PSYC 337 - Chapter 8, Mood disorders

What is major depressive disorder (MDD)?

Central symptoms (must have to be diagnosed):

• Feeling depressed daily for a long period

• Diminished pleasure and interests you usually partake in

What is MDD and its different types?

-With mixed features: mania or hypomania

-With melancholia: loss of pleasure in most activities

-Atypical features: Mood reactivity (responding positively to things that usually bring happiness)

-Peripartum onset: During pregnancy or 4 weeks postpartum

What is a relapse and recurrence in depression?

-Relapse: recurrence of depressive symptoms within a short period of time suggesting that the illness is not fully resolved

-Recurrence: symptoms present after being free of symptoms for 2 months

What is persistent depressive disorder?

-Depressed mood every day for ~2 years

• 1 year for children and teens

• During the two-year period, the individual has never been without the symptoms for more than two months at a time

What is treatment-resistant depression?

-An episode lasts 12 months

-Usually poor response to two trials of antidepressants

What are assessments for individuals with depression usually like?

-Clinical interview

• Client usually has a slow speech pattern

• Appears absent and disengaged from the world around them

• No care for personal appearance and hygiene

What is the PHQ-9 scale?

-Scale to measure depression by severity of symptoms

• 0-9: subliminal depression

• 10-14: mild depression

• 15-19: moderate depression

• 20-27: severe depression

What are the sex differences in depression?

-Women have greater comfort in expressing distress or vulnerability

• Women in general have greater role burden and life stressors that make them more vulnerable to depression

What are some comorbidities with depression?

-As high as 50%

• Anxiety disorders

• Substance abuse disorders

• Personality disorders; specifically BPD (emotional instability and mood dysregulation w/ depression)

• PTSD

What are some risk factors for depression?

-Family history (2-3x more likely to get it if a family member has it)

-Adverse childhood experiences

-Major life changes

-Socioeconomic status

-Social isolation

What are transdiagnostic variables?

-Mechanisms seen in more than one condition rather than only one

• Prevents those at risk of a range of conditions’ outcomes

• Prevents comorbidity

What are the interpersonal causes of depression?

-Lack of social support and social skills deficits

-The effects of depression on others

• Can cause negative feelings and rejection in other people

-Marriage and family life

• Increases depression and relapse

Who is Harry Stack Sullivan?

-Emphasized the importance of social relationships and interpersonal experiences in shaping MH

-Depression caused by difficulties in social relationships (loneliness, social rejection, conflict)

Why are college kids at a high risk of depression, and what are the risk factors?

-Relocation: not having access to the support system you’re used to

-Under a lot of stress

-Risk factors (students who are under additional stress) :

• Female students, low income students, students of color, students who identify as queer, students who are caregivers to other children and/or adults

What is depression in childhood like?

-Prevalence: 2%-3%

-Symptoms:

• A range of negative emotions is more often seen as behavioural/temperamental issues by adults

  • Won’t be treated unless the parent recognizes a problem and seeks treatment for the child

-Intervention: family therapy, CBT, play therapy, parent involvement in treatment

What is depression in the elderly like?

-Often takes the form of somatic complaints

-Persistent sadness and loneliness → will focus more on bodily issues rather than emotional ones

How does the DSM5 describe manic episodes?

-A. Elevated, irritable mood, increased energy lasting at least 1 week

-B. 3 or more symptoms during the elevated mood duration:

• Inflated self-esteem & grandiosity

• Decreased need for sleep

• More talkative than usual or pressure to keep talking

• Flight of Ideas or subjective experience that thoughts are racing

• Distractibility

• Increase in goal directed activity

• Excessive involvement in activities that have high potential for painful consequences

What is bipolar disorder?

-Significant mood swings, including periods of depression and periods of mania and hypomania

-Varies in intensity and duration

What are key features to bipolar disorder?

-Mood episodes: abnormal mood states (depressive, manic, hypomanic)

-Manic and depressive episodes

-Cyclic nature: episodes recur overtime, lasting days-months

-Significant distress or impairment in functioning

What are the types of bipolar disorder?

-Bipolar I: at least 1 manic episode + depressive episode (depression doesn’t meet criteria for MDD)

-Bipolar II: at least one hypomanic episode + major depressive episode (depression has to meet MDD criteria)

-Cyclothymic disorder: hypomanic + depressive symptoms that do not meet full criteria for either episode

What is the treatment for bipolar disorders?

mood stabilizers like lithium and valproate

- antipsychotic meds for acute mania

- antidepressants for depressive episodes (can trigger manic episodes)

- benzodiazepines for short-term management of anxiety or agitation

How is psychotherapy used to treat bipolar depression?

