Understanding Mental Disorders: Unipolar Mood Disorder

Understanding Mental Disorders: Unipolar Mood Disorder

Introduction to Major Depressive Disorder (MDD)

  • MDD is a significant global health concern.
  • WHO ranked MDD as the third highest cause of disease burden worldwide in 2008.
  • Projections indicate it will be the highest cause of disease burden under mental disorders by 2030.
  • Diagnostic Criteria:
    • Persistently low or depressed mood.
    • Anhedonia (decreased interest in pleasurable activities).
    • Feelings of guilt or worthlessness.
    • Lack of energy.
    • Poor concentration.
    • Appetite changes.
    • Psychomotor retardation or agitation.
    • Sleep disturbances.
    • Suicidal thoughts.
  • DSM-5 Criteria for Diagnosis:
    • At least five of the above symptoms must be present.
    • One of the symptoms must be depressed mood or anhedonia.
    • Symptoms cause social or occupational impairment.
    • History of manic or hypomanic episode must be ruled out.
    • In children and adolescents, irritable mood may be present.

DSM-5 Major Depressive Disorder

  • Recurrent condition characterized by:
    • Episodes of sad mood.
    • Loss of interest in pleasurable activities.
    • Feelings of worthlessness, pessimism, suicidal thoughts, helplessness, low energy, lack of motivation, and feelings of hopelessness.
  • Duration:
    • Lasts for at least two weeks.
    • Interferes with daily activities.
  • Changes in Appetite and Sleep:
    • Some individuals eat less, while others eat more (binge eating).
    • Some sleep more, while others sleep less.
    • Early morning awakening (e.g., waking at 3 or 4 a.m. and being unable to go back to sleep) is another symptom.
  • Psychomotor Changes:
    • Psychomotor retardation: slowing down of movements and speech.
    • Some individuals experience psychomotor agitation: inability to sit still, fidgeting aimlessly.
  • Cognitive and Thought Patterns:
    • Thoughts filled with themes of worthlessness, guilt, hopelessness, and suicide.
    • Trouble concentrating and making decisions.
  • Severe Cases:
    • Loss of touch with reality.
    • Delusions (beliefs with no basis in reality).
    • Hallucinations (seeing, hearing, or feeling things that are not real).
    • Delusions and hallucinations are usually negative (e.g., believing they have committed a terrible sin or hearing voices accusing them).

DSM-5 Criteria for Major Depressive Disorder (Table 5.1)

  • A. Five or more out of nine symptoms (including symptoms 1 & 2) in the same 2-week period:
    1. Depressed mood or anhedonia (subjective or observed); can be irritable mood in adolescents & children
    2. Loss of interest or pleasure in most daily activities
    3. Change in weight or appetite
    4. Insomnia or hypersomnia
    5. Psychomotor agitation or retardation (observed)
    6. Loss of energy or fatigue
    7. Inappropriate guilt or sense of worthlessness
    8. Impaired concentration or indecisiveness
    9. Thoughts of death, suicidal ideation or suicidal attempt
  • B. Symptoms cause significant distress or impairment
  • C. Episode is not attributable to substance or medical condition
  • D. Episode not better explained by a psychotic disorder
  • E. Patient has not had a previous manic or hypomanic episode

Clinical Picture of Major Depressive Disorder

  • Characterized by at least two weeks of pervasive sad mood.
  • Common Symptoms:
    • Persistent feelings of sadness, hopelessness, or emptiness.
    • Loss of interest or pleasure in previously enjoyable activities.
    • Significant changes in appetite, weight, or sleep patterns.
    • Fatigue or loss of energy, even with minimal activity.
    • Difficulty concentrating, remembering, or making decisions.
    • Feelings of worthlessness, guilt, or self-blame.
    • Recurrent thoughts of death or suicide.
    • Irritability, restlessness, or agitation.
    • Physical symptoms such as headaches, stomach aches, or back pain that do not respond to treatment.
    • Withdrawal from social activities or relationships.
    • Inability to enjoy life, experience pleasure, or feel joy.

