Depression self-evaluation – Goldberg Depression Scale

Instructions

You might reproduce this scale and use it on a weekly basis to track your moods. It also might be used to show your doctor how your symptoms have changed from one visit to the next. Changes of five or more points are significant. This scale is not designed to make a diagnosis of depression or take the place of a professional diagnosis. If you suspect that you are depressed, please consult a mental health professional as soon as possible.

The 18 items below refer to how you have felt and behaved during the past week. For each item, indicate the extent to which it is true, by checking the appropriate response next to the item.

Responses:

• Not at all (0)


• A little (1)


• Somewhat (2)


• Moderately (3)


• Quite a lot (4)


• Very much (5)

Questionnaire

1. I do things slowly.

• Not at all


• Just a little


• Somewhat


• Moderately


• Quite a lot


• Very much

2. My future seems hopeless.

• Not at all


• Just a little


• Somewhat


• Moderately


• Quite a lot


• Very much

3. It is hard for me to concentrate on reading.

• Not at all


• Just a little


• Somewhat


• Moderately


• Quite a lot


• Very much

4. The pleasure and joy has gone out of my life.

• Not at all


• Just a little


• Somewhat


• Moderately


• Quite a lot


• Very much

5. I have difficulty making decisions.

• Not at all


• Just a little


• Somewhat


• Moderately


• Quite a lot


• Very much

6. I have lost interest in aspects of life that used to be important to me.

• Not at all


• Just a little


• Somewhat


• Moderately


• Quite a lot


• Very much

7. I feel sad, blue, and unhappy.

• Not at all


• Just a little


• Somewhat


• Moderately


• Quite a lot


• Very much

8. I am agitated and keep moving around.

• Not at all


• Just a little


• Somewhat


• Moderately


• Quite a lot


• Very much

9. I feel fatigued.

• Not at all


• Just a little


• Somewhat


• Moderately


• Quite a lot


• Very much

10. It takes great effort for me to do simple things.

• Not at all


• Just a little


• Somewhat


• Moderately


• Quite a lot


• Very much

11. I feel that I am a guilty person who deserves to be punished.

• Not at all


• Just a little


• Somewhat


• Moderately


• Quite a lot


• Very much

12. I feel like a failure.

• Not at all


• Just a little


• Somewhat


• Moderately


• Quite a lot


• Very much

13. I feel lifeless -- more dead than alive.

• Not at all


• Just a little


• Somewhat


• Moderately


• Quite a lot


• Very much

14. My sleep has been disturbed -- too little, too much, or broken sleep.

• Not at all


• Just a little


• Somewhat


• Moderately


• Quite a lot


• Very much

15. I spend time thinking about HOW I might kill myself.

• Not at all


• Just a little


• Somewhat


• Moderately


• Quite a lot


• Very much

16. I feel trapped or caught.

• Not at all


• Just a little


• Somewhat


• Moderately


• Quite a lot


• Very much

17. I feel depressed even when good things happen to me.

• Not at all


• Just a little


• Somewhat


• Moderately


• Quite a lot


• Very much

18. Without trying to diet, I have lost, or gained, weight.

• Not at all


• Just a little


• Somewhat


• Moderately


• Quite a lot


• Very much

Scoring

• If you score points was less than 9 then depression is not indicated.


• Between 10 and 17 – perhaps some slight depression.


• Between 18 and 21 – perhaps the brink of depression.


• Between 22 and 35 – less than indicated moderate depression.


• Between 36 and 53 – moderate to severe depression can be.


• Over 54 – maybe suffering from severe depression.

About Developer

Ivan K. Goldberg, M.D specializes in the treatment of individuals with treatment-resistant depression. The founder of Depression Central , he is a psychiatrist and clinical psycho-pharmacologist in private practice in New York City. Formerly on the staff of the National Institute of Mental Health and the Departments of Psychiatry of the Columbia- Presbyterian Medical Center, and Columbia University's College of Physicians and Surgeons, he now devotes his time to evaluating and providing advanced innovative treatment for individuals whose depression or bipolar disorder has not responded to standard drug treatments.

