Depression Flashcards
What are common features of depression?
Physiological disturbances of irritable or sad mood that affect people’s capacity to function
What are the four types of depression and examples?
- Affective: persistent periods of feeling down or depressed
- Cognitive: recurrent thoughts of death or suicide
- Behavioral: reduced level of social participation
- Physiological: changes in weight, sleep
What is the course of a major depressive episode?
- Normal mood
- Progression to disorder
- Remission
- Relapse
What would a clinician do to diagnose depression?
- See if the patient has 5 or more symptoms of depression lasting more than two weeks
- Is it one episode or more than one?
What is recurrent depression that follows a seasonal pattern?
- Recurrent depressive episodes
- Hyper insomnia
- Increased appetite
- Weight gain
- Irritability
- Begin in the fall and continue throughout the winter
What percent of the population is affected by the recurrent depression and what is the mean onset?
4-6% and 23 years old
What is the Latiné symptomal experience of depression?
Complains of headaches and nerves
What is the Asian symptomal experience of depression?
Complains of weakness, fatigue, and poor concentration
What do symptoms look like in children?
Stomach ache and headaches
What do symptoms look like in adults?
- Distractibility and forgetfulness
What is the comorbidity of depression with anxiety?
2/3 of people also have anxiety
What is the tripartite model of depression?
Anxious arousal = anxiety symptoms
Negative affect = anxiety symptoms and depressive symptoms
Low positive affect = depressive symptoms
Are women or men twice as likely to experience MDD and persistent depressive disorder?
Women
What are men more likely to be depressed about?
Financial or occupational stress
What are women more likely to become stressed about?
Interpersonal life stress (breakup/divorce)
What can trigger depressive episodes?
Stressful Life Events
What is the psychodynamic view of depression?
- Link between depression and grief
- When a loved one dies, an unconscious process begins and the mourner regresses to the oral stage and experiences introjection
- Introjection is temporary
- If grief is long-lasting depression results
- Those with oral stage issues are at greater risk for developing depression
- Instead of actual loss some people experience imagined loss instead
What is Lewinsohn’s Behavioral Theory of Depression?
- Stressor leads to reduction in reinforcers
- Person withdraws
- Reinforcers further reduced
- More withdrawl and depression
What is Beck’s Theory?
- Negative schema: underlying tendency to see the world negatively
- Negative triad: negative view of self, world, and future
- Negative schema cause cognitive biases which manifest as processing information in negative ways
What is the helplessness theory?
- Most important trigger of depression is helplessness
- Desirable outcomes will not occur
- Person has no ability to change the situation
- Attributional styles (stable and global attributions can cause hopelessness)
What is the rumination theory?
- A specific way of thinking: tendency to repetitively dwell on sad thoughts
What is Beck’s Cognitive Model of Depression?
- Schemas: cognitive structures or attitudes that form in childhood and thereafter to organize the individual’s world
- Cognitive triad: The distortion of one’s experiences, oneself, and one’s future in ways that increase the likelihood of feeling depressed
What are six common errors in logic in depression?
- “all or nothing thinking”
- overgeneralization
- selective thinking
- catastrophizing
- personalizing
- personal ineffectiveness
What is Seligman’s Learned Helplessness Model of Depression?
- Depression results from being in aversive situations in which no one has control over the outcome
What attributions are most likely to lead to depression?
Internal, global, and stable
What are cognitive view of depression?
- Learned helplessness
- “It is all my fault [internal]” I ruin everything I touch” [global] and I always will [stable]”
What is Alloy and Abramson’s Hopelessness Model of Depression?
State of Hopelessness and Stressful Life Event –> Depression
Cognitive Diathesis - Stress Model
What is the Nolen-Hoeksema Rumination Model for Depression?
How was the stressful event my fault?
What does the occurrence of the stressor say about me?
How do these things always happen to me?
Do women or men have higher rates of displaying the Nolen-Hoeksema Rumination Model for Depression? And why?
Women because they have higher rumination rates
How does stress cause depression?
Learned helplessness
- A reaction that may result when a person has repeated experiences that are distressing on which they do not seem able to affect
- They have no control
How do SLE’s trigger depressive episodes?
- Learned Hopelessness
- Physiological event
- Cortisol response
How does the HPA axis play a role in depression?
It is a part of the hormonal system which triggers the release of cortisol
Aka high cortisol levels = depression
How does stress cause depression in terms of the body?
