Task 6 - Depression Flashcards
DSM 5 - major depression
A) 5 or more symptoms during same 2 week period (at least one symptom is depressed mood or loss of interest/pleasure)
- depressed mood
- diminished interest/pleasure
- weight loss, decreased/increased appetite
- insomnia/hypersomnia
- psychomotor agitation
- fatigue/loss of energy
- worthlessness/guilt
- problems concentrating/thinking
- thoughts about death/suicide
E) never been a manic or hypomanic episode
Prevalence depression
- 16p in America
- 3p in Japan
- lowest in people over age 60
- 2.5 of children
- 8.3 of adolescents
- 24 of youth will experience major depression before age 20
- women: 2x more likely
- people with major depression had spent an average of 16 weeks during previous years with symptoms
- relapse: 75p
explanations why depression is lowest over age 60
- less willing to report symptoms
- often occurs in context of serious medical illness -> can interfere with diagnosis
- more likely to have mild-severe cognitive impairment
- depressive people are more likely to die before old age
- more adapted coping skills -> psychological healthier
- historical changes to vulnerability to depression
Genetic Factors depression
- first degree relatives: 2/3 x more likely
- depression begins early in life -> stronger genetic base
- unclear if there are different genes in women/men responsible for depression
- probably multiple genetic abnormalities contribute
- example: seretonin transporter gene
Neurotransmitter theories depression
- monoamines: norepinephrine, seretonin, dopamine
- found in limbic system (sleep, appetite, emotional processes)
- seretonin and norepinephrine are synthesized in neurons from tryptophan and tyrosine -> abnormalities in synthesis process
- release process, which is regulated by seretonin transporter gene -> may be abnormal
- receptors for seretonin and norepinephrine on post-synaptic neurons may be less sensitive
PFC abnormalities - depression
- reduced metabolic activity
- reduction in volume of gray matter, particularly left side
- lower brain-wave activity left side
- left PFC: motivation, goal orientation
Anterior cingulate - depression
- subregion PFC
- response to stress, emotional expression, social behavior
- altered activity -> problems with attention and planning of response, coping
Hippocampus - depression
- smaller volume
- lower metabolic activity
- many cortisol receptors
- depressed people: high levels of cortisol -> kill/inhibit development of new neurons in Hippocampus
Amygdala - depression
- increased activity
- direct attention to stimuli that are emotionally salient and have major significance for the individual
Neuroendocrine factors - depression
- regulates hormones -> sleep, appetite, sexual drive, ability to experience pleasure
- hormones also help to respond to environmental stressors
- HPA axis -> active during stress, calms system down whens stress is over
- > elevated levels of cortisol and coticotrophin-releasing hormone (CRH)
- > hyperactivity of HPA axis
- changes in ovarian hormones (estrogen, progesterone) -> affect seretonin and norepinephtine system
- > could affect mood
Behavioral theories - depression
-life stress -> reduces positive reinforcers -> withdraw -> further reduction in reinforcers -> more withdrawal -> depression
-learned- helplessness theory:
uncontrollable negative event -> believe they are helpless to control -> lose motivation, reduce actions
Cognitive theories - depression , negative triad
-depressed people look through a negative triad: negative views about themselves, the world, the future -> ignore good events
cognitive theories depression - reformulated learned helplessness theory
- role of causal attribution
- > explain events by causes that are internal, stable, global, blame themselves
- > experience long term learned helplessness deficits
cognitive theories- hopelessness depression
-making pessimistic attributions for most important events in their lives
cognitive theories depression - ruminative response styles theory
- focus on process of thinking
- focus intently on how they feel and identify many causes
- > engage in rumination about their depression
cognitive theories depression - overgeneral memory
- depressed people store memories in more general way (people are mean instead of jane was rude last friday)
- > to cope with traumatic events
interpersonal theory depression
- interpersonal difficulties, losses -> triggering depression
- rejection sensitivity
- excessive reassurance seeking -> family and friends can become weary, frustrated, hostile
sociocultural theory depression - cohort effects
- historical changes put generations at higher risk
- rapid changes in social values in 60s, disintegration of family unit
- unrealistic high expectations for themselves
sociocultural theory depression - gender differences
-men: turn to alcohol to cope, develop alcohol abuse
- women:
- ruminate about feelings, problems
- more interpersonally oriented -> bad things happen to others or problems in relationships -> more depressive
- base self-worth on health of their relationships
- have less status and power -> more prejudice, discrimination, and violence
sociocultural theory depression -ethnicity/ race differences
- in US:
- hispanics have higher prevalence -> might be due to higher rates of poverty, unemployment, discrimination
- african americans: lower prevalance, but more anxiety disorders
sociocultural theory depression - cross cultural differences
-lower levels in less industrialized and less modern countries
in modern countries:
-> fast-paced lifestyle, lack of stable social support and community values
-people in less modern cultures -> manifest depression through physical complaints rather than psychological symptoms
Bipolar 1 DSM 5
- necessary to meet criteria for manic episode (at least one)
- major depressive episodes and hypomanic episodes possible but not necessary
DSM 5 manic episode
A) -abnormally, persistent, elevated, expansive or irritable mood
and
-abnormally and persistent increased goal-directed activity or energy
B) during this, 3 or more are present: (4 or more if mood is only irritable)
1-inflated self-esteem/grandiosity
2-decreased need for sleep
3-more talkative, keep talking
4-flight of ideas/subjective experience that thoughts are racing
5-distractibility
6-increase in goal-directed activity or psychomotor agitation
7-excessive involvement in activities that have high potential for painful consequences
- > must show this at least for 1 week
- disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.
