Depressive Disorders

Psyc 3034

core symptoms of depressive disorders

pervasive unhappy mood (dysphoria)

loss of interest in activities (anhedonia)

interference- functional impairment

childhood vs. adolescence symptoms

preschoolers- tearful, clingy, sad, irritable

• responses to depressive symptoms → don’t know yet how to process strong internal emotions

school age- social withdrawal, aggression and irritability, tantrums (a bit more sophisticated than preschoolers)

adolescence- decreased irritability, increased self blame and social inhibition, decreased self esteem

commonality across all (+ adults)- substantial changes in sleep cycles and food intake

major depressive disorder

minimum duration: 2 weeks

5+ symptoms including depressed mood or anhedonia (at least 1)

persistent depressive disorder

minimum duration: 1 year

• more days than not during this period

less severe depressed mood

2+ symptoms

disruptive mood disregulation disorder

chronic, severe irritability

temper outbursts

1+ years

premenstrual dysphoric disorder

5+ depressive symptoms in the week before a menstrual period → reduction of symptoms once period starts

irritability in depressed children/adolescents

58% display just depressed mood

36% display both depressed + irritable mood

6% display just irritable mood

depressive disorder symptoms

depressed or irritable mood

loss of pleasure in activities

weight loss/weight gain

insomnia/hypersomnia

psychomotor agitation or retardation (sluggishness)

fatigue/loss of energy

feelings of worthlessness or excessive guilt

trouble concentrating, indecisiveness

suicidal ideation, thoughts, plans, action

prevalence of depressive disorders

2-8% of children + adolescents experience MDD (episodic in nature)

• lifetime prevalence: 20% → most don’t experience first episode in childhood

about 1:5 youth will experience MDD by 18

1% of children and 5% of adolescents display PDD

about 70% of children w PDD will have a MDE → double depression

peak onset period for depression

adolescence- 15.4% at age 18

sex differences

not unitl puberty

post-puberty: 2-3x more likely in females

suicidality

suicide is the 2nd highest cause of death in adolescents 12-17

• 1st: unintentional injuries (accidents)

up to 1/3 of youth who think about suicide attempt it

attmpt rates higher among girls and black youth

higher lethality for boys

peak period for first attempt: 13-14 (beginning of adolescence)

• access to means, more detailed plans, etc.

PGQ-9

assesses degrees of depression severity

questionare: 0-3 rating

course of depressive disorders

gradual or sudden onset

MDD- usually between 13 and 15

PDD- usually between 11 and 12 (usually prolonged, 2-5 years on average)

average depressive episode lasts 8 months in youth

about 1/3 develop bipolar within 5 years after onset

preschool onset depression

predictor of later MDD
alterations in stress reactivity and brain function

cognitive biases and distortions

patterns of thinking that lead to negative emotions

• selective attention bias

• depressive ruminative style

• pessimistic outlook

• stable, global, and internal view of difficulties

comorbidities

90% have 1+ comorbid disorders

50% have 2+

most common: GAD, specific phobia, separation anxiety

genetic causes

30-45% heritability (moderate)

• diathesis-stress model - underlying vulnerabilities

gene-environment interaction

neurobiological causes

overactive amygdala, underactive ventral striatum (emotion regulation)

cortical thinning in right hemisphere

HPA axis dysregulation- hippocampus and hypothalamus

neurotransmitters- serotonin, dopamine, norepinephrine

CBT for depression

• B: increasing pleasurable activities, skills training for reinforcement

  • behavioral activation- doing enjoyable things, pushing patients to do things to improve mood

• C: identify and challenge negative thoughts (cognitive restructuring)

• not as great for younger children

  • thought record

  • identifying thinking traps

Interpersonal Psychotherapy for Adolescent Depression (IPT-A)

depression occurs in interpersonal context → effects relationships which effects mood

look at important relationships and identify negative outcomes

1. education- identify relationships, psychoed, treatment contract

2. affect identification- labeling emotions, what is being negatively impacted

3. interpersonal skills building- modeling/role play, problem solving skills, specific problem relationships

pharmacological treatments

SSRIs- prozac, zoloft, lexapro

• side effects: suicidal thoughts, nausea, vomiting, headaches, insomnia, sexual borpplems, etc. → black box warning

• about 60% of children/adolescents get treated with SSRIs

Tricyclic antidepressants- less effective, if nothing else works, in absence of effective SSRIs