Chapter 7 | Depressive Disorders

Symptoms associated with major Depressive Disorder

• Emotional — Feeling sad and dejected, experiencing anxiety. anger, or agitation

• Lack of motivation

• Less active and less productive

• Holding negative views on oneself

• Pessimism

• Headaches, indigestion, constipation, dizzy spells, and general pain

• Some eat less, sleep less, and feel more fatigued

• Some eat and sleep excessively

• Societal ideation

Depression

A low, sad state in which life seems dark and challenging

Depressive disorders

The group of disorders marked by unipolar depression

Unipolar Depression

A depressive disorder in which the individual faces depression only

Persistent Depressive Disorder

A chronic form of unipolar depression marked by ongoing and repeated symptoms of either major or mild depression

Prolonged Grief Disorder

After the death of some close, a person experiences intense preoccupation or yearning for the deceased person

Dysthymic Episode

A sad or down mood

• Poor or excessive appetite

• Disrupted sleep patterns

• Lack of energy

• Low self-esteem

• Problems with concentration and decision making

• Feelings of hopelessness

Less severe compared to Depressive disorder

Psychological theories of depression

1. Psychodynamic Model

2. Behavioral Model

3. Cognitive Model

4. Learned Helplessness Model

5. Hopelessness Model

Psychodynamic Model of Depression

• Symbolic loss: When a person equates other kinds of events with the loss of a loved one

• Object relations theorists — When early relationships leave people feeling unsafe, insecure, and dependent on others

Behavioral Model of Depression

• Changes in rewards and punishments people receive

  • Includes social rewards

Cognitive Theories

• Beck’s Theory

• Helplessness Theory

• Hopelessness Theory

• Rumination Theory

Beck’s Theory

• Maladaptive attitudes: Dysfunctional, negative, or irrational thought patterns and beliefs

• Cognitive Triad: Negative interpretations of experiences, self, and future

• Errors in thinking: Drawing negative conclusions based on little evidence

• Automatic thoughts: A steady train of unpleasant thoughts

• Schemas: Cognitive structures that form in childhood and organize the individual’s world

Helplessness Theory

The perception that one has no control over the reinforcements in one’s life

Hopelessness Theory

Hopelessness + Stressful life event → depression

Rumination Theory

The passive, repetitive, and obsessive focusing on negative emotions, their causes, and consequences

Attributions to a Depressive Diathesis

• Internal: Attributing negative events to personal factors

• Stable: Believing negative outcomes will persist over time

• Global: Generalizing negative outcomes to other areas of life

Biological treatments for Depressive Diathesis

• Antidepressants

  • Tricyclic antidepressants

  • MAO inhibitors

  • Second-generation antidepressants, SSRIs, SNRIs

• Psychotherapy

• Electroconvulsive Therapy

• Phototherapy

• Transcranial Magnetic Stimulation

• Vagus Nerve Stimulation

• Deep Brain Stimulation

MAO inhibitors

An antidepressant drug that prevents the action of the enzyme monoamine oxidase

• Increases activity level of serotonin and norepinephrine

SSRIs

A group of second-generation antidepressant drugs that increase serotonin activity

• Does not affect norepinephrine or other neurotransmitters

TMS

Procedure in which a strong pulse magnetic field is created by an electromagnetic held close to the skill

Vagus Nerve Stimulation

Treatment for depression where an implanted pulse generator sends regular electrical signals to a person’s vagus nerve

ECT

Treatment where a brain seizure is triggered when an electric current passes through electrodes attached to the patient’s forehead

Phototherapy

Uses a specialized 10,000-lux light box to treat Seasonal Affective Disorder (SAD) and other forms of depression by mimicking natural sunlight

Deep Brain Stimulation

An invasive medical procedure where a pacemaker powers electrodes in the subgenual cingulate

Deep Brain vs Vagus Nerve

• DBS — Invasive (in the brain)

• Vagus Nerve — Non-invasive

Brain Circuit for Unipolar Depression

• Prefrontal cortex

• Hippocampus

• Amygdala

• Subgenual Cingulate