Lecture 8 - Depression and Bipolar

What ratio of people are affected by depression

affects 1 in every 10 people

Symptoms of Depression

sadness

worthlessness

guilt

foreboding

poor sleep

appetitive changes

Signs of Depression

withdrawn socially

fatigue

poor concentration

inactivity

restlessness

DSM-V Definition

at least one of the following: low mood or anhedonia (inability to experience pleasure or joy)

at least 5 symptoms: changes in weight, agitation, fatigue, insomnia, difficulty concentrating, thoughts of death

symptoms present nearly everyday for at least 2 weeks

cause clinically significant distress

not due to drugs

Dysthymia

depressed mood - at least 50% of the time for at least 2 years

low mood present, accompanies by at least 2 other symptoms of depression

starts in early life and precedes first instance of major depressive episodes

double depression dysthymia + major depressive episode

Point Prevalence of Depression

what percentage of people have depression at any one time

USA 2015 = 7.3%

Lifetime Prevalence of Depression

What percentage of people will experience depression in their lifetime

2020 review estimates 2-20%

suggests lower rtes of depression in “Eastern” vs “Western” cultures

Why is there differences in prevalence?

westernised bias

under-reporting

somatisation

Cifuentes et al (2008)

251,158 people over 65 countries

found major depressive episodes lowest in moderately economically developed nations

in highly-develop nations MED rose with rising income inequality

Impact of Depression

ranked number 1 for cause of disability

relationships (parent-child and romantic)

completed suicides (10x increased)

illness and mortality (heart disease, diabetes, stroke)

Relapse definition

Return of current episodes

Recurrence definition

start of new episode

Recurrence of Depression

average number of lifetime episodes 4-6

pattern of recurrence:

20% at 2 months

30% at 6 months

40% at 1 year

50% at 2 years

76% by 5 years

Increased risk of depression

being female - twice the risk

family history

past history

loss or stressful events

poor housing, low income

negative styles of thinking

Biological Treatments

SSRIs (eg citalopram and fluoxetine)

ECT (electroconvulsive therapy) - highly controversy, now limited and last treatment option

Becks Cognitive Threapy

Core Beliefs

statement bout the elf that are of an absolute, global and stable nature

not necessarily accessible in precise verbal form

formed on basis of early experiences

Dysfunctional Assumptions

1. highly individualised, conditional generalised rules

2. rigid, overgeneralised absolute and extreme

3. dysfunctional in preventing goal attainment

4. often culturally reinforced

5. theme of achievement

6. non conscious

7. extreme excessive emotion

8. fulfilment of assumptions results in feeling better

9. activated in vunerabiltity

Schemas

organising cognitive structures that influence. an individuals representation and experience of the world and self

influences through biases in attention, memory and reasoning processes

Negative Thoughts

Becks negative triad - self, world, future

inner speech seen as full of negative propaganda - negative automatic thoughts

based on negative core beliefs

vicious spiral of depression (negative automatic thoughts, emotions, behaviours, physical sensations)

CBT for depression

activity monitoring and scheduling

tracking NATs

challenging NATs

identifying and challenging schema

relapse prevention

Bipolar I disorder

one or more manic episodes

Bipolar II disorder

one or more major depressive episodes, plus at least one hypomanic episode

What is mania?

a period of abnormally and persistently elevated moods and increased activity/energy lasting at least one week, nearly everyday

noticeable change from usual behaviour (inflated self esteem, decreased need for sleep, more talkative than usual, flight of ideas, distractibility and excessive involvement in actions with painful consequences)

Hypomania

4 days or more days of persistently elevated mods and persistently increased activity/ energy

not severe enough to cause marked impairment, hospitalisation not necessary and no psychotic features

Cyclothymic Disorder

brief spells of mild hypomania and mild depression with rare occasions when no symptoms occur

lasts > 2 years

15-20% develop bipolar

What is the prevalence of bipolar I?

1%

What is the age of onset?

between 21 and 25 years

What is the comorbidity with other psychiatric conditions?

>50%

What is the increase in suicide rates?

20 - 30x that of the general population

How does an episode develop?

Diathesis Stress Model

vulnerability → trigger → symptoms

Diathesis of Bipolar

relatively high heritability - over 70%

multiple loci associated

decreased amygdala volume and increases activity in limbic structures

Triggers of Bipolar

life events

particularly associated with goal-attainment rather than positive or negative events

Targets of CBT for BP

prodromes - warning signs of an episode

psychoeducation

social rhythm stabilisation

medication adherence

stressful life events

dysfunctional cognitions