Sources and Additional Information:

http://counsellingresource.com/quizzes/goldberg-depression/index.html

http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=973&cn=5

http://depressioninfos.com/blog/tag/dr-ivan-goldberg/

http://www.psycom.net/ikg8.html

Circadian Rhythm Chronotherapy for Depression Treatment

In one of our previous post we discussed an unusual approach to the depression treatment through sleep deprivation. This method shows very encouraging results in the critical conditions, but is difficult to apply and the received positive effects are usually not sustainable. While the related research is still ongoing, there is no doubt that sleep and depression have tight links, and there is a good potential for the further remedy for the patients.

Chronotherapy is one of the new therapies, applying developed knowledge on the connection between natural biorhythms and well-being to the depression treatment. It is using the circadian rhythm-altering interventions that treat depression by adjustments of the sleep-wake cycle and daily light exposure. In a way, it is theory combining the sleep regulation and light therapy for the patients’ treatment.

Indications for Chronotherapy

Chronotherapy has been found to benefit most forms of depression including:

• Unipolar Depression


• Depression with melancholic features


• Bipolar Depression


• Fall/Winter Depression (Seasonal Affective Disorder)

In addition to these diagnostic indications, chronotherapy is also useful in the following circumstances:

• When there is a need for a rapid antidepressant response; in other words, when someone needs to get better quickly


• Inability to tolerate or preference to avoid medication.
  
  Most often, chronotherapy is used along with antidepressant or mood-stabilizing medication. It can, however, be used on its own, especially when several different forms of chronotherapy are used in combination.

This option allows for a fully non-pharmacologic treatment for those who are sensitive to, or need to minimize medication side-effects; for example, those with other medical illnesses, the elderly, and for antepartum and post-partum depressions.

Contraindications to the use of Chronotherapy

• Psychotic Depression.
  
  People who are experiencing hallucinations or delusions while depressed (or when manic) should not receive chronotherapy.


• Mixed States (the simultaneous co-occurance of both manic and depressive states) or depressive states with significant anxiety or other manic symptoms (relative contraindication).
  
  Chronotherapy, like all other biological forms of antidepressant treatment, can cause emotional side effects. About 7% of patients treated with wake therapy will develop hypomanic symptoms. Patients experiencing manic or significant anxiety symptoms as part of their depression are at a higher risk of having this reaction. It is therefore contraindicated in this group.


• Certain eye conditions may limit the use of bright light treatment.
  
  Retinal problems, macular degeneration and the use of photosensitizing medications may complicate or prevent the use of light treatment.


• The presence of epilepsy or a seizure disorder is a relative contraindication for wake therapy.
  
  The use of antipsychotic drugs, sleep medications (sedatives), or certain anti-anxiety agents can interfere with the action of wake therapy and may need to be discontinued or temporarily suspended.

Chronotherapy Types

Chronotherapy is basically therapy using manipulation of sleep, wake and light. There are different types of Chronotherapy:

1. Light therapy - this is dosed precisely and at exact times. This therapy is well-known in the treatment of seasonal affective disorder (SAD).


2. Wake therapy – use of prolonged periods of wakefulness.


3. Sleep phase advancement – moves the time of the sleep forward to early evening to improve antidepressant action.


4. Triple chronotherapy – a combination of the above three.


5. Dawn simulation – gradual light before waking.


6. Chronobiotics – use of circadian rhythm-modifying compounds such as melatonin.


7. Social rhythm therapy – schedules daily activities.

How Chronotherapy Works?

As with most complicated things in life, scientists and doctors admit that the picture is far from being clear. What they are pretty sure about though is that natural circadian rhythms for different mental illnesses are often disturbed.

So, in the average person, they want to sleep at night and be awake during the day. They also want to sleep around eight hours a night and wake and sleep at about the same time each day. This rhythm can be interrupted by normal, life events, but the person will regain their rhythm once circumstances allow.

The problem with different mental illnesses is that people sleep too much, we don’t sleep enough, or they able to get sleep at the wrong times. It’s one of the reasons so many of the many of the people are hooked on the various sleeping medication.

