The mindful way through depression Zindel Segal at TEDxUTSC

Thank you. It’s a pleasure to be here. I’ve worked in the field of mood disorders for over 30 years and I’ve witnessed a number of advances in treatments. I’ve witnessed new generations of antidepressant medications being developed. The use of magnetic coils to stimulate the skull and affect different brain regions.

The implantation of electrodes into the brain in regions that are thought to promote recovery from depression, and even the customization of talk therapies to address certain subtypes of depression. But let’s face it, the concept of meditation was never high on that list. And there’s a good reason for that: the reason is that these are treatments that were developed.

To alleviate depression, to alleviate the suffering of patients who are trying to get their lives back on track and also to reduce the capacity for selfharm that is often carried by untreated and undiagnosed depression. But the complex challenge that depression provides us with is to do more than allow people to let go of symptoms and returning to their lives. The complex challenge involves helping people recover from depression.

And to stay well. What we now understand about depression is that it is an episodic and recurrent disorder. Getting well is half of the problem, staying well is the other half. And this is really where my work in the area started, I was tasked with addressing the problem of relapse and its prevention. And I was a cardcarrying member of a cognitive therapy group working in an outpatient at a .

My work was quite distant from meditation and other contemplative practices. I received a small grant from the MacArthur Foundation to try to modify an existing treatment for depression so that it could prevent relapse. And what I did with that money was to bring together two colleagues of mine, Mark Williams, who is at Oxford, John Teasdale, who is now at Cambridge, and we sat together and thought about how would we go ahead and do this, modify this treatment, provide something to people.

Who are in recovery to help them stay well. We kind of hit the pause button, because we didn’t want to take a treatment that was designed to help people come out of depression and just continue to sort of spool it forward to people in recovery. We wanted to understand if there were specific risk factors, specific triggers, that helped people who were in recovery get depressed and maybe see whether we could design a treatment around those specific triggers.

To try to undo their sort of pathological influence. The really cool thing about working with Mark and John is that they had done seminal work in the area of mood dependent memory. The way in which moods and thoughts come together and influence each other, bringing moods that are negative to mind much more easily if one is thinking in a depressive way, and depressive thoughts bringing moods together that are depressed more easily. One of the things that we found was that when people are depressed.

Treatment of Depression in Older Adults EvidenceBased Practices

Narrator: Retirement is supposed to mark the beginning of our golden years, a chance to pursue new interests and spend time with family. But for a growing number of seniors the reality is bleaker. Struggles with maintaining health, loss of family and work roles, and coping with the deaths of peers and loved ones has led to increasing levels of depression.

With the number of seniors increasing every year, this rise in depression among older adults presents a growing challenge for our health care system. Ina: I find with even, even senior friends, the loneliness sometimes gets to them. Because we are used to being very active in our lifetimes and then all of a sudden, it’s not there. Cynthia Zubritsky: There are very, very high rates of depression in older adults, 2025%. It’s being untreated. Narrator: This rise in depression among older adults has led to decreasing levels.

Of functioning, reduced quality of life, and worsening health conditions. Jerry Johnson: Depression and anxiety disorders – what we sometimes call the generalized anxiety disorder – are two of the most important problems that primary care physicians face. Joseph Lurio: From my standpoint, especially with my elderly patients, I talk about. the fact of depression as being something that complicates medical problems. Narrator: In fact, health care costs for seniors with depression are about 50% higher.

Than for those without depression. One challenge is that older adults are not likely to seek treatment for depression. Cynthia Zubritsky: I think the real issue for older consumers is a stigma issue. A lot of people grew up, that are in this cohort, grew up thinking that if you were depressed it was sort of your fault. Connie: Most people who have depression are afraid to admit it because they think someone’s going to think they’re crazy. Narrator: Fear of stigma among older adults is not the only inhibitor.

Of successful diagnosis and treatment – providers often overlook signs of depression or are uncomfortable asking about mental health issues. Virna Little: There was this big misconception that because these folks were maybe isolated, because they weren’t feeling well sometimes or they had these chronic illnesses or just by virtue of being seniors – of course they were going to be depressed. Jerry Johnson: Sometimes there’s a tendency in medicine to focus on one part of the human. To focus on the physical part and not the mental part. But, in fact, particularly in older adults we see both so commonly,.

Occurring at the same time that in order to provide high quality care, we really do have to be considerate of ways of treating the mental and the physical concurrently. Narrator: Researchers around the country are finding ways to do it. The Substance Abuse and Mental Health Administration’s Center for Mental Health Services has identified evidencebased practices (or EBPs) in use around the country that are succeeding. Evidencebased practices include psychotherapy interventions.

And the use of antidepressant medications. These can be used individually or in conjunction to improve symptoms. They can also be used within models of outreach services and collaborative and integrated mental and physical care. Joseph Lurio: One of the issues was how to identify patients early on and how to provide the best kind of treatment given time constraints in primary care. Nurse: Brown, Mary.

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