Chapter 16: Depressive Disorders Flashcards
Depression intro
Transient symptoms are normal, healthy responses to everyday disappointments in life.
Pathological depression occurs when adaptation is…
Ineffective
Mood is also called affect (observable)
Depression is an alteration in mood that is expressed by feelings of sadness, despair, and pessimism.
There is also psychomotor retardation. Everything slows down. Usually at hospital for this.
Epidemiology
During their lifetime, about 21% of women and 13% of men will become clinically depressed
Major depresive disorder (MDD) is one of the leading causes of disability in the U.S.
Depression is ranked by the World Health Organization as the single largest contributor to global disability and major contributor to suicide deaths, which is 800,000 per year worldwide.
More epidemiology
Gender: depression is more prevalent in women than in men by about 2 to 1
Age: Depression is more prevalent in young women than in young men. Less pronounced gap between 44 and 65
Race and culture
Depression is more prevalent in white Americans than black Americans, but when diagnosed, is more severe and disabling in blacks.
Blacks are less likely to receive treatment than are whites.
Marital status
Single and divorced people are more likely to experience depression than are married persons or persons with a close interpersonal relationship (differences occur in various age groups)
Seasonality
Affective disorders are more prevalent in the spring and in the fall
Seasonal affective disorder (SAD) is not considered as a separate disorder. It is a type of depression displaying a recurring seasonal pattern. To be diagnosed with SAD, people must meet full criteria for major depression coinciding with specific seasons for at least 2 years.
major depressive disorder
Symptoms present for at least 2 weeks
No history of manic behavior
Cannot be attributed to use of substances or another medical condition
Dysthymic disorder
Sad or “down in the dumps”
No evidence of psychotic symptoms
Essential feature is a chronically depressed mood for:
Most of the day
More days than not
At least 2 years
Premenstrual dysphoric disorder
Depressed mood, anxiety, mood swings, decreased interest in activities
Symptoms begin during week prior to menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week postmenses.
Substance induced depressive disorder
Considered to be the direct result of physiological effects of a substance
Depressive disorder associated with another medical condition
Attributable to the direct physiological effects of a general medical condition
Biological theories
Genetics may be involved
Deficiency or norepinephrine, serotonin, and dopamine has been implicated
Excessive cholinergic transmission may also be a factor
Neuroendocrine disturbances
Possible failure within the hypothalamic-pituatary adrenocorticol axis results in hypersecretion of cortisol.
Possible diminished release of TSH…treat with hormone replacement instead of antidepressants
Physiological influences of depression
medication side effects
neurological disorders
Electrolyte disturbances
Hormonal disorders
Nutritional deficiencies
Other physiological conditions
Psychoanalytic theory (Freud)
A loss is internalized and becomes directed against the ego. Freud believed melancholia occured after the loss of a loved object and the individual then turns rage inward, which reduces self-esteem and makes one vulnerable to depression.
Psychosocial theories: Learning theory
Learned helplessness: the individual who experiences numerous failures learns to give up trying
Pt: Object loss
Experiences loss of significant other during first 6 months of life
feelings of helplessness and despair
Early loss or trauma may predispose client to lifelong periods of depression
PT: Cognitive theory
Views primary disturbance in depression as cognitive rather than affective
Three cognitive distortions that serve as the basis for depression —>
1. Negative expectations of the environment
2. Negative expectations of the self.
3. and of the future
Childhood depression
Symptoms:
Under age 3: Feeding problems, tantrums, lack of playfullness and emotional expressiveness
Ages 3 - 5: accident proneness, phobias, excessive self-reproach
Ages 6 - 8: physical complaints, aggressive behavior, clinging behavior
Ages 9 - 12: Morbid thoughts and excessive worrying
Childhood depression (Cont’d)
Precipitated by a loss
Focus of therapy: alleviate symptoms and strengthen coping skills
Parental and family therapy
Adolescence
Symptoms may include anger, social withdrawal, and apathy or even substance abuse.
Best clue that differentiates normal adolescent behavior from depression is a visible manifestation of behavioral change that lasts for several weeks.
Most common precipitant for adolescent suicide –>
Perception of abandonment by parents or close peer relationship
Treatment of adolescent depression
Supportive psychosocial intervention (most are outpatient but hospitalization for severe cases)
Antidepressant medication
All antidepressants carry a black box warning for increased risk of suicidality in children and adolescents
Senescence and depression
Bereavement overload
High percentage of suicides among elderly
Symptoms of depression often confused with symptoms of neurocognitive disorder (pseudodementia)
TX: antidepressants, ECT, therapies
