Depression Flashcards
What changed in the Mood Disorder chapter from DSM-IV to DSM-V?
DSM-IV: All extremes in normal mood - MDD and Dysthymia - 3 Bipolars DSM-V: - No more Bipolar (has its own chapter) - Disruptive Mood Dysregulation Disorder - MDD - Dysthymia: Persistent Depressive Disorder - Premenstrual Dysphoric Disorder
Describe the symptoms of a Major Depressive Episode (within MDD).
Has to have 1) or 2), followed by >5 of other symptoms in 2 week period
(Never been a hypo/manic episode)
1) Depressed mood most of the day, nearly every day
2) Markedly diminished pleasure/interest in activities
- Sig weight loss/gain
- In/hypersomnia nearly every day
- Psychomotor agitation/retardation nearly every day
- Fatigue/loss of energy nearly every day
- Feelings of worthlessness, excessive guilt nearly every day
- Dim ability to concentrate nearly every day
- Recurrent thoughts of death, suicide, suicide attempts
What changed between DSM-IV and DSM-V for the Mood Disorder chapter?
- DSM-IV “Mood disorders” –> DSM-V “Depressive disorders” + “Bipolar and Related Disorders”
- IV: Dysthymia –> V: Persistent Depressive Disorder
- Removal of bereavement/grief clause from diagnosis of MDD (persisting >2 months)
V: Added “Disruptive Mood Dysregulation Disorder” and “Premenstrual Dysphoric Disorder”
Persistent Depressive Disorder (= Dysthymia) symptom description
Depressed mood most of the day, more days than not
Presence, while depressed, of two (or more) of the following:
- Poor appetite or overeating
- In/hypersomnia
- Low energy/fatigue
- Low self-esteem
- Poor concentration or difficulty making decisions
- Feelings of hopelessness
- No more than 2 months “normal” mood in 2 years
- No manic features
- Symptoms milder than MDD
- May also develop MD episodes
- Symptoms can persist unchanged over long periods (e.g. >20 years)
Disruptive Mood Dysregulation disorder symptom description
- Severe recurrent temper outbursts (verbal rages, physical aggression) that are grossly out of proportion in intensity/duration to provocation
- Mood between temper outbursts is persistently irritable or angry, and is observable by others (e.g. parents, teachers, peers)
- Diagnosis should not be made for the first time before age 6 years or after 18 years.
Prevents kids from being diagnosed as bipolar
Premenstrual Dysphoric Disorder
Majority of Menstrual cycles, >5 symptoms must be present in the final week before menses onset, start to improve within a few days after menses onset, and become minimal/absent in postmenses week.
One (ore more) of the following symptoms must be present:
- Marked affective liability (e.g. mood swings)
- Marked irritability/anger/increased interpersonal conflicts
- Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts
- Marked anxiety, tension, and/or feelings of being keyed up/on edge
One (or more) of the following symptoms much additionally be present, to reach a total of 5 symptoms when combined with symptoms from Criterion B above.
- Decreased interest in usual activities
- Subjective difficulty in concentration
- Lethargy, easy fatigability, or marked lack of energy
- Marked change in appetite; overeating; or specific food cravings
- Hyper/insomnia
- A sense of being overwhelmed or out of control
- Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of “bloating”, or weight gain
What are the subtypes/specifiers of MDD?
MD with…
- Anxious distress
- Seasonal pattern (Seasonal Affective Disorder)
- Peripartum onset (Postnatal depression)
- Atypical features (weight gain, oversleep, rejection sensitivity)
- Psychotic features
- Melancholic features: does not respond to positive events. Loss of pleasure + lack of reaction. They experience a distinct quality of depressed mood
What is an alternative way of subtyping MDD, as proposed by Parker (2000)?
Melancholic, psychotic, non-melacholic subtypes
- Assumes different symptoms, causation, and treatment
Melancholic depression:
- Lack of reactivity/total loss of pleasure
- Distinct quality of mood
- Mood worse in morning
- Early morning awakening
- Weight/appetite loss
- Marked psychomotor agitation or retardation
Melancholic and psychotic subtypes are seen as “endogenous depression” (biological)
- Best treated with bio treatments
Non-melancholic: more environmental factors
Evidence: Differences in severity of depression, rather than in cause
- Placebo: Melancholic more responsive than non-melancholic
Epidemiology of MDD: Prevalence
16% Lifetime prev
3-5% one year prev in Aus
- Steady increase in prevalence since 1950s
- Steady decrease in age of onset
Gender imbalance: 2F:1M
- Emerges during adolescence, evens out after 65
Why has there been an increase in prevalence and a decrease in onset age of MDD?
- Increased speed of change/stress
- Decreased social support/family
(loneliness has increased sig.; Assoc with depression) - More acceptable to report symptoms (perhaps not necessarily more ppl with symptoms)
- Overdiagnosis
Biological influences on Depression - Genetic
Family studies: higher rate in relatives of MDD patients
Twin studies: Concordance rates higher in identical twins than in fraternal twins
- The more severe the depression, the more genetically related the depression is
Adoption studies: Mixed findings
Perhaps no one gene passed down
Neuroticism factor: perfectionistic society/envr encourages neuroticism –> depression
(But never just nature or nurture - always both)
Biological influences on MDD - Neurochemistry
Low levels of NA, dopamine and serotonin.
- No good evidence for mechanisms
- absolute levels unlikely to be cause
- Most studies correlational - unsure of causality direction
Biological influences on MDD - Brain structures
Amygdala, Hippocampus, prefrontal cortex, anterior Cingulate Cortex
- Difference between people with current/history of depression vs no depression
- Causation?
Biological influences on MDD - Neuroendocrine System
Overactivity in the Hypothalamic-pituitary-adrenocortical (HPA) Axis: Regulates response to stress
- Excess cortisol (stress hormone) –> damage hippocampus? –> damage of serotonin receptors?
- Implicates role of early stress in depression
Genetic vulnerability x negative life events
- Magnitude of response to stress depends on number of life stress events previously experienced
Psychological Influences on MDD - Learned Helplessness Theory (Seligman, 1975)
Lack of control over life events
Based on the experiments with the dogs pushing on the plate to stop aversive events (electric shocks) from occurring
New situation –> Dog gives up, and did not even try to change the aversive events
- Learnt that they have no control over their negative life events
