Module 9 Depressive Disorders

Psych 130M - Module 9 Depressive Disorder

Anatomy of Depression

Depression

1. mood/symptom

   1. feeling sad/unhappy/miserable

2. clinical disorder

   1. (major depressive episode)

   2. children: depressed mood/irritability

anhedonia

loss of interest/pleasure

DSM-5 Diagnostic Criteria for MDD

(criteria/symptoms/time period/symptom threshold)

Major Depressive Disorder (MDD)

• has experienced one major depressive episode

• has never had manic/hypomanic episodes

• significant distress/impairment in functioning

• not attributable to substance use/medical condition

5+ of following symptoms during 2-week period:

1. depressed mood (irritability in children/teens)

2. anhedonia

3. significant weight loss

4. insomnia/hypersomnia

5. Psychomotor agitation/retardation

6. fatigue

7. feelings of worthlessness/guilt

8. Inability to concentrate/decide

9. recurrent thoughts of death

DSM-5 Diagnostic Criteria: Persistent Depressive Disorder

aks Dysthymia or DD

• lengthier

  • depressed mood for:

    • 2+ years in adults

    • 1 year for children

• fewer symptoms

• has never had manic or hypomanic episode

Characteristics not in DSM

• anger

• hostility

• irritability

Prevalence of Depression in Children

Preschool: 1-2%

School-age children: 2.5-2.8%

Prevalence of Depression in Adolescents (12-17)

20.1% major depressive episode each year

• higher in females

Prevalence of Depression in Adults

U.S:

• 18.3%

Global

• 5%

Currently experiencing a major depressive episode

• 6.7%

More common in women

More common in ages 18-25

Assessing and Diagnosing Depression in Children/Youth (stats)

• only 50% of teens with depression are diagnosed before adulthood

• 2 in 3 youth with depression not identified by PC clinician - receive no care

• even when diagnosed, only 40% of youth receive tx

• rates of completion of referral = low in youth

Guidelines for Teen Depression in Primary Care

Recommendations:

1. patients 12+ yrs should be screened annually through self-report screening

2. PC clinicians develop tx plan w/ patients and families

3. all management should include establishment of safety plan within home environment

Neurobiological systems involved in the

development of depression

• reward system (dysfunction)

  • dopamine system

• stress system

  • LHPA system

• cognitive control/executive function system

  • prefrontal cortex

The Reward System (parts of brain)

Please Send Nice Amazing Vibes

• Prefrontal Cortex

• Septum

• Nucleus Accumbens

• Amygdala

• VTA

Cognitive Vulnerability

patterns of thinking that increase a person's risk of developing disorder

depressogenic schemas:

• “I am not good at anything”

• If I fail at work, then I am a failure as a person”

Rumination

• focusing passively/repetitively on depressive symptoms and their implications

  • “why can’t i handle things better?”

  • “i think about a recent situation wishing it had gone better”

Role of Parenting in Depression

Types of parenting behaviors can influence child vulnerability to develop negative cognition styles

• parents’ own negative cognition

• parents’ attributions about child’s behavior after negative event

  • “he’s being defiant/disrespectful”

• parent’s negative reactions to children’s negative emotions

• harsh parenting

CBT for Depression

Characteristics of CBT:

• time limited

• problem oriented, focused, strategic

• collaborative therapeutic rapport

• empirically based, psycho-education

• structured and active (agenda, homework)

• clear and consistent focus on cognitive contents/processes

  • and developing social/affect regulation skills

CBT Targets (types)

Cognitive Targets

• perceptions

• problem solving skills

• cognitive distortion

Social/Environmental Targets

• stressors

• support (family, peer, community)

• cues, reinforces

Behavioral Targets

• social skills

• communication skills

• maladaptive coping (self-harm, drugs)