Depressive Disorders Flashcards
Defining major depressive disorder
Depressed mood or loss of interest/pleasure
•2+ weeks
•3+ of the following symptoms (causing significant distress or impairment)
1. Change in sleep patterns
2. Change in appetite or weight
3. Psychomotor agitation or retardation
4. Loss of energy/fatigue
5. Feelings of self blame, worthlessness, or guilt
6. Difficulty concentrating/indecisiveness
7. Thoughts of death/suicide
Depression courses
- Episodic: generally fine, drop, then fine again
•single episode: significant drop one time
•recurrent: significant drops that reoccur - Chronic:
•chronic: always down significantly
•partial remission: still down, but not as low
Comorbidities and variations
70% of people with depression have comorbidities
•anxiety: 60%
•substance use: 25%
•impuse control disorder: 30%
•eating disorders: lack of connive resources which leads to depression
- Cultural variations
•latino: complaints of nerves and headaches
•asian: complaints of weakness and fatigue - Lifespan variations
•children: irritability, acting out
•older adults: distractibility, forgetfulness
Biological factors
Genetics
•heritability: 40-50%
•can’t replicate findings for genes responsible
Neurotransmitters
•serotonin transporter gene (environmental onset)
•levels of norepinephrine, serotonin, and dopamine
•sensitivity of post-synaptic receptors
*ex: dopamine and serotonin receptors may lack sensitivity in MDD
Brain imaging (functional activation studies) •Amygdala = elevated •Dorsolateral prefrontal cortex = diminished •Hippocampus = diminished •Stratum = diminished •Subgenual anterior cingulate = elevated
Neuroendocrine system: HPA axis
•depression associated with overactivity of HPA axis
•triggers a release of cortisol (stress), overactive in MDD
•having constant stress takes tole on body/ health consequences (heart attacks)
Social factors
Stress
•early experiences
•42-67% report a stressful life event in the year prior to onset
•diathesis stress model: vulnerability factors that make people more likely to respond to something in a certain way
Interpersonal difficulties
•lack of social support
•high levels of expressed emotion in the family
•circular functioning of interpersonal problems and depression
Psychological factors
Cognitive
• Beck’s negative triad: negative thoughts about self, world, and future
•negative schemata: underlying set of beliefs (operating outside of our awareness) shape our experiences
•Hopelessness theory: belief that desirable outcomes will not occur/is not in your control (three dimensions):
1. stable vs unstable
2. global vs specific (1 thing effects everything vs it just being a breakup)
3. internal vs external
GRAPHS
Prevalence
Lifetime: 10-20% One year: 5%
•age of onset: mid 20s
•more common in women
•enormous personal, societal, and financial cost
Psychological Treatment
1. Psychological treatments •interpersonal therapy (IPT) •cognitive therapy •behavioural activation •mindfulness-based cognitive therapy
Interpersonal therapy
•because depression is tied to interpersonal problems, discussing them can improve communication
•best for postpartum, adolescents, and elderly
Cognitive therapy
•because depression is associated with maladaptive thought patterns
•focus: identifying and modifying negative automative thoughts
•together with a behavioural component = cognitive behavioural therapy
Behavioural activation
•because depression is associated with decreases in goal-directed activity and increases in social isolation
•activity assignments designed to increase positive experiences
Mindful based cognitive therapy
•because depression is associated with high rates of relapse
•focus: relapse prevention by identifying early signs of depression onset
•taught to separate from depressive thoughts
•best for those with recurrent depressive disorders
Exercise
•increasingly common, as it releases endorphins and promotes production of BDNF/grey matter volume in regions such as hippocampus
•promotes self-efficacy
Pharmacological Treatments
Antidepressants
- MAO inhibitors (ex: phenelzine)
•effects norepinephrine and serotonin systems by blocking the enzyme MAO - Tricyclic (TCA) antidepressants (ex: clomipramine)
•down regulate norepinephrine and possibly effect serotonin - Selective serotonin reuptake/SSRIs (ex: citalopram)
•inhibits serotonin reuptake - SNRI (ex: venlafaxine)
•inhibits serotonin and norepinephrine reuptake
Somatic Treatments (last resort)
- Transcanial magnetic stimulation (TMS)
•large magnetic cools positioned above patients desired area to produce an electric current in nearby neurons - Deep brain stimulation (DBS)
•electrodes surgically planted into brain, delivering pulses that disrupt activity of certain cells/chemicals in the brain - Electrocunvolsive therapy (ECT)
•small electric currents passed through brain triggering a brief seizure, possibly allowing for neural re-wiring and boosting neurogenesis
Suicide
Myths:
•people who talk about suicide are unlikely to commit suicide
•suicidal individuals are fully committed to dying
•only depressed people commit suicide
Truths:
•suicidal people usually do not warn others (warnings - the world would be better without me, praising others)
•men are more likely (they chose more lethal methods)
Risk factors of ideation
•psychological pain (depressed mood/anxiety)
•helplessness about changing situation)
Processing from ideation to attempt: capability
- Dispositional capability: genetic factors that can result in increased capability (ex: low sensitivity to pain)
- Acquired capability: experiences resulting in habituation to pain and fear of death (ex: non suicidal self unjust, previous suicide attempt, substance use)
- Practical capability: having access/knowledge about lethal means (access to firearms, anaethesiologists)
Suicide prevalence
40-60% of suicides occur during a depressive episode
Risks for psychiatric illnesses
•MDD: 15%
•Schizophrenia: 10%
•Hospitalized for alcohol dependence: 3-4%
Demographic prevalence
•women are more likely to attempt, men are more likely to die
•second leading cause of death in young people (15-34)
•highest rate in mid life (40-59)
•single > widowed/divorced > married
