3: Depression Flashcards
What are the 2 ways you can split mood disorders?
- Depressive disorders
- major depression
- Seasonal Affective Disorder - Bipolar disorders
What is the difference between bipolar and depression disorders?
- Pattern of mood shift Bipolar = high manic + low depression Depression = normal mood + depression - absence of mania in depression - cyclical nature
What is dsythymia?
- form of depression that doesn’t have a cyclical nature in mood
- at least 2 years of depressed mood
What is the difference between the 2 types of bipolar disorders?
B1: - periods of depression - alt w/ full mania B2: - episodes of depression - alt w/ hypomania (less impairment than full mania)
Although hypomania = less impairment than full mania for B2 patients, what explanation is there for the higher suicide rate among B2 vs B1 patients?
- 24% vs 17% Rihmer + Kiss, 2002
- B1 = full mania = also xp extreme mood elevation vs B2
Accodring to Freud, what is the difference between mood and depression?
mourning (mood)
- world has become poor
- doesn’t effect how they feel about themselves
melancholia (Depression)
- ego has become poor
- *sad mood have trigger vs depression
- sad mood = feeling + emotions vs depression = flattened effect
- *changes in sleep highly associated with sleep
What is the diagnosis criteria length for depression in the DSM5?
- need to have 5 specific symptoms or more within 2 week period
- symptoms should not be result of other medical conditions/ medication
- no history of mania/ hypomania
What are the diagnosis criteria in the DSM5 for depression?
- depressed mood for most of the day
- Loss of interest of things they found enjoyable before
- Weight-loss/ hypoinsomia
- tiredness/ less movement
- diminishing ability of concentrating
- recurrent thoughts of death
Why was it an issue when bereavement = no diagnosis of depression regardless of it ticking other boxes in previous DSM?
- why the exception?
- denies ppl help
How is bereavement justified in the DSM5 for the diagnosis of depression?
normal vs abnormal response
- abnormal = diagnosis
What are some differences between grief vs depression?
- grief = response to external vs internal
- grief = think about death vs ideas of taking own life
- grief = time heals vs not quiet the same
- grief = intensity difference
- grief = sudden changes vs continuously there
2 weeks for symptoms to persist is pretty short esp considering grief
Why is major depression considered a syndrome?
- combination of symptoms comming together = wear people down
- perists
Why is major depression called a mood disorder even tho it has so many symptoms which are not related with emotions?
- affective changes are prioritiesed
- high negative + low negative mood are KEY symptoms tht must be present
- high + low positivt affect
What was found when Watson et al (1988) played 3 difference piece of music and asked ppt to share how they felt?
RT:
- :( minor key slow tempo
- major key fast tempo :)
- minor key fast tempo = :)/:(
= can feel both happy + sad at the same time = separate dimension and not a continnumu
= can feel posivtie + negative affect
- they fluctuate independently from each other (Watson et al, 1988)
feeling one doesn’t mean you cant feel the other
Who is RT?
11 year old who begins to lose interest in his usual activities and engaged in more physical fights
- social withdrawal + isolation
= no signs of feeling depressed/ sad but the low positive affect is noticeable
- often beginning of depression
- showing importance of why this is emphasised in the diagnosis
What did the 2014 study on the general population on loneliness fine?
2014:
= 1/10 ppl = have no close friend 2014
= couldn’t count work colleagues as friends
- important since we are spending more time at work
= young ppl saying they haven’t xp love
What did the 2018 BBC survey on loneliness find?
2018 BBC Survey
= 33% very often felt lonely
= 40 16-25 = loneliness
- challenges current mindset that mostly old people feel loneliness but actually a large proportion of younger kids do to
What De Jong + Van Tilburg (1999) find about loneliness among over 55 and Asher et al (1984) among elementary school children?
De Jong + Van Tilburg, 1999
= 32% over 55 feeling lonely
Asher et al, 1984
= 10% of elementary children report loneliness
social withdrawal + isolation are common features of depression. Why is this important?
results in them being lonely
= loneliness is associated with depression + suicidal ideation (Beutel et al, 2017)
What did the animal study on rat by Levine et al (1997) find about cortisol levels when rats were housed alone VS in groups?
= know group to alone = sharp increase in cortisol
= alone to new group = cortisol decrease
What did Asher et al (2003) find about how humans responded to being socially isolated?
socially isolated = stress level go up in humans too
- loneliness not same as social isolation
- be around people = still able to feel loneliness
= loneliness = perceived isolation
What did Wilson, T.D et al (2014) find when ppt were put in a plain room?
majority = found unpleaseant
= some preferred giving electric shocks esp men
What does the term humania mean?
coined by Taylor, 2012
- normal state of mind is discourse
- perceived as being isolated
since we keep our attention on external things
depressed= heightened self focus + consciousness. How did Ingram + smith (1984) justify this?
= end up being focused on internal vs external
= more lonely
How common is depression?
