Mood Disorders Flashcards
Depression
- informally, saying that one’s mood is “depressed” means that one is low in arousal, low in positive affect, and/or high in negative affect.
Hippocrates: “fears and despondencies, if they last a long time”
Samuel Taylor Coleridge (1802): “A grief without a pang, void, dark, and drear. A stifled, drowsy, unimpassion’d grief, which finds no natural outlet, no relief, in word, or sigh, or tear-“
Clinical depression typically has motivational, behavioral, cognitive, and physical symptoms, in addition to depressed mood
Motivation: lack of motivation to perform one’s usual activities -> decreased behavior
Cognitive: negative self-view, sense of hopelessness, extreme pessimism, “automatic thoughts”, rumination
Physical: pain, headaches and other mild symptoms; sleep and appetite disturbances
Diagnosis of depression depends on
- the symptoms that are present
- the duration of their presence/absence
- lack of certain other symptoms, specifically mania
Two sub-types of depression
- Post-partum depression
- Seasonal affective disorder
Major Depressive Episode checklist
- For a 2-week period, person displays an increase in depressed mood for the majority of each day and/or a decrease in enjoyment or interest across most activities for the majority of each day.
- For the same 2 weeks, person also experiences at least 3 or 4 of the following symptoms:
-considerable weight change or appetite change
-daily insomnia or hypersomnia
-daily agitation or decrease in motor activity
-daily feelings of worthlessness or excessive guilt
-daily reduction in concentration or decisiveness
-repeated focus on death or suicide, a suicide plan, or a suicide attempt - Significant distress or impairment
Major depressive disorder checklist
- Presence of a major depressive episode
- No pattern of mania or hypomania
Persistent depressive disorder checklist
- Person experiences the symptoms of major or mild depression for at least 2 years
- During the 2-year period, symptoms not absent for more than 2 months at a time
- No history of mania or hypomania
- Significant distress or impairment
Metaphors for depression
- Depression is sometimes described using darkness or blackness as a metaphor
-living under a “dark cloud”, being in a “dark place”, at the bottom of a “deep pit,” life “drained of color”, etc.
-Winston Churchill called it “the black dog” - Western culture contains a strong light/dark dichotomy
light= positive, truthful, holy, pure, beautiful, etc.
dark= negative, ignorant, irrational, fearful, ugly, etc.
Some people think that these beliefs around darkness and negativity are misguide or harmful:
- Rebecca Solnit (2005): “It’s in the dark that faint light shines: starlight, candlelight, fireflies, the bioluminescence of the sea.”
- to know the world (and ourselves) fully, we need to stand in the dark as well as the light.
- Ursula Le Guin (1968): “To light a candle is to cast a shadow”
-Light and dark as interconnected, not opposites
Zhuangzi’s ‘Flight from Shadow’ Parable
“There was a man who was frightened by his shadow and disgusted with his footprints, and so he tried to outrun them. However, the more he raised his feet, the more footprints he left behind. He ran faster and faster but his shadow would still not leave him. Believing he was still too slow, he ran faster still, without pause, exhausting his strength and dying. He did not know that by staying in the shade his shadow would have vanished, and that by resting peacefully any trace of him would cease.”
Psychodynamic depression model
Freud argued that depression represented a subjective loss of self, caused by an objective loss of something we had come to identify with
Until the most recent DSM, people who had lost a loved one were excluded from a depression
diagnosis
Existentialism depression model
depression is due to a loss of meaning
- Viktor Frankl treated many patients who had recently lost jobs by prescribing volunteer work
(Devoe, 2012)
Cognitive behavioral depression model
- Depression creates a feedback loop where the consequences of self-criticism, pessimism, etc. enhance those processes
- Behavioural activation:
-Introduces patients to constructive and rewarding activities that they wouldn’t seek out themselves
-Idea is that making progress and achieving things is rewarding, which generates positive mood and undercuts negative thinking
-The clinician might also reward the patient directly - Cognitive therapy: depression is due to “negative thinking” - not negative feelings!
- CBT is based in part on the philosophy of Stoicism (Cavanna, 2019):
-Emphasizes that our feelings / experiences are not inherently good or bad; it’s what we do with them that matters
-Our psychological condition is due to our beliefs / judgments about a situation, not the situation itself; these beliefs can be changed even if the situation does not
-Viewing events and beliefs as separate allows for emotional distance and prevents catastrophizing
Neurobiological model of depression
- Depression is the result of neurological and biological
dysfunction
Genetic factors: People are much more likely to have
depression if a relative also has it, compared to the
general pop.
Neurochemical factors: association between
depression and neurotransmitter activity (serotonin,
norepinephrine, glutamate, etc.) – probably not a
simple story!
Monoamine Oxidase Inhibitors (MAOI)
inhibit production of MAO enzymes, which break down certain neurotransmitters (serotonin, dopamine, norepinephrine in particular)
-This causes these molecules to break down more slowly
