Major Depressive Disorder

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Last updated 7:18 PM on 2/22/25
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72 Terms

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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

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Major depressive episode symptom #1

Depressed mood

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Major depressive episode symptom #2

Markedly diminished interest or pleasure in activities

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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

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Major depressive episode symptom #4

Insomnia or hypersomnia

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Insomnia

Not being able to sleep despite effort to sleep

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Hypersomnia

Sleeping all the time, being overly tired

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Major depressive episode symptom #5

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

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Major depressive episode symptom #6

Fatigue and loss of energy

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Major depressive episode symptom #7

Feelings of worthlessness or excessive or inappropriate guilt

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Major depressive episode symptom #8

Diminished ability to think or concentrate, or indecisiveness

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Major depressive episode symptom #9

Recurrent thoughts of death, suicidal ideation, or suicide atempt

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Self-harm

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

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Suicide

Expect not to wake up

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Initial insomnia

Initial trouble falling asleep

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Terminal (Late) insomnia

Wake up earlier than intended

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Middle insomnia

Difficulty staying asleep after falling asleep

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Suicide main signs

1) If they have attempted in the past

2) Specificity of plan

3) Lethality and access to means

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Major depressive episode criterion B

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

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Major depressive episode criterion C

Not due to direct effect of substance or general medical condition

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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.

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Major depressive episode criterion E

There has never been a manic or hypomanic episode

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Major depressive episode

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

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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

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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

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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

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Reasons for sex differences

  • Women are more socially accepted to be sad

  • Women’s bodies work differently

  • Women with more roles are less depressed

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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.Ā 

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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

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Course Qualifiers

Average depressive episode lasts between 4-9 months

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Seasonal depression

Major depressive episode with seasonal causes

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Quality qualifiers: with anxious distress

Someone who has met MDD qualifications and anxiety symptoms are noticeable

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Quality qualifiers: with psychotic features

Hallucinations or voices are disparing

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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

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Dysthiamia

Low grade chronic depression

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Persistent Depressive Disorder (PDD)

Explains depression that has been going on for a long time

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Persistent Depressive Disorder criterion A

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

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Persistent Depressive Disorder symptom #1

Poor appetite or overeating

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Persistent Depressive Disorder symptom #2

Insomnia or hypersomnia

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Persistent Depressive Disorder symptom #3

Low energy or fatigue

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Persistent Depressive Disorder symptom #4

Low self-esteem

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Persistent Depressive Disorder symptom #5

Poor concentration/difficulty making decisions

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Persistent Depressive Disorder symptom #6

Feelings of hopelessness (correlated with suicidality)

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Persistent Depressive Disorder criterion C

Not without symptoms for more than 2 months

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Persistent Depressive Disorder criterion D

MDD criteria may be consistently present for 2 years

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Who gets PDD?

Early and insidious onset

  • Women more than men

  • Lifetime prevalence: .9%

  • 12-month prevalence: .5%

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Chronic Major Depression

Lifetime prevalence: 3.1%

12 month prevalence: 1.5%

  • Both called PDD, but function differently

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Biological Theory

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

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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

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Biochemical hypotheses

Focuses on monoamines (serotonin, dopamine, neuroepinephrine)

  • Explains functional deficit of monoamines

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Catecholamine

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

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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

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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

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Medication: Tricyclics

  • Used to treat other diagnoses, but mainly called antidepressants

  • Catecholamine reuptake inhibitors

  • Significantly less intense side effects

  • Cardiotoxic, easily overdosable

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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

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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

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Medication: Norepinephrine-Dopamine Reuptake Inhibitors

  • Tolerated well, relatively activating

  • 70% of people get better

  • No serengenic effects

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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

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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

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Deep Brain Stimulation

  • Small electrical stimulation to certain parts of the brain

  • Cirguical procedure, non-invasive

  • Unclear how well it works

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Phototherapy

  • Typical for seasonal/pattern depression

  • Works well, reason ?, possibly sleep

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Psychodynamic Theory & Treatment

  • Classic analytic theory

  • Anger turned inward

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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

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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

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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

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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%

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Behavioral Theory

  • Operant conditioning

  • People experiencing depression struggle to get positive reinforcement

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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%

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Beck’s Cognitive Theory

  • Automatic, cognitive distortions (jumping to conclusions)

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Depression Triad

Pessimistic views of oneself, their world, and their future

  • Internal, stable, global

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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

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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