Depressive Disorders

to have a depressive diagnosis one must have ___ symptoms for at least ___ weeks

5
2

three symptom clusters

- emotional
- physical/behavioral
- cognitive

emotional symptoms of depressive disorder

- consistent depressed mood
- loss of pleasure and humor
* MUST have one emotional symptom

physical/behavioral symptoms

- psychomotor agitation/retardation
-fatigue
- significant weight loss/gain
- insomnia/hypersomnia

cognitive symptoms

- feeling of worthlessness/guilt
- recurrent thoughts of death/suicide
-difficulty concentrating/indeciciveness

____ % of clients having MDD are likely to suffer from another episode

50
- this is why it is important to discuss prospect of symptoms recurring and what to do

persistant depressive disorder

- depressed mood more than 50% of days for at least 2 YEARS
- 2 symptoms required
-under/overeating
- hyper/insomnia
-low energy
- low self esteem
- poor focus/ concentration
- hopelessness
- absence of mania
- clinically significant distress

double depression

presence of major depressive disorder and persistent depressive disorder

MDD casual factors (biological)

- genetic vulnerability
- dysregulation of HPA axis--> when you have MDD your negative feedback loops (internal thermostat) do not work as well as neurotypical people= continue to release cortisol (health implications)
- increased activity in right hemisphere, less in left (pfc)--> higher levels of anxiety and negative affect
- lower hippocampal neurogenesis--> not creating neuronal connections at the same rate (we think elevated cortisol dampens neurogenesis)

MDD causal factors (psychology)

- independent vs dependent life events (when a life event is DEPENDENT on actions and behaviors/you could be at fault it is more likely to trigger depressive episode)
- neuroticism
- childhood adversity
- anger turned inward--> anger towards stressor turned towards self
-dysfunctional schemas about self/world/future

ICAND

MDD causal factors (sociocultural)

- chronic poverty
- discrimination
-family rejection

MAOIs

- treat MDD, antidepressant
- break down norepinephrine and serotonin
- must avoid tyramine in diet (choc, bananas, wine, cheese, etc)--> MAOis do not allow tyramine to be broken down by body
- tyramine + MAOIs= dangerous spike in blood pressure

tricyclics

- treat MDD, antidepressant
- ten days to work
- block reuptake of norepinephrine and serotonin
- side effects--> dry mouth, dizzy, constipation
- lethal in high doses

SSRIS/SNRIS

- not more effective
-2-4 weeks to work--> changing neuronal communication
- side effects--> sexual
- not as toxic in large doses
- experienced more relief in severe cases of depression

electroconvulsive therapy

- induce brain seizure
- 6-12 treatments
- short term memory loss
- good in cases of high suicide risk, inability to take medication, and psychotherapy is ineffective

how is bipolar 1/2 different from major depressive disorder?

presence of mania /hypomania

bipolar 1 disorder

form of bpd where the person experiences manic (or mixed) episodes and manic depressive episodes
- more extreme symptoms
- longer episodes

bipolar 2 disorder

form of bpd in which the person experiences hypomanic episodes and major depressive episodes
- less extreme symptoms
- shorter episode

symptoms of bipolar 1 and 2

* bipolar 1= manic episode, bipolar 2= hypomanic episode
mania/hypomania
- upbeat, jumpy, wired
- increased activity, energy, agitation
- exaggerated sense of well being, self confidence, euphoria
- decreased need for sleep
- racing thoughts
- distractibility
- poor decision making (buying sprees, poor sexual decisions, etc)
depressive episode
- depressed mood
- marked loss of interest
- insomnia/sleeping too much
- restlessness or slowed behavior
- fatigue or energy loss
- feelings of worthlessness--> suicidal ideation
- inability to concentrate