04b_Major Depressive Disorder Flashcards
Major Depressive Disorder:
Duration criteria
Nearly every day for at least 2 weeks
Major Depressive Disorder:
Symptom Criteria
5+ symptoms of a major depressive episode
*1 symptom = depressed mood or a loss of interest or pleasure
Major Depressive Disorder:
Symptoms
Depressed mood
Loss of interest or pleasure in most or all activities
Significant weight loss when Not Dieting
Weight gain
Change in appetite
Insomnia or hypersomnia
Psychomotor agitation or retardation
Fatigue or loss of energy
Feelings of worthlessness or excessive guilt
Diminished ability to think or concentrate
Recurrent thoughts of death, suicidal ideation, suicide attempt
Depressed Mood symptom alternative in children and adolescents
depressed mood can present as irritable mood
Major Depressive Disorder with Periartum Onset:
Diagnostic Criteria
Onset during pregnancy or within four weeks postpartum
Anxiety and preoccupation with infant’s well-being
Delusional thoughts about infant
Major Depressive Disorder with Peripartum Onset:
Prevalence
10-20%
Postpartum psychosis:
Prevalence
0.1-0.2%
Major Depressive Disorder with Seasonal Pattern:
[Seasonal affective disorder (SAD)]
Symptoms
Hypersomnia
Increased appetite and weight gain
Craving for carbohydrates
Seasonal affective disorder (SAD):
Effective Treatment
Phototherapy
Major Depressive Disorder:
Associated features related to Sleep
Early-morning awakening
Reduced slow wave sleep
Decreased REM latency & Increased duration
(sooner and longer)
Major Depressive Disorder:
Prevalence
7%
3x higher for 18-29yo compared to 60+yo
2-3x higher for females post-puberty
Major Depressive Disorder:
Course
Peak age of onset is mid-20s
Initial episodes may be precipitated by severe psychosocial stressor
Number of previous episodes increases the risk for subsequent episodes
Major Depressive Disorder:
Pseudo-dementia
Symptoms of depression in older adults that can be confused with Major and Mild neurocognitive disorder:
Memory loss
Distractibility
Disorientation
Pseudodementia Vs. Neurocognitive disorder
Pseudodementia = abrupt onset, concern about impairment
Neurocognitive disorder = gradual onset, denial/unawareness of impairments
Major Depressive Disorder:
Etiology
Strong genetic component
Catecholamine hypothesis (norepinephrine)
Indolamine hypothesis (serotonin)
Elevated levels of cortisol (shrinkage of hippocampus)
Major Depressive Disorder:
Concordance Rates
MZ = .50
DZ = .20
1.5-3x higher for first-degree biological relatives
Three Cognitive behavioral theories of depression
Behavioral theory of depression
Learned helplessness
Beck’s Cognitive Triad
Behavioral theory of depression
Low rate of response-contingent reinforcement for social and other behaviors
MDD Differential Diagnosis:
Adjustment disorder
Depressive symptoms differs in terms of severity
Adjustment with depressed mood does NOT meet criteria for MDD
MDD Differential Diagnosis:
Uncomplicated Bereavement
Experience of mood as normal
Predominant mood = emptiness or loss
Occurs in waves
Tends to decrease over days to weeks
Classic Depression
Vegetative (bodily) symptoms
Worse in the morning
Acute onset and short duration of symptoms
Moderate severity
MDD Treatment:
Classic Depression
Tricyclics
MDD Treatment:
Moderate to severe depression
SSRIs
Four Atypical depression symptoms
Anxiety
Hypersomnia
Hyperphagia
Interpersonal sensitivity
MDD Treatment:
Atypical Depression
MAOIs
MDD Treatment Efficacy:
CT v IPT v TCAs
All three treatments are effective
Imipramine slightly better for patients with severe symptoms
MDD Treatment:
Most effective treatment
CBT + Pharmacotherapy is better than any one modality alone
MDD Treatment associated with lowest risk for relapse
CBT has lower risk of relapse than pharmacotherapy
MDD Treatment:
ECT Indications
Severe endogenous forms of depression
Delusions, suicidal ideation
Depression that has not responded to antidepressants
MDD Treatment:
ECT side effects
Temporary anterograde and retrograde amnesia
Confusion
Disorientation
*Effects reduced by administering ECT unilaterally to right hemisphere