The idea of Chronotherapy then, is to reinstate a natural sleep rhythm, or to manipulate the sleep rhythm for the positive therapeutic effect.

Triple Chronotherapy

“Triple chronotherapy is a natural, ultra-rapid therapy that typically reduces depressive symptoms within one-to-two days,” explains Northwestern Medicine psychiatrist John Gottlieb, MD, who is an assistant clinical professor of psychiatry and behavioral science at Northwestern University Feinberg School of Medicine. “This approach doesn’t require medications, but it’s every bit as biologically active as antidepressant medications.”

Circadian rhythms are the fluctuations of certain physiological variables that occur over a 24-hour period, like sleeping, for instance. Circadian-shifting approaches, like bright-light therapy and dawn stimulation, have long been proven to effectively treat depression and other emotional disorders. Triple chronotherapy is no different, and has been used in Europe for nearly two decades in the successful treatment of unipolar and bipolar depression, as well as seasonal affective disorder. However, due to the intensiveness of the approach, patients were required to remain in the hospital during treatment. For the first time, the triple chronotherapeutic protocol is being administered on an outpatient basis, and Northwestern Medicine is one of few centers to offer this in the US.

“Chronotherapy has been demonstrated to be effective,” said Gottlieb. “However, it is not used for patients with psychotic depression or for patients who are bipolar and not on medication. Additionally, patients with eye disorders may be unable to undergo light therapy.”

As he explains, the first part involves wake therapy which requires a period of extended wakefulness over one night and the following day. This acts as an antidepressant response-inducer, jump starting an improvement in mood. Following wake therapy, patients move their sleep period earlier (sleep phase advance) and begin using bright light at prescribed times.

Chronotherapeutic treatments can also be used with antidepressant and other psychiatric medications. These combinations can both enhance and expedite treatment response. According to Gottlieb, standard, pharmacological therapy for depression takes between two to eight weeks before significant improvement occurs. Bright light therapy generally produces an antidepressant response within one to two weeks, while triple chronotherapy can induce remissions within hours.

“Triple chronotherapy provides a faster and lasting antidepressant option for many people who struggle with depression.” Gottlieb said.

Sources and Additional Information:

http://www.chicagochronotherapy.com/whoisitfor.html

http://www.healthyplace.com/blogs/breakingbipolar/2010/11/circadian-rhythm-and-chronotherapy-new-bipolardepression-therapy/

http://www.nmh.org/nm/triple+chronotherapy+for+depression

http://www.medicinenet.com/script/main/art.asp?articlekey=551

Quick inventory of depressive symptomatology (self-report) (QIDS-SR 16)

Instructions: Please circle the one response to each item that best describes you for the past seven days.