-CBT: changes negative thinking and behaviour

-Interpersonal and social rhythm therapy (IPSRT): focuses on stabilizing daily routines and sleep patterns to manage mood swings

-Family focused therapy: family members in treatment to improve communication and support

What is the monoamine hypothesis of depression?

-Dysregulation of monoamines such as serotonin, norepinephrine, and dopamine induces depressive like symptoms

-Antidepressants usually increase the activity of these neurotransmitters

• Most neurotransmitters for depression are blocked in reuptake by antidepressants so that the amines stay in the synaptic cleft for longer → increases rate of activity

What is the first line of treatment of depression?

-- sertraline - SSRI

- escitalopram- atypical, targets norepinephrine and dopamine

- fluoxetine - SNRI; serotonin and norepinephrine reuptake inhibitor

- bupropion

- duloxetine

-citalopram - SSRI

What are the common side effects of antidepressants?

-2-6 weeks to start showing full effects

• Nausea

• Diarrhea

• Weight gain

• Fatigue

• Dry mouth

• Drowsiness or insomnia

• Increased anxiety initially

• Sexual dysfunction

What is seen in a successful treatment in a clinical trial?

-no longer meeting the diagnostic criteria following treatment

- no longer scoring above clinical range on self-report measure of symptom severity

- 50% reduction in scores on self-report measures

What is the psychoanalytic perspective on depression?

- early parental rejection → predisposition to later development of depression

- unconscious anger toward lost love object → inward self-criticism

What is the psychoanalytic treatment?

-1) Free association: client talks, psychoanalyst says nothing

- purpose: explore thoroughly what's in the subconscious

2) Analysis of content: dreams are representations of repressed desires and feelings

• manifest content: dream as it appears to the dreamer

• latent content: actual motives that are seeking expression but are hidden or unacceptable, so they are disguised

3) Analysis of resistance: during free association, client may unwillingly talk about something and why they're resisting

4) Analysis of transference: - transference onto therapist attitudes and feelings about past relationships

• countertransference: therapist reacts in accord with client's transferred attributions rather than objectively

What is Beck’s cognitive theory?

Negative childhood memories → dysfunctional beliefs (creates a pattern of negative automatic thoughts) → schema (gets activated by events that are reminders of schema) → activates dysfunctional beliefs → symptoms of depression

What are the techniques of CBT?

-cognitive restructuring and reappraisal: restructure negative interpretation of events

• thought monitoring: tracking thoughts the client is experiencing in order to change them

- goal setting: getting client engaged in life goals

- activity scheduling

- relaxation training

- role playing: playing out scenarios to see which are best for client

- behavioural experiments

What is behavioural activation?

-Behaviourist POV: depression is a result of a decrease in positive reinforcement or rewards from the environment

-Lewinsohn’s Theory

• Trying to increase a person’s exposure to pleasant activities and to success and accomplishment activities

• The person feels more positive rewards from their environment

• Goal setting

  • Goals that can be easily translated into activities that can be planned

    • Goals then turned into activities that have a high probability of success

What is electroconvulsive therapy (ECT)?

- used in patients severely depressed and at immediate risk of suicide

• (Mostly when medication and therapy failed)

- electrical current passed through person's cortex → works fast

- 6-12 sessions, 2 - 3 times a week

- side effects: confusion, and memory loss

What is transcranial magnetic stimulation?

- noninvasive technique allowing focal stimulation in the brain

-Magnetic pulse delivered through a coil placed on the scalp → mood modulation

- Daily sessions over several weeks, each session ~ 20-40 min

• As effective as antidepressants

What is bright light therapy?

-exposure to bright lights (10,000 lux) that mimics natural sunlight

- 20-60 min each day

- regulates mood and improves sleep patterns

What is the assessment for risk of suicide?

-suicidal Ideation (do you have thoughts of harming /killing yourself?)

-plan and means to harm yourself (Do you have a plan and the means to execute it)

-previous attempts of suicide

What is Joiner’s interpersonal-psychological model of suicide?

-Desire to commit suicide when they perceive that they are a burden to others and experience thwarted belongingness

-Cannot act on suicidal desire unless they have acquired capacity for suicide