module 11: depressive disorders

Behavioral theory – stressful life events

Stressful experiences can trigger depressive symptoms, especially in people with poor problem-solving abilities or those sensitized by prior depressive episodes.

Stress generation theory

People with depression may unintentionally create or worsen stressful interpersonal or life situations, increasing depressive cycles.

Behavioral withdrawal

Reduced positive reinforcement leads to decreased engagement in activities, which reinforces depression.

Learned helplessness theory

Repeated exposure to uncontrollable negative events leads to withdrawal, passivity, and depressive symptoms.

Hopelessness theory

Depression develops when individuals attribute negative outcomes to internal, stable, and global causes.

Pessimistic attributional style (definition)

A cognitive pattern in which events are interpreted as personal fault (internal), unchangeable (stable), and affecting everything (global).

Gender and uncontrollable events

Women’s higher rates of depression may be partly due to higher exposure to uncontrollable negative life events.

Negative cognitive triad (definition)

Beck’s model stating depression involves negative views of the self, world, and future.

Cognitive schemas (definition)

Deeply held, often childhood-origin beliefs that shape interpretation of experiences; activated under stress.

Cognitive biases in depression

Distorted thinking patterns that lead individuals to interpret events more negatively.

Rumination (definition)

Repetitive, passive dwelling on negative feelings or problems; increases depression risk.

Distraction (definition)

Redirecting attention away from negative thoughts; may protect against depressive symptoms.

Rejection sensitivity

Heightened fear or expectation of rejection that increases depressive vulnerability.

Excessive reassurance seeking

Repeatedly asking others for validation, which can strain relationships and increase stress.

MAOIs (definition)

Early antidepressants that inhibit monoamine oxidase; effective but risky due to dangerous interactions with foods/medications.

Tricyclic antidepressants (definition)

Older antidepressants with moderate efficacy (about 50% improvement) but significant side effects and toxicity.

SSRIs (definition)

Most widely used antidepressants; better tolerated, fewer side effects, onset within weeks, but may be equally or slightly less effective than TCAs.

SSNRIs (definition)

Similar to SSRIs but with more stimulating effects; used for depression and anxiety.

Medication onset time

Most antidepressants take 3–5 weeks to show significant effects.

Medication relapse rate

About 25% relapse during maintenance phase.

ECT (definition)

Electroconvulsive therapy induces controlled seizures; used for treatment-resistant depression; effective but can cause memory loss and high relapse.

Repetitive Transcranial Magnetic Stimulation Therapy (rTMS) (definition)

Repetitive transcranial magnetic stimulation; non-invasive, small effects; remission ~14% vs 5% placebo in TRD.

Deep brain stimulation (definition)

Experimental surgical implantation of electrodes; used for intractable depression; infection and surgical risk.

Light therapy (definition)

Bright-light exposure used to treat Seasonal Affective Disorder.

Behavioral activation (definition)

Scheduling rewarding and meaningful activities to increase positive reinforcement.

Cognitive therapy (definition)

Identifying and challenging distorted thoughts; often paired with behavioral activation.

Interpersonal therapy (definition)

Treats depression by addressing grief, role transitions, disputes, and interpersonal deficits.

Medication vs therapy – main conclusion

Both are equally effective, but therapy has lower relapse rates long-term.

Which theory explains that reduced positive reinforcers lead to withdrawal?

Behavioral theory

Learned helplessness is most associated with:

Exposure to uncontrollable negative events

A pessimistic attributional style involves which three attributions?

Internal, stable, global

The negative cognitive triad includes negative views of:

Self, world, future

Rumination is defined as:

Repetitive passive focus on negative feelings

Which interpersonal factor increases depression risk?

Rejection sensitivity

Which antidepressant class has dangerous food and drug interactions?

MAOIs

Which medication class is most widely used today?

SSRIs

Which treatment is used for treatment-resistant depression and can cause memory loss?

ECT

Deep brain stimulation is best described as:

Surgical implantation of electrodes

Which therapy focuses on increasing rewarding activities?

Behavioral activation

Which therapy challenges distorted thinking patterns?

Cognitive therapy

Interpersonal therapy targets:

Relationship problems

Which is TRUE about medication vs therapy?

Therapy has lower relapse rates

A client repeatedly blames herself for every mistake, believes the problem will never change, and thinks it affects everything in her life. This thinking pattern represents:

Pessimistic attributional style

A patient says, “I always think people will reject me, so I seek reassurance constantly.” This best fits:

Rejection sensitivity

A man with depression stays home because nothing feels rewarding anymore, which makes his mood worsen. This illustrates:

Behavioral withdrawal

A woman with seasonal depressive episodes responds quickly to bright light exposure. This best describes:

SAD with light therapy

Major Depressive Episode (definition)

A period of at least 2 weeks where an individual experiences 5 or more depressive symptoms, including either depressed mood or anhedonia.

Major Depressive Disorder (definition)

A disorder characterized by at least one major depressive episode, no history of mania or hypomania, and symptoms not better explained by another condition.

Persistent Depressive Disorder (definition)

A chronic depressive condition lasting 2+ years with depressed mood most days and at least two additional symptoms (appetite, sleep, energy, self-esteem, concentration, hopelessness).