1. Falling asleep:

0 I never take longer than 30 minutes to fall asleep.

1 I take at least 30 minutes to fall asleep, less than half the time.

2 I take at least 30 minutes to fall asleep, more than half the time.

3 I take more than 60 minutes to fall asleep, more than half the time.

2. Sleep during the night:

0 I do not wake up at night.

1 I have a restless, light sleep with a few brief awakenings each night.

2 I wake up at least once a night, but I go back to sleep easily.

3 I awaken more than once a night and stay awake for 20 minutes or more, more than half the time.

3. Waking up too early:

0 Most of the time, I awaken no more than 30 minutes before I need to get up.

1 More than half the time, I awaken more than 30 minutes before I need to get up.

2 I almost always awaken at least one hour or so before I need to, but I go back to sleep eventually.

3 I awaken at least one hour before I need to, and can’t go back to sleep.

4. Sleeping too much:

0 I sleep no longer than 7–8 hours/night, without napping during the day.

1 I sleep no longer than 10 hours in a 24-hour period including naps.

2 I sleep no longer than 12 hours in a 24-hour period including naps.

3 I sleep longer than 12 hours in a 24-hour period including naps.

5. Feeling sad:

0 I do not feel sad.

1 I feel sad less than half the time.

2 I feel sad more than half the time.

3 I feel sad nearly all of the time.

6. Decreased appetite:

0 There is no change in my usual appetite.

1 I eat somewhat less often or lesser amounts of food than usual.

2 I eat much less than usual and only with personal effort.

3 I rarely eat within a 24-hour period, and only with extreme personal effort or when others persuade me to eat.

7. Increased appetite:

0 There is no change from my usual appetite.

1 I feel a need to eat more frequently than usual.

2 I regularly eat more often and/or greater amounts of food than usual.

3 I feel driven to overeat both at mealtime and between meals.

8. Decreased weight (within the last two weeks):

0 I have not had a change in my weight.

1 I feel as if I’ve had a slight weight loss.

2 I have lost 2 pounds or more.

3 I have lost 5 pounds or more.

9. Increased weight (within the last two weeks):

0 I have not had a change in my weight.

1 I feel as if I’ve had a slight weight gain.

2 I have gained 2 pounds or more.

3 I have gained 5 pounds or more.

10. Concentration/Decision making:

0 There is no change in my usual capacity to concentrate or make decisions.

1 I occasionally feel indecisive or find that my attention wanders.

2 Most of the time, I struggle to focus my attention or to make decisions.

3 I cannot concentrate well enough to read or cannot make even minor decisions.

11. View of myself:

0 I see myself as equally worthwhile and deserving as other people.

1 I am more self-blaming than usual.

2 I largely believe that I cause problems for others.

3 I think almost constantly about major and minor defects in myself.

12. Thoughts of death or suicide:

0 I do not think of suicide or death.

1 I feel that life is empty or wonder if it’s worth living.

2 I think of suicide or death several times a week for several minutes.

3 I think of suicide or death several times a day in some detail, or I have made specific plans for suicide or have actually tried to take my life.

13. General interest:

0 There is no change from usual in how interested I am in other people or activities.

1 I notice that I am less interested in people or activities.

2 I find I have interest in only one or two of my formerly pursued activities.

3 I have virtually no interest in formerly pursued activities.

14. Energy level:

0 There is no change in my usual level of energy.

1 I get tired more easily than usual.

2 I have to make a big effort to start or finish my usual daily activities (for example, shopping, homework, cooking or going to work).

3 I really cannot carry out most of my usual daily activities because I just don’t have the energy.

15. Feeling slowed down:

0 I think, speak, and move at my usual rate of speed.

1 I find that my thinking is slowed down or my voice sounds dull or flat.

2 It takes me several seconds to respond to most questions and I’m sure my thinking is slowed.

3 I am often unable to respond to questions without extreme effort.

16. Feeling restless:

0 I do not feel restless.

1 I’m often fidgety, wringing my hands, or need to shift how I am sitting.

2 I have impulses to move about and am quite restless.

3 At times, I am unable to stay seated and need to pace around.

Scoring the QID-SR-16

_____ Enter the highest score on any of the 1 of the 4 sleep items (#1, 2, 3 or 4)

_____ Item 5

_____ Enter the highest score on any ONE appetite item (#6, 7, 8 or 9)

_____ Item 10

_____ Item 11

_____ Item 12

_____ Item 13

_____ Item 14

_____ Enter the highest score on either of the psychomotor items (#15 or 16)

_____ TOTAL

Interpretation of Depression Severity Thresholds (QID-SR-16):

0 – 5 No Depression; 6 – 10 Mild; 11 – 15 Moderate; 16 – 20 Severe; 21 – 27 Very Severe

The QIDS-C16 and the QIDS-SR16 total scores range from 0 to 27. The total score is obtained by adding the scores for each of the nine symptom domains of the DSM-IV MDD criteria: depressed mood, loss of interest or pleasure, concentration/decision making, self-outlook, suicidal ideation, energy/fatigability, sleep, weight/appetite change, and psychomotor changes. Sixteen items are used to rate the nine criterion domains of major depression: 4 items are used to rate sleep disturbance (early, middle, and late insomnia plus hypersomnia); 2 items are used to rate psychomotor disturbance (agitation and retardation); 4 items are used to rate appetite/weight disturbance (appetite increase or decrease and weight increase or decrease). Only one item is used to rate the remaining 6 domains (depressed mood, decreased interest, decreased energy, worthlessness/guilt, concentration/decision making, and suicidal ideation). Each item is rated 0-3. For symptom domains that require more than one item, the highest score of the item relevant for each domain is taken. For example, if early insomnia is 0, middle insomnia is 1, late insomnia is 3, and hypersomnia is 0, the sleep disturbance domain is rated 3. The total score ranges from 0-27.