Bipolar 2 - DSM 5
-necessary to meet criteria for current or past hypomanic episode
AND
current or past major depressive episode
-mania CANNOT be present for diagnosis
Hypomanic - DSM 5
A) -abnormally and persistently elevated, expansive, or irritable mood
- increased activity, energy
- > 4 days
B) during this period, 3 or more (4 or more when mood is only irritable) 1-inflated self-esteem/grandiosity
2-decreased need for sleep
3-more talkative, keep talking
4-flight of ideas/subjective experience that thoughts are racing
5-distractibility
6-increase in goal-directed activity or psychomotor agitation
7-excessive involvement in activities that have high potential for painful consequences
-> same as bipolar 1
BUT: episode not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization. If there are psychotic features, the episode is, by definition, manic.
Drug treatments for depression
- drugs might have slow-emerging effects on neurotransmitter system and on action of genes that regulate neurotransmission, limbic system and stress response
- reduce depression in 50-60p
- better for treating severe and chronic depression
- at least 6m after symptoms subsided, drugs should still be taken to prevent relapse
selective seretonin reuptake inhibitors - depression and bipolar
- fewer side effects
- safer if taken in overdose
- bipolar: may develop manic episodes
- increase in suicidal thought and behavior (especially in children and adolescents) -> increased decision making
selective seretonin-norepinephrine reuptake inhibitors
- slight advantage over SSRIs
- > preventing relapse but more side effects
Bupropion: norepinephrine- dopamine reuptake inhibitors
- especially useful if suffering form psychomotor retardation, anhedonia, hypersomnia, cognitive slowing , inattention
- overcomes sexual dysfunction side effects of SSRIs
Triyclio antidepressants and monoamine oxidase inhibitors
- increase levels of seretonin and norepinephrine
- but side effects too dangerous
electroconvulsive therapy (ECT)
- passing electric current of around 70- 130 volts through head of patient for around half a second
- primarily used if severe depression and other treatment did not work well
- effective short term effects
- side effects: memory loss
- normally delivered to right side of brain: less involved in learning and memory
- relapse: 85p
repetitive transcranial magnetic stimulation (rTMS)
- exposes patient to repeated, high-intensity pulses
- focused on particular structures
- often left PFC
- few side effects
- one can stay awake
vagues nerve stimulation
- electrodes are attached to vagues nerve (ANS) that carries info to several areas of brain
- results in increased activity in hypothalamus and amygdala
deep brain stimulation
- electrodes implanted in specific areas of brain
- electrodes are connected to a pulse generator
- placed under skin
- > stimulates brain areas
CBT - article Hundt results
- depressive symptoms decreased while CBT skills use increased over time
- increase in skill use -> predicted overall change in depression
- > patients who used more skills -> higher decrease in depression symptoms
premenstrual dysphoric disorder
- increases stress during premenstrual phase of menstrual cycle
- symptoms are often a mix between: depression, anxiety, tension, irritability and anger
- mood swings
- only 2p meet diagnostic criteria
Article cowen - HPA axis
- abnormal HPA axis -> vulnerability markers
- > may be due to genetics and early adverse experiences
- cortisol hypersecretion:
- > inhibited Neurogenesis in Hippocampus
- > hippocampal atrophy
- > cognitive impairment
- > declarative memory affected
- > facilitates emotional memory
- > recovered patients return to hyper secrete cortisol
Article: lifestyle factors contributing to pathways associated with depression - Lopresti
1) Dysregulated inflammatory pathways (increased inflamation)
2) HPA disturbance (heightened cortisol secretion)
3) Increased oxidative and nitrosative damage
4) Neurotransmitter imbalances
5) Neuroprogression (neurogenesis and neural plasticity are compromised -> neuro degeneration)
6) mitochondira
Article: lifestyle factors contributing to pathways associated with depression - Lopresti - 6 mechanisms
1) Dysregulated inflammatory pathways (increased inflamation)
2) HPA disturbance (heightened cortisol secretion)
3) Increased oxidative and nitrosative damage
4) Neurotransmitter imbalances
5) Neuroprogression (neurogenesis and neural plasticity are compromised -> neuro degeneration)
6) mitochondira