Euthymia (definition)

A state of normal, stable mood without depressive or manic symptoms.

Anhedonia (definition)

Loss of interest or pleasure in previously enjoyable activities; one of the core symptoms of MDE.

Somatic symptoms in depression (definition)

Physical changes including appetite/weight changes, sleep disturbances, and psychomotor agitation or slowing.

PDD vs. MDD (compare/contrast)

MDD is more severe and episodic; PDD is less severe but lasts 2+ years. Both involve depressed mood and functional impairment.

SAD – seasonal pattern specifier (definition)

Depression that begins at a similar time each year and remits during a specific season.

PMDD (definition)

A severe form of PMS with emotional and physical symptoms the week before menses that improve with menstruation onset; requires prospective tracking.

12-month prevalence of MDD (fact)

Approximately 7% of the population, with highest rates in ages 19–29.

Gender pattern in MDD (fact)

Women experience MDD at about twice the rate of men; difference begins at puberty.

Recurrence in MDD (fact)

About 50% of individuals experience recurrent major depressive episodes.

Genetic risk for depression (fact)

First-degree relatives have 2–3× higher risk; heritability ranges from 31–42%.

Severe/early-onset depression heritability (fact)

Can be as high as 70–80%.

5-HTTLPR gene (definition)

A serotonin transporter polymorphism once believed to interact with stress to predict depression, but later studies failed to replicate the effect.

HPA axis dysregulation in depression (definition)

Overactivity of the stress-response system leading to elevated cortisol and impaired negative feedback.

Monoamine theory (definition)

The outdated theory that depression is caused by insufficient serotonin or norepinephrine.

Brain structures linked to depression (definition)

Lower PFC activation, smaller hippocampus, higher amygdala activation, and low activity in the anterior cingulate cortex.

Behavioral theory of depression (definition)

Depression is caused/maintained by reduced reinforcement in daily life, leading to withdrawal and worsening symptoms.

Cognitive theory (definition)

Depression results from distorted thinking patterns, negative schemas, and the cognitive triad (negative views of self, world, future).

Interpersonal theory of depression (definition)

Depression results from interpersonal conflict, role changes, grief, or poor communication patterns.

CBT – goal (definition)

Modify negative thinking and increase engagement in rewarding behaviors.

CBT – techniques (definition)

Cognitive restructuring, behavioral activation, thought monitoring, skill building.

IPT – goal (definition)

Improve interpersonal functioning by resolving role transitions, disputes, or grief.

IPT – techniques (definition)

Communication analysis, role-play, problem-solving, clarifying interpersonal expectations.

Antidepressants (definition)

Biological treatments that alter neurotransmitter systems; include SSRIs, SNRIs, TCAs, and MAOIs.

Treatment-resistant depression (definition)

Depression that does not improve after multiple adequate trials of therapy and medication.

ECT – controversy (definition)

Effective but criticized due to fears about memory loss, stigma, and historical misuse.

rTMS – controversy (definition)

Non-invasive, expensive, requires many sessions, and long-term effectiveness varies.

DBS – controversy (definition)

Involves surgical brain implants; highly invasive, experimental, and ethically debated.

True/False – The serotonin transporter x stress interaction is well supported

False; large replication attempts failed.

True/False – Cortisol levels are typically low in depression

False; often elevated.

What brain region shows increased activation in depression?

The amygdala, which heightens threat sensitivity.

Which treatment works fastest for some patients?

Antidepressant medication.

Which treatment has the best long-term protection against relapse?

Psychotherapy (especially CBT).

Which treatment is most invasive?

Deep Brain Stimulation (DBS)

What does “failure of feedback mechanisms” mean in HPA axis dysfunction?

The system fails to shut off cortisol production, leading to chronic stress signaling.

List the 9 MDE symptoms

Depressed mood, anhedonia, appetite/weight change, sleep issues, psychomotor change, fatigue, worthlessness/guilt, concentration issues, suicidal thoughts.

Why is the monoamine theory considered outdated?

Because research does not support consistent neurotransmitter deficiencies in depression.

Biopsychosocial understanding of depression

Depression arises from interactions among genes, neurotransmitters, hormones, cognitive patterns, stress, and social environment.

Why are invasive treatments for TRD controversial?

Risks, cost, invasiveness, uncertain long-term outcomes, and ethical issues.

Unipolar vs. bipolar disorders:

Unipolar includes MDD and PDD (no mania); bipolar includes Bipolar I, Bipolar II, and Cyclothymia (involves mania/hypomania).

MDE diagnostic requirements (question):

How many symptoms are required and for how long?

MDE requirements:

5 symptoms for at least 2 weeks, including depressed mood or anhedonia.

Case vignette – identify disorder: A woman reports feeling depressed most days for 2.5 years, low energy, low self-esteem, and poor concentration. What disorder is most likely?

Persistent Depressive Disorder

Case vignette – identify disorder: A college student has a 2-week period of anhedonia, weight loss, insomnia, guilt, and suicidal thoughts. What episode is occurring?

Major Depressive Episode