Prevalence, Age Onset, Duration, and Co-Morbidity

  • Age Onset:
    • Major depression risk is minimal until early adolescence.
    • Average age of first manifestation is 30 years based on a sample of 43,000 US individuals.
    • 10% experience their first episode at 55 or older.
  • Suicide:
    • Suicide rates are rising in correlation with depression frequency.
  • Prevalence in Age Groups (Kessler et al., 2003):
    • 25% of adults between 18 and 29 had previously suffered major depression.
  • Prevalence in Age Groups (Rohde et al., 2013):
    • 5% of kids aged 5 to 12.
    • 19% of adolescents (13 to 17).
    • 24% of emerging adults (18 to 23).
    • 16% of young adults (24 to 30).
  • Duration:
    • Depressive episodes can span from 2 weeks to many years.
    • Average initial episode lasts between 2 and 9 months if untreated.
    • Even in extreme cases, the likelihood of remission within a year is close to 90% (Kessler & Wang, 2009).
    • 38% of patients with severe instances lasting five years or more are anticipated to recover (Mueller et al., 1996).

Specifiers of Major Depressive Disorder

  • Specifiers provide more information about the course of the condition and appropriate treatments.
  • 1. Major Depressive Episode with Melancholic Features:
    • Loss of interest or pleasure in nearly all activities.
    • Lack of response to typically enjoyable stimuli.
    • Linked to a history of childhood trauma (Harkness & Monroe, 2002; Kendler, 1997).
    • Associated with greater cognitive impairment (Withall et al., 2010).
  • 2. Severe Major Depressive Episode with Psychotic Features:
    • Psychotic symptoms: loss of reality, delusions (false beliefs), or hallucinations (false sensory perceptions).
    • Hallucinations or delusions are mood congruent (negative tone, themes of inadequacy, blame, merited retribution, death, or illness).
    • Associated with longer episodes, more cognitive impairment, and worse long-term prognosis (Bora et al., 2010; Flores & Schatzberg, 2006).
    • Cognitive function measurement: Mini Mental State Examination (MMSE) and the Dementia Rating Scale (DRS-2).
    • The prevalence of MDD with psychotic features increases with age.
    • Patients are more likely to have treatment-resistant depression.
  • 3. Major Depressive Episode with Atypical Features:
    • Mood reactivity: improvement in disposition in response to happy developments.
    • Exhibits two or more of the following: weight gain, hypersomnia, leaden paralysis, acute sensitivity to interpersonal rejection.
    • More common in women, earlier onset, and prone to suicidal thoughts (Matza et al., 2003).
  • 4. Major Depressive Episode with Catatonic Features:
    • Psychomotor symptoms: mutism, stiffness, motoric immobility (catalepsy—a stuporous condition).
  • 5. Major Depressive Episode with a Seasonal Pattern (Seasonal Affective Disorder):
    • Recurrent depressive episodes exhibit a seasonal pattern.
    • Meets DSM-5 requirements: at least two bouts of depression in the previous two years at the same time of year (often fall or winter), and full remission during the same season (most commonly spring).
    • Majority of depressive episodes throughout their lifetime must be of the seasonal form.
    • Winter SAD may be more prevalent in younger people and those who live in northern climes at higher latitudes.
    • In India, more than 10 million people experience symptoms of SAD.

Other Forms of Depression

  • Recent stress is a common cause; symptoms are often transient.
  • Mood disorder diagnosis is made when severe symptoms persist.
  • Postpartum Depression:
    • Can have negative consequences on a child’s outcomes.
    • Symptoms: changeable mood, weeping readily, melancholy, and irritation mixed with positive emotions (Miller, 2002; Reck et al., 2009).
    • Prevalence of postpartum blues: 50-70% of women, appearing within 10 days of childbirth and typically resolving on their own (Miller, 2002; Nolen-Hoeksema & Hilt, 2009).
    • Postpartum depression (PPD) affects 10-30% of women worldwide.
    • In India, postpartum depression affects roughly 22% of mothers (Lanjewar S. et al., 2021).
  • Dysthymic Disorder (Persistent Depressive Disorder):
    • New category in DSM-5.
    • Chronic condition, typically mild to moderate in severity.
    • Diagnostic Criteria: consistently low mood for the majority of the day, on more days than not, for at least two years (1 year for children and adolescents).
    • May have occasional periods of normal mood, but they endure only a few days to a few weeks (maximum of 2 months).
    • Sporadic periods of normal mood differentiate dysthymic illness from major depressive disorder.

