, indecisiveness, and difficulty
concentrating.
• Depression may be associated with family
conflict and unemployment, lower exercise
tolerance compared to matched controls,
poor attendance or compliance with
prescribed therapies such as exercise.
Clinical Considerations: Treatment
• Usually treated by primary care practitioner (vs.
mental health professional)
• Antidepressant medications
– Buproprion—does not share a chemical structure with other
types of antidepressant medications and as a result is
considered a miscellaneous or “other” antidepressant medication
– SSRI = selective serotonin reuptake inhibitors
– SNRI = serotonin and norepinephrine reuptake inhibitors
– NaSSA = noradrenergic and specific serotonergic
antidepressants
Clinical Considerations: Treatment
(continued)
• Psychotherapy
– Cognitive–behavioral therapy
• Exercise training
– Impact on depression equivalent to that of antidepressive
medications
– 40 to 60 min, 60% to 75% of heart rate reserve, 5 d/wk
– Adherence a challenge in patients with depression; counter by:
• Establishing rapport
• Helping to identify benefits
• Making enjoyable
• Setting realistic goals with reward system in place
Conclusion
• Screening for depressive symptoms that
may interfere with exercise and subsequent
referral for treatment are essential.
• The clinical exercise physiologist should
recognize that the depressed person who
exercises is at risk for nonadherence, that
depression is common in patients with CHD
and other chronic diseases, and that
depressive symptoms may interfere with the
enjoyment of exercise and motivation to
fully engage in the rehabilitation process.
Conclusion (continued)
• Several treatments have shown success in
the treatment of depression, including
antidepressant medication, cognitive–
behavioral therapy, and exercise training.
• Patients who exhibit significant depressive
symptoms should be approached in an
empathetic manner and encouraged to seek
treatment to improve quality of life and gain
maximal benefit from exercise.