depression Flashcards
how many ppl suffer globally w depression
276 million
depression lifetime prevalence
- 17%
- women: 20-25%
- men 9-12%
point prevalence depression
6% women, 3% men
social costs of depression
14.4 billion dollars in canada
____% suicide can be attributed to depression and depression increases suicide rate ______
70%, 4-told
MDD criteria
- depressed mood and loss of interest + pleasure plus at least 3 more of the following:
- change in appetite/weight, worthlessness/guilt, suicidal ideation/intention/action, fatigue/loss of energy, concentration probs/lack of energy, insomnia/hypersomnia, psychomotor agitation/retardation,
bc DSm criteria for depression is based on wester ideologies, what other parts of the world have other symptoms?
- India: ‘tension’ (headaches)
- Zimbabwe: Kufungisisa (thinking too much)
episodic accounts for ___ of depressed ppl, and persistant/dysthymia is ___
70-80%, 20-30%
SLED
- single lifetime episode depression
- characterizes lifetime course of half of ppl w episodic depression
early life stress and onset of depression and anxiety
- men: emotional abuse and sexual abuse worse predictors
- women: emotional abuse, physical abuse, and sexual abuse worse
child maltreatment and depression
- emotional and sexual abuse are strongest predictors
- ppl w MDD that have history of childhood maltreatment have: younger onset, poorer premorbid functioning, more severe symptoms, more persistent/recurrent course, more treatment resistance, and higher comorbidities
resilience to early life stress
- high risk of drop out youth
- found violent exposure/family conflict were strong predictors for increasing depression overtime
- also, mother support buffered the effect and was associated with lowering depression overtim
levels of depressotypic cognition
- automatic thoughts (ie she doesnt like me)
- intermediary beliefs/assumptions (if someone gets close to me, theyll reject me
- core beliefs/schemas (im unloveable)
manner in which events are appraised/evaluated determines the ______ of the emotion
type, intensity, and persistence
cognitive schemas
- schemas about experiences leading to reactions
- hypothetical structures containing stored reps of beliefs taken from sensory experiences
- guides the encoding, storage and retrieval of info
depressotypic schemas
- enduring, rigid, and complex negative beliefs about the self, personal world and future
- resistant to change despite disconfirming info
Negative cognition and cause of depression
- those at high risk of negative cognitions had more severe depression than low risk
- not a longer duration/early onset
- high risk cognition predicted first episode and episodes that followed
neural dysregulation
- ‘gets under the skin’
- external factors that can effect internal changes (even w/out contact)
- ie experiences
vulnerability model for depression
- early life stress affects development of HPA axis (hypothalamic-pituitary-adrenal axis)
purpose of HPA axis
- releases cortisol and other neurochemicals to enable fight or flight during life threatening events
hippocampus purpose
- holds short term memories and transfers them to long term
- emotional processing (mediating anxiety and avoidance)
role of amygdala
- links emotions to other brain abilities (ie memory, learning and sensations)
- main hot bed for emotions
consequences of cortisol toxicity
- smaller amygdala and hippocampal volume
- disrupts connection between cortex and hippocampus
- causes rumination, impairs extinction of painful memories, and emotional dysregulation
childhood maltreatment has a negative asoociation with lower connectivity between cortex and ____ or ____ (brain structures)
- amygdala, hippocampus
- lower functional connectivity sig mediated relation of childhood maltreatment and dev of depression and anxiety
ppl with depression are ____x more likely to hve a mjaor life event prior to onset than ppl without depression for a matched time frame
3x
sensitivity to stress and depression
- ppl with vulnerability factors (diathesis: early life stress and neural dysregulation) are more likely to develop depression in face of stressful life event
- may need lower levels of stress in order to trigger depression than most
____ and _______ increase sensitivity to stressful life events
early life stress and neural dysregulation
stress generation in depression (depression<->stress)
- ppl w depression more likely to be exposed to future dependent life event than those w out
- vulnerability factors before onset can contribute to generation of life events
- stress begets stress
- humans are architects of our enviro
- life event generation as result of behaviour/characteristics
stress generation (depression)
- ppl with depression are more likely than non depressed ppl to be exposed to future life events
____, ______, and ____ make stressful life events more likely to occur
- early life stress, negative cognition, and neural dysregulation
emotional and sexual maltreatment and stress generation
- emotional: strong association with emotional deprevation, subjugation, and subjugation and dependent life events
- sexual: strong association with abandonment, vulnerability to harm, dependent life events, and dependence/incompetence
building depression model
genetic vulnerability/early life stress /temperament /personality >negative cognition/neural dysregulation> stress later in life > depression
- can be offset by protective resilience factors (social support, hardiness, community resources, and good habits)
_____% of ppl with MDD seek treatment
20-25%
Treatment options for depression (general names)
- Cognitive behavioural therapy
- Interpersonal psychotherapy
- Pharmacotherapy
CBT for depression
- teach power of realistic thinking (cognitive): improves mood by challenging dysfunctional cognitions
- activates behaviour: improves mood by engaging in behaviours that promote sense of pleasure and mastery
interpersonal therapy for depression
- focus on identifying and amending lapses in interpersonal functioning that contribute to depression
- ex interpersonal loss (greif), interpersonal conflict, role transiton, interpersonal deficits
pharmacotherapy for depression
- tricyclic antidepressants (TCAs): imipramine (sleep amitryptyline) > more fatal in overdose
- monoamine oxidase inhibitors (MAOIs): phenelzine (creates reverse vegetative features, effective in countering physical symptoms ie over sleeping/eating)
- selective serotonin reuptake inhibitors (SSRIs): escitalopram
- serotonin and norepinephrine reuptake inhibitors (SNRIs): vanlafaxine
t or f: people do better on treatment they chose themselves
true
in a study on different treatment effectiveness, what was found after the sample was stratified into how severely they were depressed at the start of the study
- in least depressed group: no matter what treatment, they were the same and all got better at the end
- in most depressed group: imipramine and IPT did way better than all other treatments
explain E/P>T
- the belief that the cause (E/P, etiology/pathology) of depression should indicate the treatment (T)
- ie biological cause>bio treatment/drugs, or environmental cause>enviro treatment (therapy)
is there evidence for meds being superior to therapy for depression treatment
- no
- depression involves differences at all levels of analysis and treatments result in different changes at different levels of analysis
- dif treatments target dif areas that are affected by depression (ie behaviour/cognitive/neural functioning)
what percent of people respond to any treatment
40-50%
hetrogeneity of depression
- 170 dif possible combos
- rarely will people have same symptoms, treatment, and outcome
personalized meds for depression
- w/out: some benefit, some dont
- with: each patient receives right meds for them (looks at history, biomarkers, etc)
clinical management
- patient talks to the nurse about the effects of meds, not anything about how they feel/no therapy
maintenance meds
- keep ppl on meds forever
anhedonia
loss of pleasure/interest
examples of markers of different response to pharamcotherapy vs CBT (childhood trauma, stressful live events, anhedonia, and comorbid personality disorder)
- comorbid personality disorder: pharma>CBT
- anhedonia: behavioural therapy> (doesnt respond to SSRIs)
- stressful life event: CBT>pharma
- childhood trauma: trauma focused CBT>reg CBT/pharma
who had higher relapse: patients who had imipramine and CBT or those that had placebo and CBT
imipramine and CBT
