unipolar depression

definition of clinical depression

mood affective disorder characterised by persistent extreme sadness and apathy

what are the 4 main types of depression ?

single episode, recurrent, dysthymic, mixed depressive and anxiety disorder

depression in characterised by what 3 categories ?

types, severity, presence or absence of psychotic symptoms

what type of symptoms are usually recognised first ?

behavioural

elderly patients tend to exclusively display what type of symptoms ?

physical

list 4 physical symptoms

fatigue, difficulty concentrating or sleeping, changes in appetite

list 4 emotional symptoms

guilt, irritability, confusion, withdrawal

for a diagnosis of depression..

pt must experience prolonged sadness for 2+ weeks every day most of the day and have 5/10 symptoms

what are the 2 systems of classification for depression ?

ICD-11, DSM-V

how many diagnostic categories does the ICD-11 manual have ?

17,000

what is a limitation of the ICD-11 classification system ?

does not distinguish between adult and childhood diagnosis

what is the avg. onset age for depression ?

mid 20s

how many pts have recurrent episodes ?

2/3

with each episode relapse is how much more likely ?

16%

Moussavi et al. 2007

depressive illness causes greater decrement in health state than major chronic physical illness eg. asthma

Sartorius 2001

nearly 2/3 of suicides occur in people with depression

Sheng et al. 2017

depression can exacerbate physical pain

cognitive explanation for depression

maladaptive cognitions underpin maladaptive behaviours

what 3 mechanisms did Beck (1967) propose ?

cognitive bias, negative self schemas, negative triad

what is cognitive bias ?

distortion and misinterpretation of info

what are the 5 cognitive biases ?

magnification, minimisation, arbitrary inference, selective abstraction, overgeneralisation, personalisation

arbitrary inference

negative conclusion based on insufficient evidence

negative self-schemas

set of beliefs about oneself that are negative and pessimistic

what is the goal of CBT ?

cognitive change - notice unhelpful thoughts and replace with helpful ones

what is self-instruction training ?

interrupt negative thoughts and replace with pre-prepared realistic ones

CBT comprises of…

cognitive re-structuring and behavioural activation

pros of CBT

as effective as anti-depressants, low relapse rates

cons of CBT

research suggests changing thoughts doesn’t mediate behaviour, correlation doesnt equal cause

psychodynamic explanation of depression

depression caused by imagined or symbolic loss during early childhood, leading to exaggerated feelings of guilt and self-blame

how long is a course of psychoanalytic therapy in comparison to CBT ?

1-2x a week for several months vs 1x a week for 12 weeks

Driessen et al. 2013

psychoanalytic talking therapy has similar success to CBT

behavioural explanation for depression - Lewinson et al. 1979

depression due to low rates of positive reinforcement, learnt condition (SLT)

behavioural treatment

progressive increase pleasant activities and positive interactions with social environment - ABCDE model, linked to CBT

what is the heritability range for MDD according to Sullivan, Neale + Kendler’s 2000 twin studies meta analysis ?

31 to 42%

if one twin has MDD how likely is the other to have it ?

2x

what are the 3 biological explanations for depression ?

genetic factors, changes in brain functioning, monoamine hypothesis

what are the 4 primary brain structures associated with depression ?

amygdala, hippocampus, prefrontal and anterior cortexes

role of amygdala

registers emotional significance of stimuli

role of hippocampus

memory, learning and emotion

role of pre-frontal and anterior cortexes

focus and executive planning

what is seen with the brain functioning of depressed patients ?

amygdala activity increased and hippocampus and cortex activation decreased

what is the monoamine hypothesis ?

suggests underlying basis of depression is depletion in levels of serotonin, norepinepherine and/or dopamine in CNS

limitations of SSRI treatment

delayed effect, limited efficacy in mild depression, and not all patients have serotonin deficits