5.3 Depressive Disorders Flashcards
Normal
- Occasional feeling of sadness is common and normal
Depression
- Alteration in mood expressed by sadness, despair and pessimism. Occurs when adaptation is ineffective and symptoms are enough to impair functioning
- Loss of interest in usual activities, somatic symptoms may be evident. Changes in appetite, sleep patterns, and cognition are common.
Mood
- Pervasive and sustained emotion that has major influence on a persons perception of the world (depression, joy, elation, anger, anxiety)
Affect
- External, observable emotional reaction associated with an experience.
Neurotransmitters of Depression
- Particularly serotonin, norepinephrine and dopamine
- Serotonin Deficiency
- Medications for antidepression (increase in serotonin) can have adverse effects such as serotonin syndrome. Other dangers include abrupt withdrawal
Depression Statistics
- Major Depressive Disorders are the leading causes of disability
- Lifetime presence of depression is the most prevalent psychiatric disorder
Depression Statistics
- Affects women to men 2:1 due to higher concentration of monoamine oxidase (neurotransmitter associated with depression). Also more susceptible due to thyroid dysfunction, increased sensitivity to stress, higher prevalence of anxiety, poor coping mechanisms
- Age highest prevalence is in 45 or younger. Lifetime prevalence is higher in 45+
- No definite relationship in social class or race
- Single/Divorced more likely to experience depression possibly due to lack of connectedness
- Depression most common in winter and fall
Major Depressive Disorder
- Depressed mood, loss of interest or pleasure in usual activities.
- Impaired social/occupational functioning that exists for over 2 weeks.
- No history of manic behavior
Degree of severity
- Mild, Moderate, Severe
- Evidence of psychotic, catatonic, melancholic features
KEY CHARACTERISTICS
- Depressed mood
- Loss of interest/pleasure in usual activities
- Symptoms last over 2 weeks
- No history of manic behavior
- Not attributed to use of substances or other medical conditions
Persistent Depressive Disorder (Dysthymia)
- Milder than MDD
- No psychotic symptoms
- Most essential feature is chronic depressed mood for most of the day more days than not for at least 2 years.
- Early onset (before age 21)
- Late onset (after age 21)
KEY CHARACTERISTICS
- Person feels sad or in the dumps
- No evidence of psychotic behaviors
- Depressed mood more days than not
- Lasting over 2 years
Premenstrual Dysphoric Disorder
- Markedly depressed mood, excessive anxiety, mood swings, decreased interest during week prior to menses and improves a week post meses
KEY CHARACTERISTICS
- Depressed mood
- Anxiety
- Mood swings
- Decreased interest in activities
- SYMPTOMS INTERFERE WITH ABILITY TO FUNCTION
Substance/Medication Induced Depression
- Can be caused by drugs like alcohol, amphetamines, cocaine, hallucinogens, opioids, etc.
- Meets full criteria of relevant depressive disorders
- Anesthetics, analgesics, anticholinergics, anticonvulsants, antihypertensives, anti-Parkinson’s, muscle relaxers, sulfonamides have shown to evoke mood symptoms.
Depressive Disorder Associated with Another Medical Condition
- Direct consequence of another medical condition.
- Clinically significant distress, impaired social/occupational functioning, or other functioning
Biological Theory of Depression
Genetics
- Heritability
Biochemical Influence
- Deficiency of norepinephrine, serotonin and dopamine
- Excessive cholinergic transmission
Neuroendocrine disturbances
- Failure of hypothalamic-pituitary-adrenocortical axis
- Possible diminished release of thyroid-stimulating hormone
- Hypersecretion of cortisol
- Diminished TSH response to administered TRF has been associated with risk of relapse despite treatment with antidepressants
Secondary Depression
- Caused by non-mood disorder or adverse effect of medications
Causes
- Medication side effect
(Most commonly meds that affect CNS)
- Neurological Disorders
(CVA or brain tumors particularly in the temporal lobe, Alzheimer’s, Parkinson’s, Huntington’s, Multiple Sclerosis)
- Electrolyte disturbances
(Excessive Sodium and Calcium)
(Dysfunction of adrenal cortex - Addisons/Cushings)
(Imbalance of estrogen/progesterone)
- Hormonal Disorders
- Nutritional deficiencies
- Inflammation
Psychoanalytical Theory
- Melancholia occurs after the death of a loved object either by actual death or emotional rejection or loss of other value to the individual
- Individual is pre-disposed to melancholia if they experience ambivalence (mixed feelings) in love relationships
- Loss is internalized and becomes directed at ego (psychoanalytical theory)