Source: http://www.martincbt.com/depressiveinventory.html

Free online computerized cognitive-behavioral therapy for depression

Free? Then can it be worth much? Ah, that might depend on how hard you work. This is working with a computer, not a human.

Mind you, this may not work as well as seeing a real live therapist who knows the CBT approach well. But lots of people can't get real live CBT, because they:

• Can't afford it


• Can't find it


• Don't like the whole idea of telling someone their problems (guys?)


• Think they've already had it (but haven't)

So, if there was a way to get cognitive therapy for free, that would be pretty nifty. Well, there is.

What is MoodGYM?

MoodGYM is an innovative, interactive web program designed to prevent depression. It consists of five modules, an interactive game, anxiety and depression assessments, downloadable relaxation audio, a workbook and feedback assessment.

Using flashed diagrams and online exercises, MoodGYM teaches the principles of cognitive behavior therapy – a proven treatment for depression. It also demonstrates the relationship between thoughts and emotions, and works through dealing with stress and relationship break-ups, as well as teaching relaxation and meditation techniques.

MoodGYM was designed and developed by staff at the Centre for Mental Health Research at the Australian National University, in collaboration with other researchers, mental health experts, web and graphic designers, and software engineers.

Each module explores issues such as:

• why someone feels the way they do,


• changing ‘warped’ thoughts,


• changing the way they think, 


• knowing what makes an individual upset,


• assertiveness and interpersonal skills training.

History

This idea originated, in a way, not with the internet but with another technology: telephone-based "interactive voice response" (IVR). Trying to make CBT more widely available, a team of researchers created an IVR system of therapy. I never got to try it, but apparently it worked as well as a live therapist.  Then, an intermediate form of computer-assisted therapy was tested at Harvard, in which a computer program was used to deliver some of the basic explanations and planning of CBT.  Therapist time was reduced accordingly. This worked as well as standard, "live" therapy. Now, there is a program in which all of your interaction is with your computer, none with a human.

Warning

Here are several ways in which this free program could harm you:

• You try it, it doesn't work, and you conclude cognitive behavioral therapy doesn't work for you. Don't do that.


• You try it, raise your hopes, it doesn't seem to help, you feel disappointed (especially if you tried hard)


• You try this instead of a good, live therapist whom you could go see, within a few weeks, when you could afford it.


• You stay up too late at night on your computer doing this homework instead of sleeping!

There is no evidence that this computer approach is better than a live therapist.  So since we know that good live CBT really works; and since we don't have a head-to-head comparison of computer versus live therapist yet; for now, you should only use this approach if for some reason it's clear: you need additional antidepressant help, and you are not going to be able to see a good, live therapist.

Why should you try it? If you really, for any reason, can't get CBT some other way; and if you need to add an additional antidepressant element into your treatment, and you want with all your hurt to make it work, the program might be quite useful for you and will help your recovery.  

Technical Requirements

Before using MoodGYM, please make sure that:

• You have the flash 4.0 plug in (so that you can view graphics)


• JavaScript is enabled (so that you can view extra content)


• 'Cookies' are enabled (so that you can log in). If necessary, you can enable cookies using your browser's Help utility. Cookies are temporary and are deleted when you close your browser.

MoodGYM makes frequent use of multimedia presentations and graphics. If you are visually impaired, you may be using browser software that is unable to display some of this material.

Interface Languages

English and Norwegian

Cost

The program MoodGym is free and anonymous for all users. And there are no ads!

Website: Website: http://moodgym.anu.edu.au/welcome