DSM-5 Criteria of Persistent Depressive Disorder (Table 5.2)

  • Prevalence, Onset and Duration of Persistent Depressive Disorder
    • Lifetime frequency estimated to be between 2.5 and 6 percent.
    • Dysthymia typically lasts 4 to 5 years, however, it can last up to 20 years or more.
    • Around 50% of patients who seek therapy have onsets before age 21, and dysthymia frequently starts during the adolescent years.
    • Onset before the age of 21 associates with greater chronicity, relatively poor prognosis (response to treatment), and stronger likelihood that the disorder runs in the family of the affected individual.
    • Studies have shown a typical duration of roughly 5 years for adults and 4 years for children, persistent depressive disorder may continue for 20 to 30 years or more
    • The age-standardised prevalence of MDD and dysthymia was 2.5% and 1.4%, respectively.
  • Double Depression:
    • Co-occurrence of persistent depressive disorder and MDD.
    • Major depressive episode occurs in 22% of patients with dysthymia.
    • Double depression refers to individuals with both major depressive episodes and persistent depression with milder symptoms.
    • Categorized as a kind of persistent depressive disorder in DSM-5.
  • Premenstrual Dysphoric Disorder:
    • New disorder in the depressive disorders category in DSM-5.
    • Severe and disabling form of Premenstrual Syndrome (PMS).
    • Characterized by emotional and physical symptoms in the late phase of the menstrual cycle (week or two before menstruation).
    • Emotional symptoms: sadness, hopelessness, irritability, anger, anxiety, mood swings, tearfulness, difficulty concentrating.
    • Physical symptoms: bloating, breast tenderness, headaches, and joint pain.

Diagnostic Criteria for Premenstrual Dysphoric Disorder (Table 5.3)

  • A. In the majority of menstrual cycles, at least 5 symptoms must be present in the final week before menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week after menses.
  • B. One (or more) of the following symptoms must be present:
    1. Marked affective lability (e.g., mood swing, feeling suddenly sad or tearful, increased sensitivity to rejection)
    2. Marked irritability/anger or increased interpersonal conflicts
    3. Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts
    4. Marked anxiety, tension, and/or feelings of being keyed up or on edge
  • C. One (or more) of the following symptoms must additionally be present, to reach a total of 5 symptoms when combined with symptoms from Criterion B above:
    1. Decreased Interest in usual activities (e.g., work, school, friends, hobbies)
    2. Subjective difficulty concentrating
    3. Lethargy, easy fatigability, or marked lack of energy
    4. Marked change in appetite, overeating, or specific food cravings
    5. Hypersomnia or insomnia
    6. A sense of being overwhelmed or out of control
    7. Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of bloating, or weight gain

Disruptive Mood Dysregulation Disorder

  • Introduced in DSM-5.
  • Diagnosed in children and adolescents.
  • Key Features:
    • Severe and chronic irritability.
    • Frequent temper outbursts (verbal or physical aggression) disproportionate to the situation.
    • Persistent negative mood most of the day, nearly every day.

DSM-5 Criteria of Disruptive Mood Dysregulation Disorder (Table 5.4)

  • Severe recurrent temper outbursts, including verbal or behavioral expressions of temper that the out of proportion in intensity duration to the provocation.
  • Temper outbursts are inconsistent with developmental level.
  • The temper outbursts tend to occur at least three times per week.
  • Negative mood between temper outbursts most days.
  • These symptoms have been present for atleast 12 months and do not clear for more than 3 months at a time.
  • Temper outbursts and negative mood are present in atleast two setting (at home, at school, or with peers) and are severe in at least one setting.
  • Age 6 or older (or equivalent developmental level).
  • Onset before age 10.
  • There has never been a distinct period lasting more than 1 day during which elevated mood and at least three other manic symptoms were present.
  • The behaviors do not occur exclusively during the course of major depressive disorder and are hot better at counted for by another mental disorder.
  • This diagnosis cannot coexist with oppositional defiant disorder, at- tention-deficit/hyperactivity disorder, intermittent explosive, disorder, or bipolar disorder.

Loss and Grieving Process

  • DSM-IV-TR recommended against diagnosing MDD during the first two months after a loss.
  • DSM-5 removed this bereavement exclusion.
  • Studies of bereaved individuals show that roughly 50% demonstrate resilience.
  • Stages of Grief (Bowlby, 1980):
    1. Numbness and disbelief.
    2. Yearning and searching for the deceased.
    3. Disorganisation and despair.
    4. Some reorganisation.

