Major Depressive Disorders and Treatments

Flashcards covering key vocabulary related to Major Depressive Disorders, their symptoms, diagnoses, and treatments.

Major Depression Disorder (MDD)

Aka unipolar depression. Characterized by an increase in depressed mood for the majority of a 2-week period. Experience at least 3-4 symptoms.

Persistent Depressive Disorder (PDD)

A chronic form of depression that lasts for at least two years, combining elements of major depressive disorder and dysthymia. Depressed mood for majority of 2 years + 2 sx of MDD.

Bipolar Disorder (BPD)

Mental condition marked by alternating periods of high energy (mania) and low energy (depression); occurs in about 1% of the population.

Difficulty concentrating

MDD

Suicidal Ideation

1. Active → they have a plan

2. Passive → not actually going to do the actions they talk about

Both associated with MDD

Why add PDD?

1. The chronicity is more important than the number of sx.

2. The old system resulted in “double depression"

3. 15-20% of those initially diagnosed with MDD turn into PDD

Elevated, euphoric, or irritable mood

Sx of mania

Extraordinary increase in activity level

sx. of mania

Rapid speech and/or unusual talkativeness

sx. of mania

decreased need for sleep

sx. of mania

inflated self-esteem

Can be tied to a belief they posses super powers. Sx. of mania

Distractibility

An inability to focus or pay attention, often resulting in difficulty completing tasks. Sx. of mania.

Involvement in impulsive activities

Engaging in activities with high potential for painful consequences, such as spending sprees or risky sexual behavior. Sx. of mania.

sad affect

A persistent feeling of sadness or emotional distress (MDD). Need either this or anhedonia to be dx with MDD.

anhedonia

A diminished interest or pleasure in most activities that were once enjoyable (MDD). Need to have either this or sad affect to be dx with MDD.

weight and appetite changes

Significant fluctuations in weight or appetite, such as overeating or loss of interest in food. (MDD)

sleep distrurbances

Changes in sleep patterns, including insomnia or hypersomnia, that occur in individuals with Major Depressive Disorder (MDD).

psychomotor changes

1. retardation = slowed down

2. agitation

Can be seen in motor skills and speech.

loss of energy or fatigue

Their getting up and go has gotten up and left

feelings of worthlessness and guilt

MDD

Genetic Factors MDD

2-3x greater rate in relatives of someone with MDD. Tied to 5-HTT gene (serotonin transporter)

5-HTT Gene

Codes for a serotonin transporter and is linked to MDD.

Genetic factors BPD

Believed to be a polygenic disorder with a greater genetic impact than MDD (unipolar)

3 NT tied to depression

1. Norepinephrine (NE)

2. Serotonin

3. Dopamine

Norepinephrine (NE)

• catecholamine

  catecholamine theory

• MDD = too low NE

• BPD = too much NE

Serotonin

• Indoleamine

Indolamine theory

• mania & depression = low serotonin

Permissive Hypothesis

• depletion of serotonin promotes a fall in NE

• aka serotonin indirectly affects NE

Dopamine

• reward system

• decreased Dop = lack of pleasure, motivation and energy

• also tied to substance use and schizophrenia

Functional Imaing: Amygdala

involved in

• perception of threat

• directing attention

• expression of negative emotions/memories

Depression connection

• increased activity in those with depression and their relatives who also have depression

Functional Imaging: Hippocampus

involved in

• learning

• memory

• controling your reaction to stress

depression connection

• prolonged depression = decreased in V

Cortisol Dysregulation: cortisol awakening response (CAR)

• larger CAR (spike in morning) = increased risk of MDD

• long term high levels of cortisol can damage the hippocampus

• tie to the HPA axis (hypothalamus → pituitary → adrenal)

Beck’s Theory (cognitive)

Depression may result for a tendency to interpret everyday events in a negative way. Tie to negative cognitive triad (self, world, future). It is currently being established that the negative thoughts come before the depression.

Ex.

• selective perception

• magnification

• personalization

Original Learned Helplessness (cognitive)

Depression is a result of feeling helpless and lacking control.

• used the dog experiment of shocking parts of the floor, found they could make the dog give up avoiding the shock

Problem: negative experiences could also build resilience

Attributional Reformulation Learned Helplessness (cognitive)

Negative attributions (explanation of events) are linked to depression and the durability of someone’s mood.

1. Internal/external

2. Stable/unstable

3. Global/specific

I.S.G. are tied to depression

Hopelessness depression theory (learned helplessness (cognitive))

Hopelessness Depression (a subset of general depression) is tied to an expectation of hopelessness.

• built upon the stable/global attributions and expanded by also considering social support, self-esteem, etc.

Interpersonal Theory

Relationship between stress and depression.

4 problem areas

1. interpersonal loss

2. interpersonal role dispute

3. role transition

4. interpersonal deficits

Psychological Treatment for MDD

1. Beck’s cognitive therapy

   • most popular

   • cognitive restructuring (identify, challenge, replace)

2. interpersonal therapy

   • addresses the 4 areas

   • build up skills

3. behavioral activation theory (BA)

   • focus on doing things that bring you joy

Antidepressants

3 categories

1. MAO inhibitors (monoamine oxidase)

   • nardil, marplan

   • earlies one

   • slow down production of MAO enzyme to increase NE and serotonin

   • lots of side effects

2. Tricyclics

   • tofranil, elavil

   • correct sensitivity to NE and serotonin

   • more side effects

3. SSRIs

   • prozac, zoloft,paxil

   • most prescribed

   • fewer side effects (sexual, insomnia, agitation, GI)

   • increase serotonin in the synaptic cleft

New antidepressants

1. wellbutrin

   • less sexual side effects

   • more activation

2. effexor (SNRI)

   • serotonin and NE reuptake inhibitor

   • best for chronic

3. Ketamine

   • short term treatment

Effectiveness

• 50-70% improve

Electroconvulsive theory

A short turn treatment where seizures are induced. It has been found to be very effective byt there isn’t a known explanation. (MDD)

Transcranial magnetic stimulation (TMS)

Activity is increased in the dorsolateral prefrontal cortex it’s effective for treatment resistant depression.

Medication for BPD

2 types

1. Lithium

   • don’t know why just that it helps 2/3 of people

2. Valproate aka Depakote

   • as effect as Li for treating mania but not depression

   • liver damage

   • less effective at preventing suicide

Issue with medication compliance

• problem that ~50% don’t take it as prescribed

• therefore, need to combine medication with other types of therapy

MDD Gender Diff

• no diff in children

• 13-15 more women

• women have more frequent depressive episodes

Artifact Theory

• Gender diff in MDD

• a false observation or result

• men could be underdiagnosed

• women are more likely to admit feelings of sadness

Hormone theory

• women experience frequent hormone changes

• aren’t the sole cause of high levels of depression

Life stress theory

• gender diff in MDD

• women experience more stress than men

  • poverty

  • poor housing

  • discrimination

  • increased duties at home

• marriage and employment

  • married women in traditional marriages have higher rates of MDD

  • married men in traditional marriages have lower rates of MDD

Lack of control theory

• gender diff for MDD

• women may feel less control over their lives

  • more likely to be victimized

  • attributions

Cognitive Vulnerability-Stress Model

• adolescents likely to become depressed when pessimistic + stress

• girls tend to be more pessimistic (ISG attributions) & ruminate & experience more negative life events

• syngergistic effect: the combo of the three factors in greater than the cause of an individual factor