PSY381: Ch. 7-8 Unipolar Depression

Around ___% of adults in the U.S. suffer from severe unipolar depression in any given year

As many as ____% suffer from mild forms

9% severe, 5% mild

Around ____% of all adults experience unipolar depression at some time in their lives

19% at some point in lifetime

T or F: The rate of depression is higher among poor people than wealthier people

True

Depression Response Inventories

• Beck Depression Inventory

• Burns Depression Inventory

• Hamilton Depression Inventory (HAM-D)

Types of symptoms of unipolar disorder

• Emotional Symptoms

• Motivational Symptoms

• Behavioral Symptoms

• Cognitive Symptoms

• Physical Symptoms

Emotional sypmtoms of unipolar depression

• Feeling “miserable,” “empty,” “humiliated” “worthless” “sad all the time”

• Experiencing little pleasure: Anhedonia

Motivational symptoms of unipolar depression

Lacking drive, initiative, spontaneity

Behavioral symptoms of unipolar depression

• Less active

• Less productive

• Sleep changes

• Appetite changes

• Self- harm or suicidal behaviors

Cognitive symptoms of unipolar depression

• Hold negative views of themselves

• Blame themselves for unfortunate events

• Pessimistic

• Guilt

• Difficulty concentrating

• Between 6% and 15% of those with severe depression die by suicide

Physical symptoms of unipolar depression

Headaches, dizzy spells, general pain, fatigue

Criteria for diagnosing unipolar depression

1. Major depressive episode

   • Marked by five or more symptoms of lasting two or more weeks

2. No history of mania

In extreme cases of unipolar depression, symptoms are ________.

psychotic - include hallucinations and delusions

Two diagnoses to consider for unipolar depression

1. Major depressive episode

2. Dysthymic disorder/Persistent depressive disorder

Major depressive disorder

Criteria 1 and 2 are met

Dysthymic disorder/persistent Depressive disorder

symptoms are “mild but chronic”

• depression is longer lasting but less disabling

• consistent symptoms for at least two years

what is it called when dysthymic disorder/persistent depressive disorder leads to major depressive disorder?"

double depression

what is a trigger for depression

stress

• people with depression experience greater number of stressful life events during month jus before onset of symptoms

what factors do current explanations of unipolar depression point to

biological, psychological, and sociocultural factors

clinicians distinguish reactive (________) depression from ________ depression, which seems to be a response to internal factors

exogenous, endogenous

four main models from biological view

• medication

• ECT

• brain stimulation

• modern treatments

first three have research support and fourth holds promis

four main models from psychoilogical view

• psychodynamic model - no strong research support

• behavioral model - modest research support

• cognitive views - considerable research support

• sociocultural views - research support

medication

• cause: Unipolar depression may result from imbalances in neurotransmitters like serotonin and norepinephrine or deficiencies in BDNF within neurons.

• treatment: FDA-approved antidepressants, including SSRIs like Prozac and Lexapro, work by adjusting neurotransmitter activity to alleviate depressive symptoms.

ECT

• cause: Chemical imbalances involving serotonin and dopamine are believed to be corrected through induced seizures via ECT.

• treatment: ECT involves sending controlled electric currents through the brain to trigger seizures, offering rapid relief in severe, treatment-resistant depression.

brain stimulation

• cause: Low levels of norepinephrine and serotonin, sometimes drug-induced, are implicated in the development of unipolar depression.

• treatment: Treatments like deep brain stimulation, tDCS, and TMS stimulate brain regions via electrodes or magnetic pulses to improve mood regulation.

modern treatments

• cause: Unipolar depression is linked to low serotonin activity, dysfunctional brain circuits, and other biochemical and genetic factors.

• treatment: New treatments like Esketamine and Psilocybin promote neural plasticity and are being used for treatment-resistant depression.

behavioral

• cause: Depression can stem from a lack of rewards and reinforcements in a person’s environment, especially social rewards.

• treatment:

  • Reintroduce clients to pleasurable activities and events, often using a weekly schedule

  • Appropriately reinforce their depressive and nondepressive behaviors

    • Use a contingency management approach

  • Help them improve their social skills

cognitive

• cause: negative thinking triggered by current upsetting situations, maladaptive attitudes (self-defeating attitudes), automatic thoughts (train of unpleasant thoughts suggesting inadequacy and hopelessness), and learned helplessness (people believe they have no control over reinforcements in lives)

• treatment: Beck’s cognitive therapy

  • Designed to help clients recognize and change negative cognitive processes in four phases

sociocultural

• cause: Depression may arise from interpersonal issues such as loss, role transitions, disputes, or social deficits.

