*Lectures 7,8,9 - Unipolar Depressive Disorders Flashcards
What is the main criteria of Major Depressive Disorder (MDD)?
A Single or Recurrent depressive episode
What does a Major Depressive Episode entail?
◦ Depressed mood most of the day, nearly every day
◦ Markedly diminished pleasure/interest in activities
◦ Significant weight loss or gain
◦ Insomnia or hypersomnia nearly every day
◦ Psychomotor agitation or retardation nearly every day
◦ Fatigue/loss of energy nearly every day
◦ Feelings of worthlessness, excessive guilt nearly every day
◦ Diminished ability to concentrate nearly every day
◦ Recurrent thoughts of death, suicide, suicide attempts
5 or more is needed, (including 1/ or 2/) in a 2-week period
There has never been a manic episode or a hypomanic episode.
What was the major change between the DSM-IV and DSM-5 for Major Depressive Disorder (MDD)?
Removed Grief exclusion from diagnosis of Major Depressive Disorder.
What are the subtypes/specifiers for MD?
1 anxious distress
2 seasonal pattern (Seasonal Affective Disorder)
3 peripartum onset (Postnatal Depression)
4 atypical features
(Weight gain, oversleep, rejection sensitivity)
5 psychotic features
6 melancholic features
What are the 3 alternative subtypes according to Parker, 2000?
- Melancholic
- Psychotic
- Non-melancholic
Assumes different symptoms, causation and treatment.
Evidence: difference in severity, rather than in cause.
What is the lifetime prevalence of MDD?
Kessler et al, 2003
16.4% lifetime prevalence
What is the one-year prevalence of MDD in Australia?
3-5 % one-year prevalence in Australia
Why has there been a steady increase in the one-year prevalence of MDD in Australia since the 1950s?
Why has there been a steady decrease in the age of onset for MDD?
Increased speed of change/stress
Decreased social support/family support
More acceptable to report symptoms
Overdiagnosis
What is the gender ratio in MDD?
Gender imbalance (2:1) female:male
What is the course of MDD?
Emerges during adolescence, evens out after 65
What evidence is there that MDD is genetic?
- Family Studies
(High rate in relatives of probands) - Twin Studies
(Concordance rates higher in identical twins than in
fraternal twins) - Adoption Studies
(Mixed findings)
What 3 neuro- chemicals are likely involved in depression?
Are these chemicals too low or too high?
Low levels of:
◦ Noradrenalin
◦ Dopamine
◦ Serotonin
HOWEVER:
No good evidence for mechanism
Absolute levels are unlikely to be the cause
Which 4 brain structures are likely to be different in people with current or history of depression vs. no depression?
- Amygdala,
- Hippocampus
- Prefrontal Cortex
- Anterior Cingulate
How is the neuroendocrine system (hormonal) involved in depression?
◦ Overactivity in the Hypothalamic-pituitary- adrenocortical axis (HPA Axis)
Involved in regulating response to stress
Excess cortisol (stress hormone)
Related to damage to hippocampus?
Lower density of serotonin receptors?
◦ Implicates role of (early) stress in depression
Interaction between genetic vulnerability and
negative life events
What are 5 psychological theories that may influence MDD?
(Seligman, 1975) (Abramson, Seligman , & Teasdale, 1978) (Abramson, Metalsky, & Alloy, 1989) (Beck, 1976) (Nolen-Hoeksema, 2002)
- Learned Helplessness Theory (Seligman, 1975)
◦ Lack of control over life events - Attribution Theory (Abramson et al., 1978)
◦ Internal vs external attributions
◦ Stable vs unstable attributions
◦ Global vs specific attributions
Interaction between cognitive style and life event - Hopelessness Theory (Abramson et al., 1989)
◦ helplessness expectancy plus
◦ negative outcome expectancy - Schema Theory (Beck, 1976)
◦ Pre-existing negative schema
◦ Developed during childhood (esp if vulnerable)
◦ Activated by stress
results in cognitive biases (memory, attention,
interpretation):
Arbitrary Inference, Overgeneralization,
Magnification
Depressive Cognitive Triad:
negative thoughts about the self, the world,
the future become dominant in
consciousness - Response style theory (Nolen-Hoeksema, 2002)
◦ Rumination vs distraction, problem solving,etc
FIX CARD
According to the Attribution Theory (Abramson et al., 1978) what are the three different kinds of attributions that one can make about the cause of a life event, and how does this relate to MDD?
