Task 6 - Depression & Mood Disorders Flashcards
Major Depression DSM criteria
A. 5 or more of symptoms every day for at least 2 weeks at least one either depressed mood or loss of interest or pleasure
B. symptoms do not meet criteria for mixed episode
C. symptoms cause clinically significant distress/impairment (social, occupational or other areas)
D. not due to substance of mediction
E. Symptoms not better accounted for by bereavement
Symptoms of Depression
- depressed mood out of proportion to any cuase
- Anhedonia
- changes in appetite, sleep, and activity levels either way
- psychomotor retardation/agitation
- thoughts of worthlessness, guilt, hopelessness, suicide,
Psychomotor retardation
slowed down behavior
-walk, gesture, and talk more slowly
Psychomotor agitation
feel physically agitated
-> e.g. cant sit still
Comborbidities of depression
over 70% diagnosed also have another psychological disorder at some time
-> substance abuse, eating disorders, anxiety disorders most common
Dysthemic disorder
persistent depressive disorder
- less severe than major depression but more chronic
- must experience depressed mood + 2 symptoms for at least 2 years
- never be without symptoms for longer than 2 months
Chronic depressive disorder
-dystemic disorder and/or major depressive episodes lasting longer than 2 years
Double depression
When episodes of major depression are experienced alongside dystemic disorder
Subtypes of Major Depression
- melancholic features
- psychotic features
- catatonic features
- atypical features
- postpartum onset
- with seasonal pattern
Seasonal Affective Disorder
- depression with seasonal pattern
- history of 2 years of experiencing + recovering from major depressive episodes
- become depressed when daylight hours short and recover when long
Prevalence of Unipolar depressive disorders
- 16% lifetime prevalence in US
- international: 3-16%
- 18-29 y.o. most likely
- lowest in people over 60, then rise again above 85
- high risk for relapse
Biological Theories of Depression
- Genetics
- Neurotransmitter theories
- Brain abnormalities
- Neuroendocrine factors
Genetic Factors of Depression
- first-degree relatives of people with depression 2-3x more likely to also get it
- depression earlier in life has stronger genetic base
- multiple genetic abnormalities might contribute: e.g. serotonin transporter gene
- 30-40% heritability
Neurotransmitter Theories
- Monoamines most often implicated (norepinephrine, serotonin, dopamine)
- associated with limbic system: regulation of sleep, appetite, emotional responses
- > processes affecting neurotransmitters might be impaired
- > release process might be impaired:(e.g. serotonin transporter gene)
- receptors may be less sensitive
Brain Abnormalities in Depression
Structures:
- prefrontal cortex
- anterior cingulate
- hippocampus
- amygdala
Prefrontal cortex abnormality in depression
- reduced metabolic activity and reduction of gray matter
- > esp. left side: motivation and goal-orientation impaired
Anterior cingulate abnormality in depression
- different levels of activity
- > problems in attention, planning of appropriate responses, coping and anhedonia
Hippocampus abnormality in depression
- smaller volume and lower metabolic activity
- > contains many cortisol receptors: constantly elevated levels might lead to killing or inhibition of development of neurons in hippocampus
Amygdala abnormality in depression
- enlarged & increased activity
- > might bias towards aversive or emotionally arousing information and lead to rumination
Neuroendocrine Theories of depression
Implies impairment in hormonal functioning: specifically in Hypothalamic-pituitary-adrenal axis (HPA)
-depression: hyperactive HPA axis (overreaction in response to mild stressors)
Hypothalamic-pituitary-adrenal axis (HPA axis)
- involved in fight-or-flight response
- hypothalamus releases corticotropin-releasing hormone CRH) onto receptors on anterior pituitary which releases ACTH to adrenal gland
- adrenal gland releases cortisol (+feedback loop of cortisol to ACTH and CRH)
Behavioral Theories of Depression
Focus on role of uncontrollable stressors in reducing depression
- > depression as arising due to stressful negative events in life
- > e.g. reduction in positive reinforcers
- learned helplnessness theory
Learned Helplessness theory
- uncontrollable negative events as reason for depression
- leading to belief of being helpless in those events
- > low motivation, passivity, indecisiveness
Cognitive Theories of Depression
- Negative cognitive triad
- reformulated learned helplessness theory
- ruminative response style theory
- overgeneral memory
Negative cognitive triad
- depressed peope: have negative views of themselves, the world, and the future
- make thinking errors: ignore good events, exaggerate negative events
- > causes and perpetuates depression
Reformulated learned helplessness theory
- cognitive factors might influence whether someone becomes helpless and depressed after negative event
- > causal attribution differences: people who explain negative events by internal, stable and global causes tend to blame themselves
- > long-term helplessness deficits + loss of self-esteem
Ruminative response style theory
Focus on process of thinking, rather than content
- > engage in rumination about depression
- bias towards negative thinking in basic attention & memory processes
Overgeneral Memory
Tendency of depressed people to store and recall memories in general fashion to cope tih past
-> less emotionally charged and painful
Interpersonal Theories of Depression
- interpersonal difficulties and losses as causing depression
- rejection sensitivity
- excessive reassurance seeking
Sociocultural Theories of Depression
Suggest differences in social conditions of demographic group leading to differences in depression vulnerability
- Cohort effects (changes in social values -> higher rate)
- gender differences (women diagnosed more often)
- Ethnicity/Race differences (hispanics in US higher rate)
- Cross-cultural differences (major depression prevalence lower in less industrialized countries)
Psychodynamic Theories of Depression
Propose depression developing as reaction to loss of loved ones
