• Home
  • Store
    • Newsletter Subscriptions
    • Multimedia Subscriptions
    • Books
    • eBooks
    • ABPN SA Courses
  • CME Center
  • Multimedia
    • Podcast
    • Webinars
    • Blog
  • Newsletters
    • General Psychiatry
    • Child Psychiatry
    • Addiction Treatment
    • Hospital Psychiatry
    • Geriatric Psychiatry
  • Log In
  • Register
  • Welcome
  • Sign Out
  • Subscribe
Home » Blogs » The Carlat Psychiatry Podcast » Depressed and Indecisive [60 Sec Psych]

The Carlat Psychiatry Podcast
The Carlat Psychiatry Podcast RSS FeedRSS

Clear, engaging, and practical updates on clinical psychiatry.
Earn CME for listening to the podcast with a Podcast CME Subscription.
Listen for free here or using Apple Podcasts, Android, or Stitcher.

Depressed and Indecisive [60 Sec Psych]

August 15, 2020


Today’s study looked at psychological factors that predict relapse into depression. They people who were recovered from depression and taking antidepressants along with healthy controls, nearly 200 in total. All the underwent a decision making test that asked them to exert effort─a button pressing task─to get rewards. The antidepressants were then discontinued and the patients followed for 6 months to see who relapsed. [Link]

Published On: 8/15/2020

Duration: 2 minutes, 48 seconds

Transcript:

Today’s study looked at psychological factors that predict relapse into depression. They people who were recovered from depression and taking antidepressants along with healthy controls, nearly 200 in total. All the underwent a decision making test that asked them to exert effort─a button pressing task─to get rewards. The antidepressants were then discontinued and the patients followed for 6 months to see who relapsed. Here’s what they found:




  1. The patients in remission were less likely to exert effort to gain rewards than the healthy controls. This was true whether they were on or off the antidepressant (they tested that out in a randomized withdrawal phase as part of the study).

  2. The patients who wrestled with the decision to exert effort–taking a long time to make it–were more likely to relapse within 6 months of coming off the antidepressant.


And here’s what was not different: The health controls and recovered patients both exerted the same amount of effort once they made the decision to, and both found the results equally rewarding. Other research has found that depressed patients are less sensitive to rewards when in a depression, so it’s interesting that their reward sensitivity returns during recovery but their decisiveness does not.


In my practice I have patients rate their “difficulty making decisions” at every visit, and I’ve found this is often the most disabling symptom of depression. Patients can feel bad and still function well, but not if they are severely indecisive. I’ve also found this symptom useful in discriminating patients who are stressed out and emotional from those with clinical depression–healthy patients under acute stress are usually pretty good at making decisions. It’s when depression sets and everything seems equally worthless that this goes to pits.


The study also informs behavior therapy. People with depression have a tendency to make unrealistic plans that take a lot of effort for little reward. When it comes time to take action on those plans, they change their mind and give up, and this pattern becomes habitual. Next time you see a patient with depression, ask them about the plans they’ve been procrastinating on, and help them come up with something that requires less effort.


Got feedback? Take the podcast survey.
Introducing Carlat Total Access Subscriptions

Complete access to every article you search on the website.

Shop for Total Access
Free Psychiatry Updates
The latest unbiased psychiatric information sent to your inbox.
Specify Your Interests
Featured Book
  • CMFB2e_Cover.png

    (PRE-ORDER) Child Medication Fact Book for Psychiatric Practice, Second Edition (2023)

    All the important facts covering child and adolescent psychopharmacology.
    READ MORE
Featured Video
  • therapist_canstockphoto9201097.jpg
    General Psychiatry

    Using SAMe In Clinical Practice with Garrett Rossi, MD

    Read More
Featured Podcast
  • canstockphoto11543850.jpg
    General Psychiatry

    Elvis, Adderall, and a Broken Heart - Part 1

    A new medical investigation changes our understanding of Elvis Presley’s untimely death and offer some pearls for modern psychiatric practice.

    Listen now
Recommended
  • Approaches to Autism Intervention

    January 31, 2022
    canstockphoto2240982_child-bubbles_thumb.jpg
  • Currently Available Cannabis Products

    September 1, 2022
  • Interpreting Assessment Discrepancies from Multiple Sources

    October 17, 2022
    ChildAssessment.png
  • Approaches to Autism Intervention

    January 31, 2022
    canstockphoto2240982_child-bubbles_thumb.jpg
  • Currently Available Cannabis Products

    September 1, 2022
  • Interpreting Assessment Discrepancies from Multiple Sources

    October 17, 2022
    ChildAssessment.png
  • Approaches to Autism Intervention

    January 31, 2022
    canstockphoto2240982_child-bubbles_thumb.jpg
  • Currently Available Cannabis Products

    September 1, 2022
  • Interpreting Assessment Discrepancies from Multiple Sources

    October 17, 2022
    ChildAssessment.png

About

  • About Us
  • CME Center
  • FAQ
  • Contact Us

Shop Online

  • Newsletters
  • Multimedia Subscriptions
  • Books
  • eBooks
  • ABPN Self-Assessment Courses

Newsletters

  • The Carlat Psychiatry Report
  • The Carlat Child Psychiatry Report
  • The Carlat Addiction Treatment Report
  • The Carlat Hospital Psychiatry Report
  • The Carlat Geriatric Psychiatry Report

Contact

info@thecarlatreport.com

866-348-9279

PO Box 626, Newburyport MA 01950

Follow Us

Please see our Terms and Conditions, Privacy Policy, Subscription Agreement, Use of Cookies, and Hardware/Software Requirements to view our website.

© 2023 Carlat Publishing, LLC and Affiliates, All Rights Reserved.