Dynamics or Causal Factors of Unipolar Depression

  • Blend of biological, psychological, and social causes.
  • These factors might modify brain function, including neural circuits.
  • Major depression is characterized by a pervasive sense of melancholy or loss of interest, behavioral and physical symptoms, changes in sleep, hunger, energy level, attention, everyday behavior, or self-esteem, suicidal thoughts.
Biological Causal Factors
  • Genetic Factors:
    • Family studies: blood relatives have a two to three times greater frequency of mood disorders.
    • Twin studies: genetic factors account for between 31 and 42 percent of the range in risk.
    • Monozygotic co-twins are almost twice as likely to develop the condition as dizygotic co-twins (Sullivan, Neale, & Kendler, 2000).
    • Estimates are greater (70-80%) for more severe, recent-onset, or recurring depressions.
  • Specific Genes:
    • Attempts to pinpoint individual genes have not yet proven effective.
    • The serotonin-transporter gene is a candidate.
  • Neurochemical Factors:
    • Depression could be brought on by alterations in the precise balance of neurotransmitter molecules that regulate and modulate the activity of the nerve cells in the brain.
    • Alterations in neurotransmitter levels or activity at the synapse may change due to pharmaceutical interventions, including electroconvulsive therapy and antidepressants
  • Abnormalities of Hormonal Regulatory and Immune Systems:
    • Hypothalamic-Pituitary-Adrenal (HPA) axis: cortisol, secreted by the outermost region of the adrenal glands and is controlled by a complicated feedback loop.
    • HPA axis is known to be more active during the human stress response.
    • Norepinephrine activity in the hypothalamus brought on by a sense of stress or threat, Corticotropin-Releasing Hormone (CRH) is released, which in turn causes the production of Adrenocorticotropic Hormone (ACTH) from the pituitary.
    • Cortisol is then normally produced by the adrenal cortex of the adrenal glands after the ACTH has passed through the circulation.
    • Consistent increases hurt the body, contributing to obesity, heart disease, and hypertension.
    • 20-40% of outpatients with depression and 60-80% of hospitalized patients with severe depression have high blood plasma cortisol levels (Thase et al., 2002).
  • Hypothalamic-pituitary-thyroid axis:
    • Another endocrine system that may be important in the treatment of depression.
    • 20-30% of people with depression who have normal thyroid levels yet exhibit dysregulation of this axis have low thyroid levels (hypothyroidism).
  • Immune system dysregulation:
    • Higher production of pro-inflammatory cytokines indicates that depression is linked to inflammation response system activation (Dowlati et al., 2010).
    • These two things both have a direct impact on the onset of depressive symptoms.
Neurophysiological and Neuroanatomical Factors
  • Anterior Prefrontal Cortex:
    • Depression is frequently caused by damage to the left anterior prefrontal cortex, but not the right.
    • Those with depression have comparatively low left hemispheric activity during EEG and relatively high right hemispheric activity.
    • Similar findings using PET neuroimaging.
    • Reduced positive affect symptoms and approach behaviours to rewarding stimuli are thought to be related to relatively lower left-side prefrontal cortex activity in depression, whereas increased right-side prefrontal cortex activity is thought to be related to increased anxiety symptoms and increased negative affect associated with increased vigilance for threatening information.
  • Orbital Prefrontal Cortex:
    • Individuals with recurrent depression exhibit lower volume in comparison to healthy controls in a number of prefrontal cortex areas, including the orbital prefrontal cortex, which is implicated in responsivity to reward.
  • Dorsolateral Prefrontal Cortex:
    • Working memory, attention, and problem-solving are just a few of the cognitive and executive activities that the DLPFC is engaged in.
    • Individuals with depression have been shown to have lower levels of dorsolateral prefrontal cortex activity (Disner et al., 2011; see also Chang et al., 2011), which is linked to decreased cognitive control.
    • Following antidepressant therapy, this activity appears to return to normal (Fales et al., 2009).
  • Hippocampus:
    • Important for memory and learning as well as regulating adrenocorticotropic hormone.
    • Protracted depression frequently results in a reduction in hippocampus volume.
    • Hippocampal volume decreases occur prior to the beginning of depression.
  • Anterior Cingulate Cortex:
    • The modulation of pain, the allocation of attention, and the response of the autonomic nervous system are just a few of the many functions carried out by this area of the brain.
    • In individuals with depression, it exhibits both reduced volume and unusually low levels of activity.
    • ACC has a role in selective attention, which is crucial for prioritising the most crucial pieces of information, and as a result, in self-regulation and adaptability—all critical functions that are impaired in depression.
  • Amygdala:
    • Individuals with depression tend to exhibit higher activation of this region, which may be explained by their biased attention to negative emotional input.
