Task 6 - Depression Flashcards
Symptoms of Depression
- anhedonia: loss of interest in everything in life
- psychomotor retardation: many people with depression are slowed down, talk more quietly, report feelings of being chronically fatigued
- psychomotor agitation: feeling physically agitated, not being able to sit still, moving around, or fidgeting aimlessly
- thoughts: worthlessness, guilt, hopelessness, suicide
- trouble concentrating and making decisions
- delusions and hallucinations
DSM-5 Criteria for Major Depressive Disorder
A Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure
1. Depressed mood most of the day, nearly every day, as indicated by either subjective report or observation made by others
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
3. Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day
4. Insomnia or hypersomnia nearly every day
5. Psychomotor agitation or retardation nearly every day
6. Fatigue or loss of energy nearly every day
7. Feelings of worthlessness or excessive or inappropriate guilt nearly every day
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day
9. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or suicide attempt or a specific plan for committing suicide
E There has never been a manic episode or a hypomanic episode
Complicated Grief
- 10-15% of bereaved people
- strong yearning for the deceased person and preoccupation with the loss
- difficulty accepting the finality of the loss
- having a sense that life is empty and meaningless
Persistent depressive disorder
- depressive mood for most of the day; for more days than not; for at least 2 years
- presence of 2 + of: poor appetite, insomnia/hypersomnia, low energy or fatigue, low self-esteem, poor concentration, and hopelessness
- no symptoms period never longer than 2 months
- major depressive disorder for 2 years = persistent depressive disorder
Subtypes of depression
- anxious distress: prominent anxiety symptoms as well as depressive symptoms
- mixed features: meet the criteria for major depressive disorder and have at least three symptoms of mania, but do not meet the full criteria for a manic episode
- melancholic features: physiological features of depression are particularly prominent; inability to experience pleasure, distinct depressed mood, depression regularly worse in morning, early morning awakening, marked psychomotor retardation or agitation, significant anorexia or weight loss, excessive guilt
- psychotic features: experience delusions and hallucinations, either mood-congruent or mood-incongruent
- catatonic features: display catatonia, ranging from a complete lack of movement to excited agitation; not actively relating to the environment, mutism, posturing, agitation, mimicking other’s speech or movements
- atypical features: positive mood reactions to some events, significant weight gain or increase in appetite, hypersomnia, heavy or leaden feelings in arms or legs, long-standing pattern of sensitivity to interpersonal rejection
- seasonal pattern: history of at least 2 years in which major depressive episodes occur during one season of the year (usually winter) and then remit when the season is over –> Seasonal Affective Disorder (SAD)
- peripartum onset: onset of major depressive episode during pregnancy or in the 4 weeks following delivery
premenstrual dysmorphic disorder
- significant increases in distress during the premenstrual phase of the menstrual cycle
- depression, anxiety, tension, irritability and anger, which might occur in mood swings during the week before the onset of menses, improve once menses begin, and become minimal or absent in the week post-menses
- 2% of women
Comorbidity
- 70%
- substance abuse
- anxiety disorders
- eating disorders
Prevalence
- 3-16%
- most prevalent in 18-29-year-olds
- least prevalent in people 65+
- rise among people at 85+ –> severe, chronic, debilitating
- children tend to show irritability instead of sadness
- women are 2x more likely as men to experience a depressive disorder
Causes: Genetic
- first-degree relatives of people with major depressive disorder, are 2-3 times more likely to have depression themselves
- abnormalities in the serotonin transporter gene –> dysfunctional regulation of serotonin
Causes: Neurotransmitter
- limbic system –> regulation of sleep, appetite, and emotional processes
- abnormal levels of serotonin and norepinephrine –> cognitive, behavioral, and motivational deficits
- low dopamine –> deficits in reward system
Causes: 5-HTT Gene
- the 5-HTT gene interacts with life events to predict depression symptoms, an increase in symptoms, depression diagnoses, new-onset diagnoses, and suicidality
- individuals with one or two copies of the short allele of the 5-HTT promoter polymorphism exhibit more depressive symptoms, diagnosable depression, and suicidality in relation to stressful life events
- gene-environment (G x E) interaction: an individual’s response to environmental insults is moderated by his or her genetic makeup
Causes: Structural and Brain Abnormalities
reduced metabolic activity and reduction in the volume of grey matter in the PFC (left side)
- motivational deficits
altered activity in the anterior cingulate
- problems in attention, planning, coping, and anhedonia
smaller volume and lower metabolic activity in the hippocampus
- chronic arousal of the body’s stress response
- bodies overreact to stress and levels of cortisol do not return to normal as quickly
- cortisol hypersecretion predisposes to depression
- neurotoxicity in the hippocampus
enlargement and increased activity in the amygdala
- rumination over negative memories and negative aspects of the environment
Causes: Neuroendocrine
Hypothalamic-pituitary-adrenal axis (HPA axis):
- involved in the fight-or-flight response
- elevated levels of cortisol and CRH –> chronic hyperactivity in the HPA axis
- difficulty in the HPA axis’ returning to normal functioning following a stressor
- excess hormones –> inhibiting effect on receptors for monoamine neurotransmitters
–> overreaction of the HPA axis to minor stressors later in life
Causes: Behavioral
- life stress leads to depression as it reduces the positive reinforcers in a person’s life
- once a person begins engaging in depressive behaviors, these behaviors are reinforced by the sympathy and attention they engender in others
- learned helplessness theory = people believe they are helpless to control important outcomes in their environment, which leads to loss of motivation and reduction of actions that might control the environment, or leaving one unable to learn how to control situations that are controllable
Causes: Cognitive
- negative cognitive triad = depressed people have negative views of themselves, the world, and the future
- reformulated learned helplessness theory = cognitive factors might influence whether a person becomes helpless and depressed following a negative event
- hopelessness depression = develops when people make pessimistic attributions for the most important events in their lives, and perceive that they have no way to cope with the consequences of these events
- ruminative response styles theory = focuses on the process of thinking more than on the content of thinking as a contributor to depression
