Major Depressive Disorder

Major depressive episode criterion A

Five or more of the symptoms in a two week period, 9 symptoms, at least one has to be one of the first two

Major depressive episode symptom #1

Depressed mood

Major depressive episode symptom #2

Markedly diminished interest or pleasure in activities

Major depressive episode symptom #3

Significant weight loss or gain, or decrease or increase in appetite

• DSM says 5% of bodyweight in a month, unintentional

Major depressive episode symptom #4

Insomnia or hypersomnia

Insomnia

Not being able to sleep despite effort to sleep

Hypersomnia

Sleeping all the time, being overly tired

Major depressive episode symptom #5

Psychomotor agitation (irritability, aggression) or retardation (slowing down observable by others)

Major depressive episode symptom #6

Fatigue and loss of energy

Major depressive episode symptom #7

Feelings of worthlessness or excessive or inappropriate guilt

Major depressive episode symptom #8

Diminished ability to think or concentrate, or indecisiveness

Major depressive episode symptom #9

Recurrent thoughts of death, suicidal ideation, or suicide atempt

Self-harm

Intended to cause pain, but not to end one’s life

Suicide

Expect not to wake up

Initial insomnia

Initial trouble falling asleep

Terminal (Late) insomnia

Wake up earlier than intended

Middle insomnia

Difficulty staying asleep after falling asleep

Suicide main signs

1) If they have attempted in the past

2) Specificity of plan

3) Lethality and access to means

Major depressive episode criterion B

Clinically significant distress or impairment in social, occupational, or other important aspects of functioning

Major depressive episode criterion C

Not due to direct effect of substance or general medical condition

Major depressive episode criterion D

The occurrence of the major depressive episode is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders.

Major depressive episode criterion E

There has never been a manic or hypomanic episode

Major depressive episode

If you are experiencing A, B, and C, you are experiencing disorder, only takes one episode to diagnose

What age do people get depression?

Mean age of onset: The 20’s

• Getting younger: the younger you are, the more likely you are to be experiencing depression

Why is mean getting younger?

Media: Decreased in-person interactions

• Comparisons become larger and more artificial

• Comparing yourself to an illusion

• More acceptable to talk about mental health now

Sex differences

Women get depression more frequently

• Lifetime prevalence: 10-25% for women, 5-12% for men

• Point prevalence (right now): 5-9% for women, 2-3% for men

• 2.5 times more common for women then men

Reasons for sex differences

• Women are more socially accepted to be sad

• Women’s bodies work differently

• Women with more roles are less depressed

Rumination

A cognitive process characterized by repeatedly dwelling on negative thoughts and experiences. It involves focusing on the causes, consequences, and symptoms of distressing events, rather than seeking solutions or distractions. 

Cultural differences

• Higher in western industrialized societies

• Marital status

• Parents who stay together affect kids more than parents who divorce

• Socioeconomic (moderate risk factor)

• Long-term committed relationships tend to be a protective factor

Course Qualifiers

Average depressive episode lasts between 4-9 months

Seasonal depression

Major depressive episode with seasonal causes

Quality qualifiers: with anxious distress

Someone who has met MDD qualifications and anxiety symptoms are noticeable

Quality qualifiers: with psychotic features

Hallucinations or voices are disparing

Quality qualifiers: with melancholic features

Explains a particularly severe variety of a major depressive episode

• People believed this was biological depression for some time, but people experiencing this episode respond equally well to treatment and doesn’t predict future episodes

Dysthiamia

Low grade chronic depression

Persistent Depressive Disorder (PDD)

Explains depression that has been going on for a long time

Persistent Depressive Disorder criterion A

Depressed for two years, during the 2 years experiencing 2 or more symptoms

Persistent Depressive Disorder symptom #1

Poor appetite or overeating

Persistent Depressive Disorder symptom #2

Insomnia or hypersomnia

Persistent Depressive Disorder symptom #3

Low energy or fatigue

Persistent Depressive Disorder symptom #4

Low self-esteem

Persistent Depressive Disorder symptom #5

Poor concentration/difficulty making decisions

Persistent Depressive Disorder symptom #6

Feelings of hopelessness (correlated with suicidality)

Persistent Depressive Disorder criterion C

Not without symptoms for more than 2 months

Persistent Depressive Disorder criterion D

MDD criteria may be consistently present for 2 years

Who gets PDD?

