Unipolar Depressive Disorders

What is the diagnostic criterion for Major Depressive Disorder (MDD)?

A person must be in a major depressive episode and never had a manic, hypomanic, or mixed episode.

What is the difference between a single episode and recurrent Major Depressive Disorder?

A single episode refers to one major depressive episode, while recurrent involves multiple episodes.

At what stage of life does the onset of unipolar depressive disorders most often occur?

During late adolescence up to middle adulthood

• Incidence of depression rises sharply during adolescence

What are some specifiers for Major Depressive Episodes?

Severity, single episode vs recurrent, anxious distress, mixed features, and peripartum onset.

Specifier - with Melancholic Features: Characteristic Symptoms

Three of the following:

early morning awakening, depression worse in the morning, marked psychomotor agitation or retardation, loss of appetite or weight, excessive guilt, qualitatively different depressed mood

Specifier - with Psychotic Features: Characteristic Symptoms

Delusions or hallucinations (usually mood congruent); feelings of guilt and worthlessness common

Specifier - with Atypical Features: Characteristic Symptoms

Mood reactivity—brightens to positive events; two of the four following symptoms:

weight gain or increase in appetite, hypersomnia, leaden paralysis (arms and legs feel as heavy as lead), being acutely sensitive to interpersonal rejection

Specifier - with Catatonic Features: Characteristic Symptoms

A range of psychomotor symptoms from motoric immobility to extensive psychomotor activity, as well as mutism and rigidity

Specifier - with Seasonal Pattern: Characteristic Symptoms

At least two or more episodes in past 2 years that have occurred at the same time (usually fall or winter), and full remission at the same time (usually spring). No other nonseasonal episodes in the same 2-year period

What are the symptoms of postpartum blues?

Changeable mood, crying easily, sadness, irritability, often intermixed with happy feelings.

• 1 in 500 to 1 in 1000 experience psychotic features

Persistent Depressive Disorder

characterized by persistently depressed mood most of the day, for more days than not, for at least 2 years

Double Depression

Moderately depressed on a chronic basis with episodes that meet the criteria for a major depressive episode.

What are the four phases of normal response to the loss of a loved one? and when do depressive symptoms peak?

Numbing and disbelief, yearning and searching, disorganization and despair, reorganization. 2-6 months after the loss.

What genetic influence is associated with unipolar mood disorders?

The prevalence of mood disorders is about 2-3 times higher among blood relatives of persons with clinically diagnosed unipolar depression.

• serotonin-transporter gene

Monoamine Theory of Depression

that depression was at least sometimes due to an absolute or relative depletion of one or both of these neurotransmitters [norepinephrine and serotonin] at important receptor sites in the brain

Neurochemical Factors in Unipolar Mood Disorders

Monoamine theory of depression and decreased dopamine appears relevant for some symptoms and types of depression

What endocrine axises are relevant to depression?

the hypothalamic-pituitary-adrenal (HPA) axis and the hypothalamic-pituitary-thyroid axis

Damage to which side of the anterior prefrontal cortex leads to depression?

the left side

What brain regions are involved in mood disorders?

The orbital prefrontal cortex, dorsolateral prefrontal cortex, hippocampus, anterior cingulate cortex, and amygdala.

What sleep patterns are commonly observed in depressed patients?

Difficulty falling asleep, waking periodically during the night, and early morning waking.

What role do stressful life events play in unipolar depression?

Severely stressful life events often serve as precipitating factors for unipolar depression.

• Severe stress more likely to precede a 1^st episode than a recurrent episode

• Those at genetic risk for depression not only experience more stressful life events but also are more sensitive to them

What is neuroticism in the context of unipolar depression?

A personality trait characterized by negative affectivity, which can increase vulnerability to depression.

How does early adversity contribute to depression?

It can create short-term and long-term vulnerabilities to depression, increasing sensitivity to stress in adulthood.

What is the focus of psychodynamic theories regarding depression?

The similarity between clinical depression symptoms and those seen in mourning loved ones.

What do behavioral theories suggest about the cause of depression?

Depression occurs when an individual's responses no longer produce positive reinforcement or when negative experiences increase.

What is Beck's cognitive theory of depression?

It posits that negative cognitions often precede mood symptoms, with dysfunctional beliefs leading to a pattern of negative automatic thoughts.

Depressogenic Schemas (dysfunctional beliefs)

rigid, extreme, and counterproductive

• When activated by current stressors or depressed mood, they create a pattern of negative automatic thoughts

What is learned helplessness theory in relation to depression?

It suggests that individuals may develop depression due to a perceived lack of control over negative events.

Ruminative Response Styles Theory of Depression

Rumination involves a pattern of repetitive and relatively passive mental activity; those with negative cognitive styles tend to ruminate and are more likely to develop depression

What is the relationship between anxiety and mood disorders?

There is an overlap between measures of depression and anxiety, with neuroticism being a common factor.

How does lack of social support affect mood disorders?

It can exacerbate the effects of depression and lead to deficits in social skills.