• treatment: IPT focuses on improving relationships and coping skills across phases addressing grief, role changes, and social effectiveness.

which therapies are highly effective treatments for mild to sever unipolar depression

cognitive, cognitive-behavioral, and interpersonal therapies

• lower likelihood of relapse, but are not relapse-proof

what combination is more helpful for depressed people than either treatment alone

psychotherapy and drug therapy

psychodynamic

• cause: Depression can stem from unconscious grief over real or imagined losses, especially in individuals fixated at the oral stage or with insecure relationships.

• treatment: Psychodynamic therapy uses techniques like free association and interpretation to uncover unresolved grief and relational patterns that contribute to depression.

strengths of behavioral view

lots of data

four phases of beck’s cognitive therapy

1. Increasing activities and elevating mood

2. Challenging automatic thoughts

3. Identifying negative thinking and biases

4. Changing primary attitudes\

mood tracking

clients are instructed to keep track of mood changes hour by hour, day by day and to note situations/thoughts that cause mood to change

two kinds of sociocultural views

1. family-social perspective

2. multicuiltural perspective

family-social perspective

connection between declining social rewards and depression is a two-way street

• depressed people often display social deficits that make others uncomfortable and may cause them to avoid depressed individual (leads to decreased social contact and further deterioration of social skills)

artifact theory in multicultural perspective

women and men are equally prone to depression but clnicians often fail to detect depression in men

hormone explanation in multicultural perspective

hormone changes trigger depression in many women

life stress theory

women in our society experience more stress than men

what kinds of relationships have captured the interest of multicultural theorists

cultural background and depression

• research suggests precise picture of depression varies from country to country

Depressed people in non-Western countries are more likely to be troubled by ________ symptoms of depression than by ________ ones

physical, cognitive

As countries become more Westernized, depression seems to take on the more ________ character it has in the West

cognitive

interpersonal therapy (IPT) addresses what four interpersonal problems

• Interpersonal loss

• Interpersonal role dispute

• Interpersonal role transition

• Interpersonal deficits

is IPT as effective as cognitive therapy for treating depression

yes

does genetics play a part in depression

yes, Family pedigree, twin, adoption, and molecular biology gene studies suggest that some people inherit a biological predisposition

Researchers have found that as many as ___% of relatives of those with depression are themselves depressed, compared with fewer than ___% of the general population

20, 10

biochemical factors of depression

high blood pressure meds caused depression—> discovery of truly effective antidepressant medications, which relieved depression by increasing either serotonin or norepinephrine, confirmed the NT role

True or false: depression involves only serotonin

False. involves not just serotonin nor norepinephrine; other NTs may be involved

True or false: people with depression have found to have abnormal levels of cortisol

True

ECT

• most controversial forms of treatment, but used frequently due to effectiveness and fast-acting intervention

• targets electrical stimulation to cause brain seizures

• some cases of memory loss

Studies find imrpovement in ______% of patients who have undergone ECT

60-80

why has the use of ECT declined since the 1950s

because of the memory loss caused by the procedure, the frightening nature of the procedure, and the emergence of effective antidepressant drugs

antidepressant drugs

• Monoamine oxidase inhibitors (MAO inhibitors)

• Tricyclics

why are MAO inhibitors potentially dangerous

People who take MAOIs experience a dangerous rise in blood pressure if they eat foods containing tyramine (cheese, bananas, wine)

True or false: In recent years, a new MAO inhibitor in the form of a skin patch has become available

true

what percentage pf patiens taking tricyclics find symptom improvement

• Drugs must be taken for at least 10 days b60-65%

what happens to most patients who immediately stop taking tricyclics upon relief of symptoms

they relapse within a year

• can significantly decrease risk of relapse by continuing to take tricyclics for five additional months for for 3+ years

second-generation antidepressants

• structurally different form MAO inhibitors and tricyclics

• most are labeled selective serotonin reuptake inhibitors (SSRIs)

• increase serotonin activity specifically

• Selective norepinephrine reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are also now available

why do clinicians prefer second-generation antidepressants over tricyclics

harder to overdose, no dietary restrictions, fewer side effects

True or false: antidepressant drugs work for everyone

False. Even the most successful of them fails to help at least 35 percent of clients with depression

Brain stimulation

• Vagus nerve stimulation

• Transcranial magnetic stimulation

• Deep brain stimulation

True or false: Depressed people who receive strictly behavioral therapy have shown less improvement than those who receive cognitive, cognitive-behavioral, interpersonal, or biological therapy

True