Early and insidious onset

• Women more than men

• Lifetime prevalence: .9%

• 12-month prevalence: .5%

Chronic Major Depression

Lifetime prevalence: 3.1%

12 month prevalence: 1.5%

• Both called PDD, but function differently

Biological Theory

Genetic links: depression runs in families, but not a genetic disorder, can be treated

Twin Studies

• Identical twins are more genetically similar, if twin has depression, the other twin is more likely to have depression

• Fraternal twins are more similar than the rest of the population

Biochemical hypotheses

Focuses on monoamines (serotonin, dopamine, neuroepinephrine)

• Explains functional deficit of monoamines

Catecholamine

Dopamine and neuroepinephrine, these two suggest a functional deficit of catecholamines

Indolamines

Serotonin, believed people had too little serotonin

• Melatonin is also indolamine

• Manipulating catecholamines decreases depression

• Medicines change availability of neurotransmitters, but if change doesn’t occur then something else is going on

Medication: MAOI’s

• Increase functional availability of catecholamines in the synapse

• 70% of people who take them get better

• Not commonly used because bad side effects and don’t interact well with other medications

• Really bad side effects

Medication: Tricyclics

• Used to treat other diagnoses, but mainly called antidepressants

• Catecholamine reuptake inhibitors

• Significantly less intense side effects

• Cardiotoxic, easily overdosable

Medication: Selective Serotonin Reuptake Inhibitors (SSRI’s)

• 70% of people get better

• Mild side effects overall

• Very low overdose risk

• Side effects: some are activating while others are sedating, increased suicidal ideation in children and adolescents, appetite changes, sexual side effects, emotional blunting

Medication: Serotonin Neuroepinephrine Reuptake Inhibitors (SNRI’s)

• Norepinephrine reuptake inhibitors

• Side effects: dry mouth, blurred vision, tolerated very well

• 70% of people using SNRI’s get better

Medication: Norepinephrine-Dopamine Reuptake Inhibitors

• Tolerated well, relatively activating

• 70% of people get better

• No serengenic effects

Medication: Ketamine

• Sedative/recreational drug- effects MMDA’s-glutamate system

• People see results much earlier, 14 day medication, no long-term data

• Not much research, but tends to be more effective after other medications are tried

Electro Convulsive Therapy (ECT)

• Running 10,000 volts of electricity through ones brain

• 50% of people respond who don’t respond to anything else respond

• Side effect: don’t remember treatment, small effect of memory loss through treatments

• Start low and go slow

Deep Brain Stimulation

• Small electrical stimulation to certain parts of the brain

• Cirguical procedure, non-invasive

• Unclear how well it works

Phototherapy

• Typical for seasonal/pattern depression

• Works well, reason ?, possibly sleep

Psychodynamic Theory & Treatment

• Classic analytic theory

• Anger turned inward

Object Relations Theory

You perceive that in some way your primary caregiver is abandoning you

• Actual, perceived, or threatened loss leads to depression

• Can get angry at internalized picture of person, displacing anger onto someone when its actually you

Psychodynamic Treatment

• Insight into unconscious conflict (e.g., talk therapy)

• Dream analysis, free association

• Requires multiple hours a session, multiple times for weeks

• Long-term strategy: people get better, but takes longer

Modern Dynamic Theory

• Starts with observation that majority of depressive episodes are rooted in interpersonal problems

• Interpersonal psychotherapy (IPT, Klerman, Weissman, Frank): person talks about current interpersonal problems, works to change the past by looking at present, reinterpretation

Modern Dynamic Theory Short-term effects

• Grief

• Role Disputes

• Role transition

• Social skills deficit

• 70% of people experiencing symptoms get better

• Long-term efficacy: 2 years later, 60% of people are still depression free, boster sections increase to 70%

Behavioral Theory

• Operant conditioning

• People experiencing depression struggle to get positive reinforcement

Behavioral Treatment

• Behavior change, change in affect, etc.

• Behavior Activation: activity generally is reinforcement

• Doesn’t work as well, 65% of people get better

• More severe cases respond better

• Long-term efficacy: 60%

Beck’s Cognitive Theory

• Automatic, cognitive distortions (jumping to conclusions)

Depression Triad

Pessimistic views of oneself, their world, and their future

• Internal, stable, global

Cognitive treatment

• Change thoughts, change affect. etc.

• When you feel your mood shift, write it down to help determine cause which slows down process

• 70% of people get better, short-term, symptom based intervention

• Long-term efficacy: 2 years, 60%

• Lots of ways to get better need to choose whats best for you

Combination treatments

• Put meds and therapy together, but data doesn’t support that this increases chance of people getting better

• About 70% get better

• Tend to do this because you don’t know what will work better