(Abramson, Seligman, & Teasdale, 1978)
• Internal vs external attributions
◦ internal attributions are more likely to lead to self-
esteem problems
• Stable vs unstable attributions
◦ e.g. every day sucks vs. just a bad day
• Global vs specific attributions
◦ e.g. this always happens vs. it was only due to
specific circumstances (the first one is for the more
vulnerable)
Interaction between cognitive style and life event
FIX CARD
Learned Helplessness Theory (Seligman, 1975)
• A theory to help explain why some people are more vulnerable to depression than others
○ vulnerable people perceive a lack of control over life events
Evidence:
○ monkeys received electric shocks. But one group has power to stop, other does not.
○ even if have same kind same number of shocks, you have no power - wait what…? FIX ME
FIX CARD
Hopelessness Theory (Abramson, Metalsky, & Alloy, 1989)
Requires
1) helplessness expectancy/attribution AND
2) negative outcome expectations
E.g. “I did something bad and it is catastrophic!”
According to this theory, you will not get depressed if you do not feel hopeless.
FIX CARD
Schema Theory (Beck, 1976)
Beck was the Father of cognitive psychology.
○ pre-existing negative schema
○ dvlp. during childhood (esp if vulnerable)
○ activated by stress
○ results in cognitive biases (memory, attn, interpretation)
○ collect info that reinforces our ideas, tend to ignore others or make it fit our schema
○ arbitrary inference, over-generalisation, magnification
○ Depressive Cognitive Triad
○ negative self-beliefs, the world, the future. These become dominant in consciousness.
FIX CARD
Response Style Theory (Nolen-Hoeksema, 2002)
○ not just the thoughts/content, but the WAY we think, what we do with the content
○ Rumination vs Distraction, problem solving etc.
○ so distraction is better, can then go when feeling better and problem solve
○ rumination is strongly associated with depression
FIX CARD
Interpersonal approaches
(Hammen, 2002; Joiner, 1995; Joiner & Metalsky, 2002)
Interpersonal relations are negatively altered as a result
of depression. Depressed people:
○ have limited social support networks
○ seek excessive reassurance from others
○ have / display limited social skills
○ elicit rejection from others
○ can maintain or exacerbate depression
What is the Stress-generation hypothesis?
Hammen, 1991; 2006; Liu, 2013
Depressogenic cognitions and behaviours generate negative life events
Self-generated negative life events may partly explain depression recurrence
What ways can we treat unipolar disorders?
- ECT
- Drugs
- Psychological therapy
Outline Electroconvulsive Therapy (ECT)
◦ First introduced in 1938 (to treat schizophrenia.)
◦ Only effective treatment for MD prior to 1950s
◦ Applying brief electrical current to the brain
◦ Results in temporary seizures
◦ A course of 6 to 10 treatments are administered
◦ Effective for severe depression (85%+)
◦ Still used in people not responsive to other trmt
◦ Relapse is common
◦ Few side effects (short-term memory loss)
◦ Uncertain why /how ECT works
When was ECT first used?
1938
What was ECT first used to treat?
Schizophrenia
True or False?
ECT was seen as the only effective treatment for MD prior to 1950s?
True
How effective is ECT for severe depression?
85% + effective
Why do we not use ECT as the first line of treatment?
Uncertainty as to why or how it works
Painful
Side effects inc. short term memory loss
Relapse is common
What are the 3 waves of drug treatments?
- Monoamine Oxidase Inhibitors (MAOIs)
- Tricyclic Medications
- Selective Serotonin Reuptake Inhibitors (SSRIs)
