Depressive Disorders Flashcards
Orientation
=unipolar - major depression
= bipolar - elevated mood (mania) and depression
=caveats
-unipolar mania: does it exist? it can, but it is very rare
-never had a depressive episode - still get a bipolar diagnosis
=cannot have both, if you have ever had a hypomanic or manic mood means you have bipolar not depression
Defining Feature of Depression and bipolar
=textbook says it is disrupted mood for both
=depression: could just be loss of interest in pleasurable activity
=bipolar: could be high increase in goal directed behavior, not grandiose thought
DSM depression
=see textbook
=loss of interest
=psychomotor retardation - speaking and moving more slowly
=psychomotor agitation - keyed up, restlessness
Depression: heterogenous presentation
=Person 1
-sadness, weight gain, psychomotor retardation, hypersomnia, fatigue, excessive guilt, suicidal ideation
=Person 2
-loss of interest, weight loss, psychomotor agitation, insomnia, can’t concentrate
Course Specifiers
=Table 7-1 in textbook =with melancholic features =with psychotic features =with atypical features =with catatonic features =with seasonal patterns
- with melancholic features
2. with psychotic features
- black void, nothingness, no feelings
- depressed delusions or hallucinations
- psychotic symptoms occur only when someone is in a mood episode
- with atypical features
- with catatonic features
- with seasonal patterns
1 - 3. see table 7-1 in textbook
Etiology of Depression
early experience –> formation of dysfunctional beliefs
critical incidents –> beliefs activated –> negative automatic thoughts –> symptoms of depression = behavioral, motivational, affective, cognitive, somatic
“if I’m not the best, I’m nothing” - easier to become depressed when proved right
Negative Cognitive Triad
=negative cognitions about world, self, future
=errors in thinking and logic that maintain depression
Errors in Thinking and Logic
=overgeneralization =selective abstraction =excessive responsibility =catastrophizing =should statements - perfectionism
Cognitive Behavioral Therapy
Make a chart with: =situation =mood =automatic thought =evidence supports the thought =evidence that does not support the thought =alternative thoughts =mood now
Acceptance and Commitment Therapy
=change your relationship to your thoughts and moods
=trying to change a thought or feeling can you to muse on it
=choose valued action, even if you feel down
Reformulated Helplessness Theory
=based on Seligman’s experiments with animal models
-learned helplessness
=addition of a cognitive component - attributing thought
-internal/external
-stable/unstable
-global/specific
Attributing Thoughts of someone depressed
=Depressed
- negative events: internal, stable, global
- positive events: external, unstable, specific
Hopelessness
=a real certain belief that bad things are going to happen and not good things
=a real problem for treating depression, makes it harder for patients to see solutions
Coping Styles
=ruminate on problems --> depression -women more than men -problem focused -emotion focused =distraction --> protective -men more than women -ex working out, running
Interpersonal Aspects
=lack of social support
-friends get tired of dealing with depressed person and she gets more depressed
=social skills deficit
=marital distress
=depression’s negative effects on others
=for children, having a depressed mother
-much worse than depressed father
Interpersonal Psychotherapy
=depression arises i the context of interpersonal relationships
=focus on skill building, asking for support, role-playing, reenactments
Behavioral Activation
=decrease avoidance behaviors
=fill out activity diary in therapy
Pharmacological Treatments for Depression
=MAOIs
-have to follow a strict diet
-atypical features
=TriCyclics
-no dietary restrictions, but toxic in high doses
-easy to overdose - not good for a suicidal population
-side effects
=SSRIs
-less toxic, fewer side effects
-placebo effect - only work in people with very severe depression
Other Biological Treatments
=ECT - in very severe, last resort, but effective
- 6-12 treatments
-induce seizures
=TMS - transcranial magnetic stimulation
=DBS - surgical procedure
-thing attached to head with wires and a stimulator
=bright light therapy - seasonal
Psychotherapy
=on par with medication for treatment
=people tend to try meds before psychotherapy because of HMOs
=long term
-withdraw meds –> recurrence
-withdraw cbt -> still have skills –> less recurrence
Could depressive symptoms ever be adaptive
=guide your actions
=tell you if this is not the right place to be
=can’t eliminate all symptoms because sometimes they are adaptive
prevalence of MDD (major depressive disorder)
=lifetime in us: 17%
-ratio of women: men is 2:1
=12 month prevalence: 7%
=white people are most likely to have depression
=where there is greater income, depression rates are lower
=the us has one of the highest rates of depression
MDD is typically persistent
=average duration of untreated episode: 6-9 months
-for 10-20% of people, takes >2years
=financial difficulties, severely stressful life events and high genetic risk –> longer time to remission
MDD is often recurrent
=recurs in 40-50% of cases
=kindling hypothesis
-with each new episode the likelihood of another episode increases
=residual symptoms are common, especialy when reccurrent
-these are symptoms that dont’ meet criteria for depression
onset of mdd
=typically late adolescence to middle age
-boys as likely as girls in children
=significantly lower in >65 years old
=sharp rise in teens
comorbidities are common
=personality disorders
=alcohol abuse/dependence
=anxiety
Tripartite Model
=anxious arousal + negative affect –> anxiety symptoms
=negative affect + low positive affect –> depressive symptoms
Persistent Depressive Disorder
=milder intensity, more chronic
=worse outcomes, equal impairment
=lifetime prevalence between 2.5 - 6% in us
=average duration of 4-5 years
What causes depressive disorders: nature
- genes: moderate heritability
- neurotransmitters: DA, 5HT, NE
- hormones: cortisol, HPA axis, hypothyroidism, immune system dysregulation
- brian influences: figure 7.2
- biological rhythms: sleep, circadian cycle, seasons
What causes depressive disorders: nurture
- stress
- psychological factors
Stress and depression
=severe life stress sometimes plays a role
-20-50%
=life stress implicated less over time
=dependent life stress more problematic than independent
=women experience more and are more sensitive to stress
=interaction with genetics