    • It is engaged in the sense of threat and in directing attention (Davidson et al., 2009; Disner et al., 2011; Phillips et al., 2003).
  • Sleep and Other Biological Rhythms:
    • The majority of mood disorders are characterised by sleep problems.
    • There is a noticeably shorter interval after falling asleep before Rapid Eye Movement (REM) sleep starts in people who are sad.
    • According to studies using EEG recordings, many patients with depression show larger levels of REM sleep during the early cycles, have more frequent and intense rapid eye movements, and enter the first phase of REM sleep after just 60 minutes or less of sleep—15 to 20 minutes earlier than non - depressed patients.
    • One or more sleep problems, such as difficulty falling asleep, numerous overnight awakenings (poor sleep maintenance), or early morning awakenings, are typically present in people who are depressed.
  • Insomnia in Older Adults:
    • The prevalence of insomnia in older persons increases the probability of depression’s development and maintenance.
    • Researchers discovered that treating insomnia directly in people who also have depression may improve the results of depression therapy.
  • Circadian Rhythms:
    • The body of a human employs an array of circadian cycles (24- or daily cycles) to adapt to its surroundings (e.g., sleep–wake cycle, locomotor activity cycle).
    • Research has found some irregularities in each of these cycles in depressed individuals, including notable changes in mood, sleep, eating, and social interactions.
    • Circadian rhythms, the human stress response, and disorders like depression are all connected.
  • Sunlight and Seasons:
    • The majority of persons affected by seasonal affective disorder appear to be responsive to the total amount of light in the surroundings, which indicates another sort of rhythm aberration or disruption.
    • The majority of SAD sufferers (but not all) feel depression in the fall and winter before things return to normal in the spring and summer.
    • The therapeutic use of regulated exposure to light is backed by a significant body of research on people with seasonal affective disorder.
Psychological Factors
  • Psychological causative elements are significant in the majority of unipolar mood disorders.
  • Stressors may have an impact on biochemical and hormonal balances, as well as biological cycles, among other things (Hammen, 2005; Monroe, 2008).
  • Numerous studies have demonstrated that extremely stressful life experiences frequently function as triggers for unipolar depression
    Stressors may have an impact on biochemical and hormonal balances, as well as biological cycles, among other things (Hammen, 2005; Monroe, 2008).
  • Growing interest in the influences of contexts and individual traits on the occurrence of stressors as well as the possibility of gradual and interactive relationships between stress and depression over time, including the influence of early stress exposure and lifelong stress exposure on subsequent reactivity to stress (Harkness et al., 2010).
  • Young female adults are more likely than males to experience stressful life experiences that result in a greater stress-depression link.
  • The majority of episodic stressful life situations entailed triggering depressive worries, losing a loved one, substantial dangers to crucial close connections or one’s job, severe economic challenges, and serious health issues (Monroe et al., 2009).
  • Stress and Onset of Depression:
    • Persons with depression have a very gloomy view of themselves and the world.
  • Vulnerabilities for Unipolar Depression:
    • Personality and Cognitive Diathesis: According to research, neuroticism is the main personality trait that increases one’s susceptibility to depression.
      More stressful life situations, which usually result in depression, are predicted by neuroticism, according to several studies.
      A poorer prognosis for full recovery from depression is linked to neuroticism.
    • Negative Patterns of Thinking: The cognitive diathesis that has been examined for 0depression often focuses on certain negative thought patterns that increase the likelihood of depression in persons who are predisposed to it when they are exposed to one or more stressful life events.
      A variety of early-life traumas, including as family conflict, parental psychopathology, physical or sexual abuse, and other instances of invasive, harsh, or forceful parenting, can increase a child’s sensitivity to depression both in the short and long term.
Social Factors
  • Lack of Social Support and Social-Skills Deficits:
    • Women without a strong, confiding connection were more likely than those with at least one close confidant to have depression if they faced a very stressful incident (Brown and Harris’ (1978).
    • Those who lack social support, are lonely, or are socially isolated are more likely to develop depression.
    • Depressed individuals have social skill deficiencies and appear to speak more slowly and dryly, making less eye contact.
  • Marriage and Family Life:
    • There is a considerable association between marital discontent and depression for both women and men, a large percentage of couples suffering marital hardship have at least one spouse who is clinically depressed.
    • A partner with depression whose symptoms have subsided has a terrible outlook if their marriage is in trouble.

