Unipolar depression Flashcards
Changes from DSM-IV to DSM-V?
DSM-IV - there was one chapter for Mood Disorders
DSM-V - there is now a separate chapter for Bipolar Disorders
How many symptoms are needed for a major depressive episode?
5 or more (including ‘depressed mood most of the day, nearly every day’ and/or ‘marked diminished interest in activities’) in a 2 week period
What is the difference between DSM-IV and DSM-V in regards to MDD?
DSM-IV specifies that the symptoms must not be better accounted for by bereavement (allowed to feel like this for 2 months)
Why is DSM-IV’s Dysthymia now called Persistent Depressive Disorder?
Research has suggested that Dysthymia is not really a different disorder
While depressed, the person with PDD must have 2 of the following:
- poor appetite or overeating
- insomnia or hypersomnia
- low energy or fatigue
- low self-esteen
- poor concentration or difficulty making decisions
- feelings of hopelessness
What is the duration criterion of PDD?
Symptoms must have last 2 years, no more than 2 months of normal mood during those 2 years
DSM-5 Disruptive Mood Dysregulation Disorder is characterised by…
- childhood onset
- severe, recurrent temper outbursts that are grossly out of proportion in intensity or duration to situation or provocation
- at least 3 times a week
- 12 months duration
- child is persistently irritable or angry
How to treat Disruptive Mood Dysregulation Disorder?
Emotion regulation rather than drugs
Risk of developing another depressive episode increases by ___ after each episode
16%
What are the different subtypes/specifiers of MD?
- anxious distress
- seasonal pattern (Seasonal Affective Disorder)
- peripartum onset (Postnatal depression)
- Atypical features (eg weight gain, oversleep, rejection sensitivity)
- Psychotic features (hallucinations and delusions)
- Melancholic features
Some research suggests that depression with ______ features is a very distinct subtype of depression, almost like a different disorder.
Melancholic
Parker (2000) suggests that depression should be categorised under 3 subtypes. What are they?
Melancholic, psychotic and non-melancholic
- assumes different symptoms, causation and treatment
What is melancholic depression characterised by?
Lack of reactivity / total loss of pleasure. Even something highly stimulating is unable to lift their mood.
Distinct quality of mood. (diff. to normal depression)
Mood worse in morning
Early morning awakening
Excessive guilt
Weight/appetite loss
Marked psychomotor agitation or retardation - feelings of heaviness
Melancholic and psychotic subtypes are seen as “_________ depression”
endogenous (biological) - more ass. with genetic loading compared to non-melancholic subtype which is more environmentally based
Melancholic and psychotic subtypes are best treated with _____ and don’t respond to ______ as well as non-melancholic subtype
biological treatments, placebo pill
Lots of researchers argue that melancholic depression is not a separate type of depression but…
Just a more severe form of depression, not a different cause
Lifetime prevalence of MDD is around ___
16%
One-year prevalence of MDD in Australia is around
3-5%
Since the mid-20th century, more people have been diagnosed with depression and at an increasingly younger age. Why?
- Increased speed of change/stress
- Decreased social support/family support
- Possible that it is more acceptable to report symptoms - less stigma, more education
- Overdiagnosis
- Change of values? You have to be happy always etc
What is the gender ratio of diagnosis of MDD?
Twice as many woman are diagnosed with depression.
This imbalance emerges during late adolescence and evens out after 65
For MDD: Concordance rates are…
higher in identical twins than fraternal twins
Bipolar depression has a _____ genetic influence than unipolar depression and is ________ separately
higher, inherited
Has been argued that individuals with depression have lower levels of …. (neurochemistry). Why is this aetiology controversial?
Dopamine, serotonin, noradrenaline.
No good evidence for how these lower levels lead to depression (the mechanism)
The absolute levels of dopamine, serotonin, noradrenaline are not important in determining unipolar depression but rather the…
sensitivity of the receptors to the neurotransmitters
Which brain structures are implicated in unipolar depression?
amygdala hippocampus prefrontal cortex anterior cingulate - remember it is correlation not causation
In addition to the functional abnormalities in brain structures, the _________ system (hormonal) is also implicated in depression
neuroendocrine
___________ in the ____ Axis is strongly related to depression
Overactivity, HPA
The HPA axis is involved in _________ response to _________
regulating, stress
Individuals with depression tend to have an elevated stress response: that is,
they release too much cortisol, and take longer to switch off their stress response - cortisol keeps coming into the system
Therefore, (early) stress is highly implicated in the causation of depression even at the biological level
How does the elevated stress response (excess cortisol) impair functioning?
Related to damage to hippocampus?
Causes/interacts somehow with lower density of serotonin receptors
Caspi et al (2003) studied the interaction between genetic vulnerability for depression and number of negative life events. Describe their findings.
There was no difference on symptoms for the three groups if they had faced 0 stressful life events.
But as the number of stressful life events increased, the three groups start separately more and more.
The higher one’s genetic loading towards depression, the more likely they are to develop depression as a result of experiencing negative life events.
In Learned Helplessness Theory (Seligman, 1975), what differentiates people who become depressed and people who don’t is that …
people who are more vulnerable to depression have a perceived lack of control over life events
– the important thing is how they view the life meanings
Learned Helplessness Theory, when applied from a cognitive point of view, was developed into _______________ (1978)
Attribution Theory
What are three important attributions humans make in the face of a negative life event according to Attribution Theory?
