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Major Depressive Disorder (MDD) - emotional symptoms
depressed mood
anhedonia (lack of interest or pleasure)
Major Depressive Disorder (MDD) - behavioral symptoms
appetite change
sleep disturbance
psychomotor disturbance
moving slow, slow speech
fatigue
Major Depressive Disorder (MDD) - cognitive symptoms
feeling guilty or worthless
concentration difficulty
thoughts of death or suicide
need ___ of symptoms for at least ___diagnose MDD
5 or more symptoms
2 weeks
Major Depressive Disorder
symptoms must be cause of significant distress or impair functioning
not attributable or explained by something else
never experienced a manic or hypomanic episode
“normal & expected” depressive response to a negative event such as a loss should not be diagnosed as MDD unless other, more atypical symptoms are present (e.g., worthlessness, suicidal ideas, psychomotor disturbance)
MDD Specifier - with anxious distress
prominent anxiety symptoms
MDD Specifier - with mixed features
presence of at least 3 manic/hypomanic symptoms but does not meet criteria for a manic episode
MDD Specifier - with melancholic features
inability to experience pleasure
distinct depressed mood
depression worse in morning
psychomotor retardation or agitation
significant weight loss
excessive guilt
MDD Specifier - with atypical features
positive mood reactions to some events
significant weight gain or increase in appetite
hypersomnia
longstanding pattern of sensitivity to interpersonal rejection
MDD Specifier - with psychotic features
mood-congruent or incongruent delusions or hallucinations
MDD Specifier - with catatonia
not actively relating to environment, mutism, posturing, agitation, mimicking another’s speech or movements
MDD Specifier - with seasonal patterns (seasonal affective disorders)
occurs mostly in the winter months & generally lifts during spring and summer
same time every year
2-year period
responds to antidepressants, psychotherapy, light therapy
Why did Postpartum Depression get renamed to major depressive disorder with peripartum onset?
50% of postpartum episodes begin prior to delivery
Specifier - MDD with Peripartum Onset - Prevalence
10-22% of adult women, 60% of women have their first depressive episode in the postpartum period
~10% of fathers without a prior history of depression
Specifier - MDD with Peripartum Onset - risk factors
low income, sleep disturbances, low social support
mothers → stressful pregnancy, complicated birth, previous miscarriage or stillbirth
fathers → increased risk when mother is depressed or relationship problems present
Specifier - MDD with Peripartum Onset - prevention factors
home visits, peer support, therapy - mothers
paternal involvement - fathers
Persistent Depressive Disorder (PDD) - aka Dysthymia
over 2 years, individual has never been without symptoms for more than 2 months at a time
never had a manic or hypomanic episode
not attributed to or better explained by something else
clinically significant distress or impairment
Persistent Depressive Disorder (PDD) - symptoms
2 or more symptoms (including depressed mood or lack of interest & pleasure, same as MDD) for at least 2 years
Biological Etiology of Depressive Disorders
neurotransmitters: serotonin & norepinephrine
~50% heredity - most evident after puberty
cortisol (stress hormone) - interacts with experiences
hippocampus - smaller in people with depression
circadian rhythm disturbance
Psychological Etiology of Depressive Disorders - behavioral
limited opportunities to engage in reinforcing activities
a person’s behavior reduces the likelihood of positive social interactions
Psychological Etiology of Depressive Disorders - cognitive
aaron beck → negative self-schema
learned helplessness
negative attributional style - on causes that are internal, stable, global
Beck’s 6 Types of Faulty Thinking
arbitrary inference - drawing conclusions without sufficient evidence
personalization (and blame) - take others’ behaviors personally and take total responsibility for external events occurring
overgeneralization - holding extreme beliefs on the basis of a single incident and applying these inaccurate beliefs to other situations
magnification & exaggeration - overestimating the significance of negative events
polarized thinking - all or nothing, good or bad, either/or, black and white thinking
selective abstraction (mental filtering) - only focusing on the negative aspects of a situation
Social Etiology of Depressive Disorders
adverse childhood experiences (ACEs)
abuse, neglect, poverty, divorce, exposure to substance abuse, exposure to violence, family member in prison, death of a parent
parental depression
stressful life experiences
social rejection
Sociocultural Etiology of Depressive Disorders
women more likely to be diagnosed with MDD than men, across all ages, ethnic/racial groups, and nationalities
Biological Treatments of Depressive Disorders
tricyclics, monoamine oxidase inhibitors (MAOIs), and serotonin-norepinephrine reuptake inhibitors (SNRIs) - block the reuptake of norepinephrine and serotonin
SSRIs
lots of side effects - off-putting (can’t abruptly get off meds, less side effects with Wellbutrin but it can exacerbate anxiety symptoms)
omega-3 fatty acid supplements reduce depressive symptoms + can boost effectiveness of antidepressants
best outcome = therapy + treatment
Psychological Treatments of Depressive Disorders - CBT
challenge dysfunctional thinking
evaluate thoughts, not emotions
very effective
Psychological Treatments of Depressive Disorders - behavioral activation
replace behaviors that lead to depression with behaviors that are reinforcing
Psychological Treatments of Depressive Disorders - acceptance & commitment therapy (ACT)
acceptance
cognitive defusion
contact with the present moment - mindfulness
values
committed action
self-as-context
Psychological Treatments of Depressive Disorders - mindfulness-based cognitive therapy
techniques → present moment awareness, mediation, breathing exercises
group setting (8 weeks) - utilizes homework, good for preventing relapse of depressive symptoms
sadness → trigger for relapse of depression
accept sadness rather than try to change it
you are not your thought patterns
Premenstrual Dysphoric Disorders
clinically distressing or impairment
not merely an exacerbation of the symptoms of another disorder
not attributable to something else
at least 5 symptoms present in the final week before menstruations begins
symptoms start to improve within a few days of onset of menstruation and become minimal or absent in the week following
Premenstrual Dysphoric Disorders - Criteria A
one of these present
marked affective lability
marked irritability or anger or increases interpersonal conflicts
markedly depressed mood, feelings of hopelessness, self-deprecating thoughts
marked anxiety, tension, and/or feelings of being keyed up or on edge
should be confirmed by prospective daily ratings during at least 2 symptomatic cycles
Premenstrual Dysphoric Disorders - Criteria B
one or more of the following symptoms - additionally present, total of 5 when combined with A
decreased interest in usual activities
subjective difficulty in concentration
lethargy, easy fatigability, marked lack of energy
marked change in appetite; overeating or specific food cravings
hypersomnia or insomnia
a sense of being overwhelmed or out of control
physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of “bloating” or weight gain