-> esp. in oral stage: dependence on parents
Bipolar Disorder
Alternation between periods of mania and periods of depression
-Bipolar I and Bipolar II differ in presence of major depressive disorder & episodes meeting full criteria for mania & hypomanic episodes
Bipolar I criteria
- major depressive episodes can occur but are not necessary for diagnosis
- episodes meeting full criteria for mania are required
- hypomanic episodes can occur between episodes of severe mania or depression but not necessary
Bipolar II criteria
- Major depressive episodes necessary
- full manic episodes cannot be present
- hypomanic episodes are necessary for diagnosis
Mania Symptoms
- unrealistically positive ad grandiose self-esteem
- racing thoughts and impulses
- grandiose thoughts can be delusional (also with grandiose hallucinations)
- rapid and forceful speech: stream of fantastic thoughts
- easily agitated and irritable
- impulsive
DSM criteria manic episode
A. distinct period of abnormal, elevated mood lasting at least 1 week
B. 3 or more of the common symptoms
C. symptoms don’t meet criteria for mixed episode
D. mood disturbance sufficiently severe to cause functioning impairment
E. symptoms not due to substance or medical condition
Cyclothymic disorder
Less severe but more chronic form of bipolar disorder
-> alternating episodes over at least 2 years
Rapid cycling bipolar disorder
4 or more cycles of mania and depression within 1 year
Prevalence & course of BPD
- less common than unipolar depression
- 1-2% lifetime prevalence
- no gender differences
- chronic problems in job and relationships
Genetic Factors in BPD
-strong link to genetic factors: first-degree relatives of affected 5-10x more likely to also have it (identical twins 45-70x more likely)
Brain abnormalities in BPD
Amygdala (emotions)
Prefrontal cortex (cogn. control of emotion, planning, judgment)
-Striatum: processing of reward
-Striatum-amygdala circuit
-abnormalities in white matter: disorganized emotions and extreme behavior
Neurotransmitter factors in BPD
- monoamine neurotransmitters implicated
- > dysregulation of dopamine system:
- > excessive during manic phase
- > lack of reward seeking during depressive phase
Biological treatments for Mood Disorders
- drug treatments
- electroconvulsive therapy
- Brain stimulation
- light therapy
Drug treatments for depression
SSRIs
SNRIs
Bupropion (norephinephrine-dopamine reuptake inhibitor)
-tricyclic antidepressants (heavy side effects)
-monoamine oxidase inhibitors (heavy side effects)
Drug Treatments for Mania
Mood stabilizers:
- Lithium (increases serotonin, decreases norepinephrine
- Anticonvulsant & Atypical Antipsychotic Medications (
Efficacy of Antidepressant drugs
Reduce depression in 50-60% of people who take them
- work better for severe and chronic depression than mild-to-moderate
- choice of drugs depends on ability to tolerate side effects
- discontinuation in first 6-9 months doubles risk of relapse
Electroconvulsive Therapy
Series of treatments in which brain seizure is induced by passing electrical current through brain
- > decrease in metabolic activity in frontal cortex and anterior cingulate
- > high relapse right
New methods of brain stimulation
Repetitive transcranial magnetic stimulation (rTMS)
Vagus nerve stimulation (VNS)
Deep brain stimulation
-> have antidepressant effects
Psychological Treatments for Mood disorder
Behavior Therapy Cognitive Behavior Therapy (CBT) Interpersonal Therapy (IPT) Interpersonal and Social Rhythm Therapy Family-Focused Therapy (FFT
Behavior Therapy
- focus on increasing positive reinforcers and decreasing aversive experiences in life by helping to change interaction patterns with environment and people
- first phase: functional analysis of connections between circumstances and symptoms
- 2nd phase: helping to change aspects of environment contributing to depression
Cognitive Behavioral Therapy
Goals:
- change negative hopeless patterns of thinking
- help solve concrete life problems and develop skills to be more effective in “world”
- 6-12 weeks
CBT Steps
- help discover negative automatic thoughts and understand link between them and depression
- help challenge negative thoughts
- help clients recognize deeper, basic beliefs or assumptions they might hold that are facilitating depression
Interpersonal Therapy (IPT)
- four types of problems focused on as sources of depression:
1. grief, loss
2. interpersonal role disputes
3. role transitions
4. interpersonal skills deficits
Interpersonal and Social Rhythm therapy
Enhancement of IPT for bipolar disorder
- combination of therapy techniques with behavioral techniques to help patients maintain:
- regular eating routines
- sleeping
- activity
- stability in relationships
- > fewer relapses in combination with medication
Family-Focused Therapy
Focus on reducing interpersonal stress in people with bipolar disorder in family context
- > patients and families educated about disorder and trained in communication and problem-solving
- > lower relapse rates
Comparison of Treatments
Depression:
-Behavioral
-CBT
-Interpersonal
-Drug treatment
-> about equally effective
-> combination of psychotherapy and drug therapy more effective than alone
-> relapse rate high in depression: maintenance (drug) therapy suggested
Bipolar Disorder: combination of drug treatment with psychological therapies leads to people maintaining medication
Cognitive Biases and Deficits in depression
- difficulty disengaging from negative stimuli
- negative interpretation bias
- enhanced recall of negative events
- inhibitory impairments in processing of emotional material (removal of irrelevant negative material from WM)
- > biases in attention, interpretation, memory
Lifestyle Factors Associated with Major Depression
Diet: mediterrenean diet, moderate alcohol intake, low consumption of meat/meat products or whole-fat dairy products protective against depression
Sleep: worse sleep, worse depressive symptoms
Exercise: exercise generally positive effect on functioning
Poor lifestyle
poor diet, sleep and physical activity:
- neuroprogression
- immunoinflammation
- neurotransmitter imbalances
- oxidative & nitrosative stress
- HPA imbalances
- Mitochondrial disturbances
- > facilitate depression