Internal vs External (failed exam bc stupid vs noisy)
Stable vs Unstable (I’m also going to be stupid vs next time won’t be noisy)
Global vs specific attributions (bc I failed exam I will fail at everything vs this is a one-off)
Attribution Theory assumes an interaction between ________ and __________
cognitive style, life event. Both need to be present to trigger depression
Attribution Theory was then updated into _________ (1989)
Hopelessness Theory
Hopelessness Theory added the idea that
the person has to view the consequences of the negative event as catastrophic - negative event (failed exam) is viewed much more negatively than by others, and they feel that it reflects badly on the person.
Thus the person develops hopelessness expectancies (a sufficient proximal cause of depression)
In Hopelessness Theory, a person can have bad attributions etc but will not develop depression UNLESS..
they have Hopelessness thinking = I can’t do anything about bad things (helplessness expectancy) x bad things are likely to happen (negative outcome expectancy)
Beck’s 1976 Schema Theory suggests that we interpret the world in a way that fit in with our pre-existing schemas (knowledge structure). These schemas are developed..
during childhood - a negative thinking schema is more likely to develop if genetically vulnerable to depression, highly influenced by parents
Negative schema can be activated by ______. Eg the schema “I’m unloveable” might be activated when…
stress, you walk past your best friend and she doesn’t look at you - you start recycling lots of cognitively biased thoughts - anything that happens will begin to be interpreted in terms of this schema —-> this schema becomes strengthened
Response style theory posits that there is a way of thinking about negative life events that causes some people to become more depressed than others. What style is most implicated in depression?
Rumination - start recycling the same thoughts over and over, no solution
There is a lot of research that suggests that depressed people tend to _______ negative life events. Which means that negative life events are _______ based.
cause, genetically
Stress-generation hypothesis argues that
depressed people think/behave in a way that generates stressful life events for themselves. This may partly explain depression recurrence
What is the distinction between dependent and independent stressors (stress-generation hypothesis)?
Independent stressor - something that happens without your involvement eg family member dies
Dependent stressor - interpersonal problems, fired from job
What was the first effective treatment for depression?
Electroconvulsive therapy - introduced in 1938 to treat schizophrenia
How effective is ECT for severe depression?
85+%
What are limitations of ECT?
Relapse is common
Short-term memory loss
Some argue there are serious long-term cognitive impairments as a result of ECT
First wave of drugs to treat depression were …
Monoamine Oxidase Inhibitors (MAOIs) introduced in 1956
- originally treated tuberculosis
How long do MAOIs take to take effect?
2-3 weeks
How do MAOIs work?
blocks Monoamine Oxidase –> serotonin/norepinephrine becomes available in the brain for longer
What are the side effects of MAOIs?
Can cause hypertension –> stroke if not on strict diet (no Tyramine - cheese, red wine, beer)
What were the second wave of drugs to treat depression?
Trycyclic Medications - introduced early 1960s
- originally for psychosis
How do Trycyclic drugs work?
Block presynaptic reuptake of serotonin and norepinephrine, takes 2-3 weeks
Effective in 75-80% of people
What are the side effects of trycyclic drugs?
The vegetative symptoms of depression lift first - ie increase in energy
—> increased suicide risk around 10th-14th day
Also: dry mouth, blurred vision, tremor, anxiety, nausea, muscle weakness, so on and so forth
Cardiotoxicity - can be overdosed
SSRIs have less side effects because they…
specifically block the reuptake of serotonin
Just because SSRIs work to treat depression, doesn’t mean that..
the absolute levels of serotonin levels in the brain are the cause of depression - illogical extrapolation
SSRIs are not treating the cause of depression because..
- they can induce a manic effect on non-depressed people
- non-specificity of treatment effects eg treat anxiety disorders, etc
- biochemical effect of the drug is very fast ie the levels of serotonin increase immediately, however the symptoms of depression only lift 2 to 3 weeks later
We don’t know how/why SSRIs work
There is the possibility that SSRIs can slowly reverse…
Stress-induced hippocampal damage
What are the CBT components for depression?
- Address cognitive biases in thinking
2. Behavioural components - behavioural activation eg start engaging in activities again
Compare CBT and drug therapy for depression?
Outcomes are comparable but lower relapse rates for CBT - have learnt skills to deal with future stressors
What is anhedonia?
inability to experience pleasure for previously pleasurable activities
The presence of anxiety in depression has important clinical implications as….
anxiety being comorbid with depression increases the risk of suicide and predicts a longer length of the depressive episode
How has DSM-5 attempted to minimise the chances of inappropriately diagnosing bereaved individuals with depression?
Listing some distincts between non-pathological grief and major depression
eg a preoccupation with thoughts about the deceased in the former versus self-critical thoughts in the latter
Melancholic depression can be characterised by significant __________ disturbance, while psychotic depression is characterised by both __________ disturbance and psychotic features.
psychomotor
Ge and colleagues (2001) demonstrated that the marked gender disparity in the incidence of depression symptoms that begins in adolescence is explained best by the interaction of…
- pubertal biological changes
- the psychosocial connotation of puberty and associated interpersonal stressors
- pre-existing gender-dependent vulnerabilities such as a prominence on emotion focused coping and over-reliance on interpersonal sources of self-esteem
What are several explanations for why children who live with a parent with a psychological disorder are at greater risk of experiencing a depressive episode?
- genetic factors
- problems in early attachment and bonding
- ongoing parenting difficulties that lead to conflict
- the child experiencing a feeling of abandonment or neglect as their parent may not be able to adequately meet their needs
- child needing to assume the role of ‘parent’
Up to ____ of those with a depressive disorder will recover within the first ___ months following treatment
50, 6
