Lecture 3 + Readings Flashcards
Symptoms/diagnostic criteria of MDD
At least 1 of core symptoms
•Depressed mood
•Loss of interest in activities or people
AND TOTAL of at least 5 (including at least one of the core):
•Marked insomnia or hypersomnia
•Low energy
•Appetite disturbance
•Psychomotor retardation or agitation
•Feeling of worthlessness or guilt
•Poor concentration or indecision
•Thoughts of death and/or suicide
Symptoms last at least 2 weeks (avg. is 6 months)
Symptoms must cause clinically significant distress/impairment
Symptoms interfere with normal functioning
What is the lifetime prevalence of MDD?
10-15% (some studies 20%)
Depression increases suicide risk by how much?
4xs
responsible for 70% of suicides
What is secondary depression?
Secondary depression is when another illness is the cause of the depression
ex: someone diagnosed with cancer then becomes depressed
Explain relationship between overall health and depression
Depression worsens overall health of chronically ill patients by about 10%
Recurrence
85% of people have a recurrence
Predictors of recurrence
being female, more prior episodes*, longer episodes, never marrying
Prior episdoes
The risk for another recurrence goes up 16% after each episode.
Teens with depression
increases rates of suicide - 5xs more likely than non-depressed
Persistent or Chronic Depression
Longer duration More severe symptoms More comorbidity Poorer social support Poorer response to treatment Family history of affective disorders
What is the link between poor social support and chronic depression?
- Persistent depression can decrease someone’s motivation to get help = poor social support, Or even a feedback system – they might not be so nice to other people and therefore they don’t want to deal with them…
Anger in depression
isn’t an official symptom - but 40% of MDD have this.
but unrecognized
Disruptive Mood Regulation disorder
characterized by anger/irritable outbursts quite often
When are you considered in recovered from MDD?
2 months symptom free
What is remission in MDD?
still some symptoms, but don’t meet criteria for diagnosis
What are the SCID and K-SADS
Interview measures for depression
SCID for adults
K-SADS for kids
What are
Beck Depression Inventory
Hamilton Depression Rating Scale
Montgomery-Asberg rating scale
Self-report measures of depression
Brain areas involved in depression
Less activation: - Prefrontal Cortex (PFC), Cingulate More activation: - Amygdala - Orbital cortex (OC)
Family studies and depression
1st degree relative 2-5x more likely to develop unipolar depression
Twin studies and depression
Concordance rates for unipolar depression:
- 40-59% for MZ twins
- 20-30% for DZ twins
Bipolar disorder 65% MZ and 14% DZ
Adoption studies and depression
Adoption studies:
- rates of bipolar disorder in biological relatives = 32% vs. 12% of adoptive relatives
Serotonin
Involved in regulation of emotion
Low serotonin linked to depression; but not the cause*
Serotonin pathway to PFC important in mood regulation and mechanisms of antidepressants
Norepinephrine
Mostly related to anxiety
Plays a role in depression
Brain-derive Neurotrophic factor (BDNF)
Important in neuroplasticity
Episodic and emotion-related memory, fear
Stress = decreased hippocampal BDNF
CBT on depression
CBT reverses altered activation patterns to emotional stimuli = cognitive therapy can affect the activity of the brain regions involved in how emotions are processed
*Based on studies using MRI and fMRI
Integration of CBT and biology
Cognitive related therapies lead to brain alterations
Biological vulnerability and cognitive vulnerability might be related