Inflammatory response
- Cytokines (proteins that are released as a part of an immune response)
- These fight off infections
How does inflammation play a role in how SLE’s trigger symptoms?
Life stressors can lead to an increase in pro-inflammatory responses (cytokines)
What do we know about the role alleles play in reporting symptoms of depression and number of stressful life events? and how does it serve as a means for medication
- short/short alleles associated with higher reporting and number of stressful life events
- then short/long
- then long/long
- you can predict the type of medication a patient might need
What is the goal of cognitive therapy for depression?
To challenge and change the maladaptive automatic thoughts that contribute to depression
What is the goal for behavior therapy for depression?
To encourage clients to avoid social isolation and restriction of activities that may be contributing to their depression
What is the goal for psychodynamic therapy (interpersonal) for depression? and the four aspect’s of the patients’ relationships?
To encourage clients to strengthen social relationships that provide personal satisfaction
- Improving social and communication skills
- Resolving significant relationship conflicts
- Examining grief
- Addressing transitions in interpersonal roles
What neurotransmitters are low in someone who has depression?
Norepinephrine, dopamine, and serotonin
What receptors lack sensitivity in people who have depression?
Dopamine and serotonin
What happens when you deplete tryptophan?
It causes depression symptoms in people with personal or familial history of depression
What are biological interventions for major depressive disorder?
- Antidepressants
- Electroconvulsive therapy (ECT)
- Transcranial Magnetic Stimulation (TMS)
- Phototherapy
- Deep brain stimulation
What are different types of antidepressant medications?
- MOA inhibitors (Azilect, marplan)
- Tricyclic antidepressants (Norpramin, pamelor)1
- SNRIs (Fetzima, cymbalta)
- SSRIs (Prozac)
- NaSSAs (Zispin, norval)
Why should you never mix St. John’s Wort and antidepressants?
It interferes with birth control and serotonin levels get too high
How do antidepressants work?
- block re uptake of monoamines (norepinephrine, serotonin)
- tricyclics are somewhat selective in their actions
What are the side effects of antidepressants?
- dry mouth
- weight gain
- tiredness
How do MOA inhibitors work?
– make monoamines more available by inhibiting the enzyme that breaks down the monoamines
What are the side effects of MOA inhibitors?
- dangerously raise blood sugar by affecting substance called tyramine
- must severely limit food (wine, cheese, cured meats, chocolate)
- hypertension, sweating,
What are examples of monoamines?
Serotonin, norepinephrine, dopamine, epinephrine
How do SSRI’s work?
They selectively block the re uptake of serotonin
What are the side effects of SSRI’s?
Nausea Dry mouth Dizziness Headache Sexual side effects
How do SNRI’s work?
They selectively block the reabsorption of serotonin and norepinephrine
What are the side effects of SNRIs?
Same side effects as SSRI’s
What is a atypical example of an antidepressant?
Wellbutrin
– inhibits the removal of NE and DA in the synaptic and prolongs their actions
What are the side effects of Wellbutrin?
- Nausea
- High blood pressure
- Joint pain
- Constipation
What is melancholic depression?
The most severe form of depression
What are the symptoms of melancholic symptoms of depression?
- Decreased appetite
- ## Waking up early in the morning Anhedonia
What is the best treatment for melancholic depression?
Antidepressants
ECT
Describe ECT
- Two electrodes are attached to someone’s head
- An electric current is sent to someone’s head for a matter of a few seconds
When is ECT needed?
- Need for an immediate response if the person is in a vegetative state
- Antidepressant medications cannot be used or there is a lack of response
Is ECT the oldest and most effective?
Yes
What is transcranial magnetic stimulation?
- a strong pulse magnetic field is created by an electromagnet held close to the skull
- pulses are sent through
What are the differences between transcranial magnetic stimulation and electroconductive therapy?
TMS:
Relatively experimental technique
Uses magnetic field changes to induce current
Much lower energy required to change neuronal activity
Magnetic field can be highly focused
Reportedly fewer cognitive side effects
ECT:
Established technique
Uses electric current to change cortical activity
Direct electric stimulation of CNS
Very large currents needed to change neuronal activity
More widespread passage of current through the cortex
More cognitive side effects
What areas of the brain are responsible for major depression?
Hippocampus, amygdala, prefrontal cortex
What occurs during seasonal affective disorder?
Sleep tendencies go up and energy goes down
What are treatments for seasonal affective disorder?
Antidepressants, psychotherapy, phototherapy
