problem 4

Question 1

What are the DSM-5 requirements for major and persistent depressive disorder?

Answer 1

• diagnosis requires a presentation five symptoms across the categories
  
  • mood: depressing mood for the majority of a day/multiple days, presentation of anhedonia (loss of interest in daily activities)
  • behaviour: less physically active and productive
  • cognitive: negative view, feeling of worthlessness, distractibility, thoughts of suicide and self-harm
  • physical: changes in sleeping patterns (hypersomnia, insomnia), weight and eating behaviour (lack of appetite or overeating), psychomotor retardation (moving slower)
• MDD: more constant and intense experience, symptoms present for more than two weeks
• PDD: for majority of the day/multiple days, present for more than two years

Question 2

What are the subtypes of depression?

Answer 2

• Seasonal Affective Disorder: depressive episodes that occur during specific seasons for at least two consecutive years
• Premenstrual Dysphoric Disorder: depressive feelings start to arise in the week before menses
• ## Peripartum Onset: depression around childbirth (four weeks after) and during pregnancy

Question 3

What are the subtypes of depression?

Answer 3

• Seasonal Affective Disorder: depressive episodes that occur during specific seasons for at least two consecutive years
• Premenstrual Dysphoric Disorder: depressive feelings start to arise in the week before menses
• Peripartum Onset: depression around childbirth (four weeks after) and during pregnancy

Question 4

What are some specific features that can occur with depression?

Answer 4

• catatonic features: showing strange behaviours, catatonia (unresponsive to the environment)
• anxious distress: anxiety symptoms
• psychotic features: with hallucinations and delusions
• mixed features: presence of at least three manic/hypomanic symptoms, but doesn’t meet the full criteria for the disorder
• melancholic features: inability to experience pleasure, worse mood in the morning, waking up early, being slower (may also be psychomotor agitation), weight loss (more focused on the physical aspects)
• atypical features: positive mood reactions, weight gain, increase in appetite, hypersomnia, heavy feeling in the limbs, sensitivity to interpersonal rejection

Question 5

What is the prevalence and onset of depression?

Answer 5

• more common than bipolar disorders
• the highest reported rates are in people aged 18-29
• 1.7% of children are diagnosed with PDD, 8% of adolescents
• 2.5% of children are diagnosed with MDD, 8.3% of adolescents

Question 6

What are the gender and cultural differences in depression?

Answer 6

• Gender Differences
  
  • more prevalent in women (especially during menarche and menopause)
  • could be as a result of expectation of men to repress feelings (more likely to turn to substance abuse) while women are more able to express feelings
  • suicidal rates for men are higher
  • women may be more sensitive to the environment (distressed by others experiences)
• Culture
  
  • prevalence higher in America (US), 16% versus 3% in Japan (may be socially/culturally unacceptable to express)
  • in non-Western cultures, individuals are more likely to present physical as opposed to cognitive symptoms

Question 7

What are the biological causes of depression?

Answer 7

• early on, depression has a stronger genetic basis
• abnormalities in the Serotonin Transporter Gene make individuals more susceptible to depression (in response to negative events)
• lower sensitivity of serotonin receptors (influences re-uptake)
• abnormalities in the synthesis of monoamines (e.g. norepinephrine, serotonin and dopamine)
• neurotransmitters help to regulate sleep, appetite, and emotional processes
• Brain Abnormalities
  
  • prefrontal cortex (attention + working memory + planning), reduction of grey matter, mostly in the left side (more involved in motivation, lower brain waves).
  • anterior cingulate (bodily responses to stress, different levels of activation–treatment allows for a return to normal activation, involved in anhedonia + planning + attention)
  • hippocampus (smaller and less active, constant arousal from stimuli, higher levels of cortisol–stress response which further impacts development of neurons, involved in memory + fear response)
  • amygdala (enlarged and increased activity, involved in emotional stability + emotional memory)
  • changes in blood flow

Question 8

What are the psychological causes of depression (behavioural, cognitive and sociocultural)?

Answer 8

• Behavioural theories:
  
  • learned helplessness: distress due to an inability to control situations, impacting motivation
• Cognitive theories:
  
  • cognitive triad: negative view of the self, experiences, and futures in reference to Beck’s theory and ideas regarding maladaptive attitudes
  • errors in thinking (according to Beck), cognitive biases such as catastrophising, jumping to conclusions, overgeneralisation
  • automatic negative thoughts (according to Beck), referring to a stream of negative thoughts (potentially related to confirmation bias)
  • hopelessness theory: seeing important life events in a pessimistic manner (idea that they are unable to cope)
  • rumination response style: to dwell on certain ideas (focus on the negative thoughts and feelings as opposed to causes or solutions)
• Interpersonal and Sociocultural Theories
  
  • rejection sensitivity: tend to look for reassurance very often (may annoy others, leading to a negative response towards then which is then focused on by the individual, leading to look for more reassurance–a cycle)
  • cohort effect: secular trend that shows that recent generations are at a higher risk for depression (due to rapid changes in social environment, disintegration of the family unit, higher expectations from the self)
  • family-Social Perspective: those without enough support from their family are more likely to express depressive symptoms

Question 9

Which drug treatments are used for depression?

Answer 9

• Antidepressants
• SSRIs
  
  • they are less effective in the treatment of depression than other antidepressants, but they have fewer difficult-to-tolerate side effect
  • much safer if taken in overdose to other older antidepressants
  • they have many positive effects on symptoms that co-occur with depression
  • some people with bipolar disorder may develop manic symptoms when they take SSRIs
• SNRIs
  
  • drug targets two neurotransmitters so may have a slight advantage over SSRIs in preventing a relapse of depression and could account for their broader array of side effects than SSRIs
• Bupropion
  
  • can help treat psychomotor retardation, anhedonia, hypersomnia, cognitive slowing, inattention, and cravings (e.g., smoking)
  • can help reduce the sexual dysfunction side effect from SSRIs
• Tricyclic antidepressants
  
  • shown to consistently relieve depression but has a lot of side effects
  • can cause a drop in blood pressure and cardiac arrhythmia in people with heart problems
  • can be fatal in overdose
• MOAIs
  
  • as effective as tricyclic but side effects are quite dangerous

Question 10

Which brain methods can be used to treat depression?

Answer 10

• Electroconvulsive therapy:
  
  • giving brain seizures by passing electrical current through the patient’s head
  • results in decreases in metabolic activity in several regions of the brain, including the frontal cortex and the anterior cingulate
  • not clear of its effects with depression
  • can lead to memory loss
  • relatively high relapse rate
• Repetitive transcranial magnetic stimulation:
  
  • consists of exposing patients to repeated, high-intensity magnetic pulses focused on particular brain structures
  • patients experience fewer side effects
• Vagus nerve stimulation (VNS):
  
  • vagus nerve carries information to several areas of the brain which are involved in depression
  • VNS results in increased activity in the hypothalamus and amygdala, which may have antidepressant effects
• Deep brain stimulation:
  
  • electrodes are put in the brain to cause deep brain stimulation
  • very small trials of deep brain stimulation have shown promise in relieving intractable depression