Lecture - Psych Med (Depression Valentine)

Question 1

What is unipolar depression vs bipolar disorders?

What is dysthymia?

What about bipolar II and cyclothymia?

For diagnosis, what do you need to make sure?

Answer 1

Depression is this dropped and persistent drop of mood. Bipolar also has elevation of mood.

Even in the psychological realm, it’s hard to make diagnosis. Dysthymia means the symptoms aren’t fully met for a depressive episode.

Bipolar 2 and cyclothymia are a low level of fluctutaion of mood.

Make sure for diagnosis, there are no other medical conditions like low iron or being physically run down that are affecting it.

Question 2

What are the symptoms of depression?

Answer 2

1. Concentration - difficulty in concentrating
2. Feeling super guilty
3. Reduced to increased appetite
4. Having sleep problems
5. Psychomotor agitation/retardation (real fidgety or slow af)
6. Feeling suicidal
7. Anhedonia - lack of interest in things that were enjoyable
8. Lack of energy
9. Sadness and impairment of functioning if diagnosing

Question 3

What’s the prevalence of depression like?

Answer 3

1. In 6% of general population
2. Onset is like late 20s
3. But the second period of risk is in older life and that can be missed

Question 4

What’s the global burden of depression?

Answer 4

In 2004, it was the 3rd leading cause of death and disability

2020: depression
2nd leading cause
of premature
death and poor
health (WHO)

Question 5

What are some of the physical effects of depression?

Answer 5

It has biological effects like metabolic syndrome, excessive clothing etc.

It affects people in all aspects of life and cellular level. Affects at a system level and volume + density of brain areas. Therapies which are mental can bring about physical changes.

People have this idea that since it’s in their head, it’s not as important as breaking a leg. Depression is actually a real illness with real consequences and it’s altering their physical biology

There is profound regulation in HPA axis for how poeple regulate cortisol etc and in depression, there is a prolonged response to a stressor. There is a dysfunction of the HPA axis so you can get like overactive response to stressors or impaired inhibition of cortisol release

Question 6

What sort of medical condition can lead to depression?

Answer 6

Myocardial infarction (heart attack), stroke

There is generally depression in the first month - if you do have depression then poor outcomes

With MI, you mightttt get anxiety but after stroke, 23% chance you’ll get depression

Question 7

What medical conditions can depression lead to?

Answer 7

1. Dep and anxiety predict coronary heart disease

2. Depression is a risk factor for nonfatal CHD and for mortality in med and incident hypertension

Question 8

What psychological conditions can lead to medical conditions?

Answer 8

Depression associated with diabetes and increases risk of type 2 diabetes

Undetected diabetes can lead to depression and that depression impairs help-seeking

Question 9

Depression complicate medical conditions like?

Answer 9

Depression in diabetes can lead to nephropathy and retinopathy etc

People with depression will impair their adherence and exercise and diet

Question 10

What are some risk factors for depression?

Answer 10

1. Being female
2. Being age 16 to 24
3. Family history of depression
4. Substance abuse
5. SES deprivation

Question 11

NZ guidelines around screening - what are they?

Answer 11

Screen those who are under suspicion or new/infreuent and those at risk. Ask them about symptoms and their patient history

Question 12

Why do people become depressed?

Answer 12

Because there are gender differences and they can be due to childhood sexual abuse (women more abused) or social roles or hormonal differences or sex role differences

You need diathesis and stress both together to become depressed and esp stress.- they can bring about depression. Also when there are losses that permanently change one’s life

Question 13

What’s the thing with genetics and depression?

Answer 13

If you have the s allele, you have less production of serotonin

Takes fewer stressful life events for the s/s to become depresed. Look at when there are 2 stressors, the l/l group arent too sad but the s/s are.

This combination of genes and environ is important - the environ can turn on/off certain gene

Even when we are in s/s group - still need stressors to bring about that response. These stresors are so modifiable and the way we react to them is in our control

Question 14

Go read slide 25 why people become depressed

Answer 14

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Question 15

What’s the treatment for depression?

Answer 15

Phsyical activity, sleep improvement, daily planning, mindfulness, stress management

Food, light, exercise,

For mild depression: CBT and moderate to severe is CBT + anti depressants

IPT has similar effectiveness as CBT

Other therapies are like ACT, mindfulness etc