WHO 2012;
5/20% xp depression at least once in lifetime from all ages
- less/ more depending on where you live/
= chronic medical conditions + poverty - high change of depression
leading cause of disability world wide
- can = risk factor for physical health conditions
What are the 3 reasons for why we should pay attention to major depression?
- Suicide
- Recurrence
- Age of Onset
- Suicide
What are some potential explanation for why there is a higher diagnosis of depression among females than male during adolescence?
- increased/ changes in female role in society
-men actually less likely to seek help due to stigma
= high suicide rate in men - hormones - oestrogen = sad mood
why we should pay attention to major depression: recurrence?
- after initial exp - after 50% will xp again
- more episode you have the more at risk you are at it reoccurring
>3 episode = 70-80% risk in the next 12 months - often then don’t need an external trigger/ stressor
= history reducing threshold
why we should pay attention to major depression: Age of Onset?
- often thought depression was a late life problem BUT NOW:
- common age for first depressed = during adolescent
- Age of onset predicts persistence + severity of depression (Pine et al, 1988)
= more severe
Why has the age of onset for major depression become lower?
- more aware of it and diagnosing it?
Shift in age actually real as suggested by… - same questions asked
- there is just many more stressors illnesses
- suicide rates in young people have also gone up
why we should pay attention to major depression: Suicide?
- WHO, 2012
60% suicide takes place when they are xp mood disprders = depression - could cut out 80% suicide if we but out depression
Describe the timing nature of suicide
suicidal ideation - not much time between thinking + doing it
- 90% unplanned
- 60% planned and takes place within the first year
Why is suicide often difficult to detect?
- Small time gap between suicide ideation + suicide
- often have rational out look
- 1/3 leave a rational reflection note together
What are the 3 explanation here for why depression develops?
- Bio
- neurotransmitter imbalance
- Monoamine hyp
- genetics - environment
- traumatic event = learned helplessness - Cognitive
- Attribution style Theory
What is the monoamine hyp?
low seretoning + adrenaline/ norepinephrine produces depressed mood (Coppen 1967, Schildkraut 1965)
- v little evidence LOL
- pharmaceutical industries latched onto idea = antidepressants widely available
How did the monoamine hyp come about?
accident:
1. Reserpine - hypertension
- reduced lvl of seretonin = more depressed mood reported as side effect
Harris 1957
2. Isoniazine - tuberculosis
- increased lvl of seretonin = more happy reports
Robitzek et al 1952
How do antidepressants work?
- low lvlv at synaptic cleft of serotonin
- re-uptake naturally
- drug blocks re-uptake = more left in synaptic cleft
antidepressant = 1st approach for severe depression but what are some problem with antidepressants?
- Many don’t respond
- remission rate = 50%
- tend to work better for mild depression - time scale problem
- drugs = lvl of monoamine normalise quickly
- but mood doesn’t improve at same rate
- not sure about how they work - increased risk of suicide - so not good for younger ppl
(Sharma et al, 2016) - do little to address underlying reasons
(Hirschfield, 2001)
What evidence is there to suggest that genetic has a role to play in the development of depression?
- twins studies MZ = 60/70 % DZ = 20/30% concordance McGuffin et al 1996 - but could be due to shared environment so lack of clarity
What is the environmental explanation for the development of depression?
- traumatic event, esp first onset
= learned helplessness (Seligman et al, 1968)
What is learned helplessness?
- theory of depression that argues people become depressed following unavoidable negative life events because they learn to become ‘helpless’
What evidence is there supporting learned helplessness?
research in animals
- animals + uncontrolled shock = nothing could be done to avoid
- part 2 - there is a escape but just passively accept shock
= learnt to become helpless since it was unavoidable
Similar findings in humans with distressing sounds
What is an explanation for why people become helpless?
= loss of control = the ability to modify outcomes by voluntary responding (Seligman et al, 1968)
having control = more likely to make effort so no control = less effort
What are some issues with the learned helplessness theory?
TOO simplistic
- not all life stress = depression
- not just exp = helpless (Brown + Harris 1978)
- actually the inference of events?
(Klein et al, 1976)
What did Klein et al (1976) find when depressed + non-depressed ppt were asked to do an anagram after they had been placed in an insolvable situation challenging the learned helplessness theory?
= non-depressed exp insolvable = same response as those with depression
BUT
- response could be changed by changing attribution
- internal blame = helplessness
=
What did Klein et al (1976) conclude about learned helplessness?
helplessness dependent on the attributions people made (Klein et al 1976)
- internal attribution of failure = helplessness
= shift from environmental to psychological
=Attribution style theory
According to the attribution style theory, what do depressed individuals attribute the casue of negative events to?
- Internal vs external
- Stable vs unstable
- never change - Global vs specific factors
- something which they always do rather than just one-off
= attribution style = long-lasting + pervasive depression
Although the attribution style theory suggested to be able to predict depression, why did this theory not pick up?
- same time, another cognitive model was around:
Arron Beck’s model which actually had a treatment
