Major depressive disorder Flashcards
What is the natural course of Major Depressive Disorder (MDD)?
The progression of MDD varies and may include:
* No further episodes (50% experience full remission)
* Unremitting (15% remain chronically depressed)
* Recurrent (35% experience multiple episodes with increased risk after each episode)
Example: A 30-year-old woman diagnosed with MDD at age 25 experiences a second episode of depression three years later, reflecting recurrence statistics.
What are the risk factors for Major Depressive Disorder (MDD)?
Risk factors include:
* Female gender (2:1 female-to-male ratio)
* Younger age
* Family history of depression
* Prior substance abuse or panic attacks
These factors increase vulnerability to MDD.
What are the primary symptoms required for diagnosing MDD according to DSM-5?
Primary symptoms include:
* Depressed mood most of the day
* Loss of interest or pleasure in almost all activities (anhedonia)
Symptoms must persist for at least two weeks.
What additional symptoms are required for a diagnosis of MDD?
At least three of the following additional symptoms are required:
* Significant weight or appetite change
* Insomnia or hypersomnia
* Psychomotor agitation or retardation
* Fatigue or loss of energy
* Feelings of worthlessness or excessive guilt
* Diminished concentration or decisiveness
* Recurrent thoughts of death or suicidal ideation
These symptoms must cause significant distress or impairment in functioning.
What are the inclusion criteria for diagnosing MDD?
Inclusion criteria include:
* Symptoms cause significant distress or impairment in functioning
* Symptoms not better explained by substance use or a medical condition
This ensures accurate diagnosis.
What are the exclusion criteria for diagnosing MDD?
Exclusion criteria include:
* No history of manic or hypomanic episodes
This is to rule out bipolar disorder.
What are the screening considerations for comorbid conditions in MDD?
Screening for comorbid conditions includes:
* Bipolar Disorder: Assess for episodes of mania or hypomania
* Schizophrenia: Look for auditory hallucinations or delusions
Example: A 28-year-old patient with MDD reports hearing voices daily, indicating the need for further investigation.
What psychological models explain the development of MDD?
Psychological models include:
* Cognitive-behavioral theories (negative thoughts, dysfunctional beliefs)
* Learned helplessness theory (perceived lack of control)
Example: A person internalizes failure as incompetence, perpetuating depressive symptoms.
What neurochemical models are associated with MDD?
Neurochemical changes include:
* Reduced levels of serotonin, norepinephrine, dopamine
* Structural changes in the amygdala and prefrontal cortex
These changes affect emotional regulation and decision-making.
What are the principles of initial treatment for MDD?
Principles of initial treatment include:
* Pharmacological interventions (SSRIs like fluoxetine)
* Psychological interventions (Cognitive Behavioral Therapy)
* Combination therapy for severe cases
Combination therapy shows better outcomes than either approach alone.
What social factors contribute to the risk of depression?
Social factors include:
* Early maternal loss
* Unemployment
* Caring responsibilities
* Lack of confidants
Vulnerability is mediated by low self-esteem and hopelessness.
What is the heritability rate of depression in men and women?
Heritability rates are approximately:
* 40% in men
* 50-60% in women
Twin studies indicate these rates vary by gender.
What is Beck’s Cognitive Model of depression?
Beck’s Cognitive Model includes a cognitive triad:
* Negative view of self
* Negative interpretation of experiences
* Pessimistic view of the future
Example: After losing a job, an individual feels incapable and believes they will remain unemployed.
What is the Revised Learned Helplessness Model?
The Revised Learned Helplessness Model emphasizes:
* Attributional styles (stable, global, internal)
Example: A student failing a test may attribute it to a lack of intelligence, reinforcing helplessness.
What neuroanatomical structures are implicated in mood regulation?
Key structures include:
* Amygdala
* Hippocampus
* Prefronto-striato-thalamic loops
These structures are involved in mood regulation and emotional processing.
What are first-line treatments for less severe depression?
First-line treatments include:
* Guided self-help
* Group CBT
* Physical exercise programs
These treatments focus on changing negative thought patterns and enhancing mood.
What is one type of medication used for depression?
True
SSRIs like fluoxetine are commonly prescribed due to their efficacy.
What is the role of glutamate and Gaba?
Balance between excitatory due to make and inhibitory gather neurotransmission is important for synaptic mechanisms of learning and network connectivity
There’s evidence between functional connectivity abnormalities and alterations in these two neurotransmitters for people with depression
What explanation is there for why women experience more depression than men?
Bowlby attachment theory suggests there are vulnerability factors
What is an attachment based explanation for depression?
Having an early loss of a mother, a lack of a confident, unemployment or having to care for young children cause women to feel more susceptible to developing depression and this is mediated by hopelessness
What is the recurrence percentage for major depressive disorder?
Up to 70%
Describe Kraepelin’ model of depression
Disturbed thoughts lead to disturbed mood which needed disturbed will which then lead to depression
What is Freud’s theory of depression?
Mourning and melancholia
Soft plane needs to depression and there are ambivalence in relations with deceased people which leads to unconscious anger and self directed anger
Explain the positive and negative affect study
In a study conducted by Robins (1981) they looked at depression and anxiety and found that negative affect was associated with anxiety but positive affect was only negatively associated with depression, suggesting that depression is about a loss of pleasure
What is one positive outcome about depression treatment?
A combination of SSRIs SNRI and TCAS, group CBT and CBT were effective for reducing occurrences in depression and we’re also cost-effective with data showing periods of two years remission
What are first line treatments for less severe depression according to the nice guidelines 2022?
Session
What are line treatments for less severe depression?
Guided self-help for 6-8 sessions
Individual CBT for eight sessions for 8 sessions
Group CBT
SSRIS
What are first line treatments for more severe depression? According to the nice guidelines 2022?
Combination of individuals CBT for about 16 sessions and antidepressants or either
If a person hasn’t responded to antidepressants, what should they be given?
Vortioxetine
