MDD Flashcards
What are the symptoms to be diagnosed with MDD?
Cardinal symptoms
- Dysphoric mood→ sad, empty, tearful
- Anhedonia→ Markedly diminished interest or pleasure in all or almost all activities
—>at least one of those two are needed¸
Other symptoms→ need 4 of them OR three if both cardinal symptoms
- Weight loss or weight gain
- Insomnia or Hypersomnia
- Psychomotor agitation or retardation
- Fatigue or loss of energy
- Feelings of worthlessness or excessive or inappropriate guilt
- Diminished ability to think or concentrate, or indecisiveness
- Recurrent thoughts of death; suicidal ideation or attempts
- Symptoms must cause serious distress or impairment
—>very heterogenous symptoms
What are the different forms of unipolar depression?
Recurrent depression→ more than one episode
- proneness to psychological distress
Melancholia
- supposed to be endogenous
- biological disorder→ do well with ECT but not antidepressants and placebos
- respond to psychotherapy
- Cluster of symptoms→ Anhedonia, early waking hours, bad mood in the morning, anorexia/weight loss, excessive guilt
- more abrupt onset
—>not stable across episodes
Atypical→
- more likely to be women (70%)
- exhibit dysphoric mood
- leaden paralysis (heavy feeling in limbs), high sensitivity
- improved mood in response to positive events
- earlier onset, more comorbidity
- 15% of depressed patients
Chronic Major Depression
- episode lasting at least 2 years with no period of relief
- higher rates of depression
- more heritable
- more severe course
- 25% of depressed patient
What is the tripartite model?
a theory to help explain the comorbidity between anxious and depressive symptoms and disorders
Divide symptoms in three groups
- Depression specific factors→ anhedonia
- Anxiety specific factors→ Physiological/ Hyperarousal
- Common factors→ General Distress/Negative Affect
What is the epidemiology of MDD?
Lifetime prevalence→ 16-17%
- 20-25% for women, 9%-12% for men
Persistent depressive disorder→ 3-6%
Age of onset→ teens/nid-20s
Duration of episodes→ 5-6months
- prediction of longer episodes→ personality disorder, non-mood comorbid disorders
- 20% of time, episodes last >2years
- 1/2 of individual with one depressive episode will have at least one more
- 4-6 episodes over lifetime
- Persistent Depressive Disorder→ very chronic course/ high risk for relapse
Ethnic groups→ mixed data
- Rates lower in Asia than Europe and North America
- Some data showing Black/ African-American groups have lower lifetime prevalence (~10%) than White Americans (~18%)
- Prevalence rates may be higher among Black youth than among White youth
Differ cross-culturally
- more somatic presentation in Asian, Latin American, and North African cultures
What is the link between stressful life events and depression?
Increased rate of stressful life events→ 6months before the onset of MDD
- 20% of women who experienced these events became depressed
- 75% of depressed women studied had experienced such an event in the 6 months prior
Stressors→ usually related to loss
- ex: loss of a loved one, job, ideal or goal
Causality?
- might be that depressed people more sensitive to effects of stress
- might also generate stress in their lives (interpersonal stress)
Types of stressors
- Dependent→ link with characteristics of the person (ex: intrapersonal)
- Independent→ ex: getting struck by lightning
—>still associated with higher number of independent events for depressive people
What is a model of depression based on reward and positive reinforcement?
Behavioral models→ Reward and Positive Reinforcement
- reduction in behaviors that are positively reinforced
- receive less positive reinforcement→ mood declines
- become less likely to engage in behaviours that receive positive reinforcement
—>one treatment is behavioural and forcing depressed patient to seek positive reinforcement
What are the three components of the cognitive triad model?
Cognitive Triad→ Aron Beck
- the way patient thinks is crucial to depression
- each negatives views reinforces each other
- ex: I know I am bad because I get bad feedbacks from others which mean people are bad and it is not gonna change…
Components
- Negative self-statements/ automatic thoughts
- cognitive errors
- underlying core beliefs
What are some cognitive errors thought to contribute to depression?
- all or nothing thinking
- arbitrary inference→ drawing negative conclusions without evidence
- overgeneralization
- selective abstraction→ concentrating only on one negative aspects of an event
- magnification/ minimization
- personalization→ attributes negative events to inner flaws
- emotional reasoning→ thinking must be true because of strengths of emotions
What does the revised learned helpessness model state about the different types of attribution?
Revised→ 3 dimensions of attributions
- external VS internal→ internal attributions more linked with depression
- Global VS Specific→ global attributions “all my relationship will be like that”
- Stable VS unstable→ Stable “the situationship will stay the same”
—>Internal, global and stable attribution styles associated with depression
What are some studies that show the cognitive biases of people suffering from MDD?
SRET→ see list of positively and negatively valanced adjectives
- then ask which words describes them or which one they remembers
- also use Stroop Task, Dichotic listening task (harder time supressing negative distractors)
—>seem to be unique to MDD and not anxiety disorders
What is the monoamine hypothesis for depression?
Monoamine hypothesis→ depression caused by a deficiency in central nervous system in serotonin and norepinephrine
Serotonin→ 5-HT
- deficiency in 5-HT signaling plays a role in depression and suicide
- improvement with SSRI (Selective serotonin reuptake inhibitors)
Norepinephrine
- increase in depressed individuals