Theories of Depression

Psychological Theories of Depression
  • Psychodynamic Theory
  • Behavioral Theory
  • Hopelessness & Helplessness Theory
  • Beck’s Cognitive Theory
  • The Ruminates Response Styles Theory of Depression
Psychodynamic Theory
  • Freud noticed the significant overlap between the symptoms of clinical depression and those experienced by those who are grieving the death of a loved one in his seminal work “Mourning and Melancholia” (1917).
  • Depression may also happen as a result of perceived or symbolic losses.
Behavioral Theory
  • Individuals experience depression when either their actions no longer result in positive reinforcement or when the frequency of negative reinforcement rises.
  • Persons with depression do actually experience more unpleasant experiences and receive less positive and constructive and social reinforcement from their relatives and friends.
  • They are less active, and their emotions appear to change in response to both positive and negative reinforcement patterns.
Beck’s Cognitive Theory - One of the Most Influential Theories of Depression
  • The emotional or mood symptoms of depression frequently precede and contribute to the cognitive symptoms rather than the other way around.
  • There are the inflexible, severe, and counterproductive depressogenic schemas, which are the underlying dysfunctional beliefs.
  • According to Beck, the incidence of some kind of stress is necessary for these dysfunctional beliefs to become active.
  • When present stressors or an unfortunate mood trigger dysfunctional beliefs, they can lead to a pattern of unfavourable automatic thinking thoughts that frequently take place just below the awareness’s surface and feature unpleasant, pessimistic judgments.
  • The three themes Beck refers to as the negative cognitive triad, which include:
    • Negative self-perceptions (I’m worth less),
    • Negative perceptions of the outside world (No one loves me), and
    • Negative perceptions of the future (It’s hopeless because things will always be this way).
  • Negative cognitive biases:
    • Dichotomous or all-or-none reasoning calls for a propensity towards extreme thinking.
    • Selective abstraction is the propensity to concentrate on one unfavourable aspect of a situation while dismissing other aspects of it.
    • Arbitrary inference entails reaching a judgement based on scant or no evidence.
The Helplessness and Hopelessness Theories of Depression
  • Martin Seligman made the initial suggestion that learned helplessness may serve as a helpful animal model of depression in 1974 and 1975.
  • He went on to suggest that learned helplessness could be the root cause of some forms of human sadness after establishing that learned helplessness also happens in people
The Reformulated Helplessness Theory
  • A significant revision of the helplessness theory that takes into account the intricacies of human behaviour in the face of uncontrolled occurrences
    Individuals create attributions that are essential to developing depression when they are subjected to uncontrolled unfavourable occurrences.
  • Internal/external, global/specific, and stable/ unstable are the three crucial aspects on which attributions are made, according to these researchers.
The Hopelessness Theory
  • According to Abramson and colleagues (1989), depression cannot be caused by having a pessimistic attributional style along with one or more traumatic life experiences without first feeling hopeless.
  • A hopeless ex- pectancy was described as the belief that one had no control over what would happen and the absolute confidence that either a highly wanted good outcome would not materialise or that an important terrible event would.
The Ruminative Response Styles Theory of Depression
  • Nolen-Hoeksema’s Ruminative Response Styles Theory of Depression fo- cuses on the many reactions people have to feelings and signs of sorrow and suffering, as well as how these reactions determine how depressed people feel over time.
  • There are constant individual variations in the propensity to ruminate, and those who ruminate a lot are more likely to experience prolonged depression symptoms.

Depression and Anxiety

  • A person with MDD has a number of symptoms that are more severe than those in lesser kinds of depression, in addition to mood signs of sorrow.
  • There isn’t a lot of worry at the diagnostic level (e.g., Merikangas et al., 2003; Mineka et al., 1998; Watson, 2005).
  • The problems related to depression and anxiety co-occurring, which have attracted a lot of attention lately, are quite complicated.
Co-morbidity of Mood Disorders and Anxiety
  • More than 50% of individuals with panic disorder, defined by intense anxiety attacks that come on suddenly, or generalised anxiety disorder, characterised by persistent worry, have at least one episode of depression throughout their lifetimes, according to several studies.
  • There is overlap between measurements of depression and anxiety.

Summary

  • Major Depressive disorder is also known as major depression or major depressive episode and the person as never experienced mania, hypomania or mixed episodes.
  • Formerly known as Dysthymic disorder or dysthymia and now known as Persistent Depressive Disorder characterized by persistent depressed mood most of the day, for more days than not, for at least 2 years (1 year for children and adolescents).
  • Numerous studies have demonstrated that extremely stressful life experiences frequently function as triggers for unipolar depression.
  • Several researches have looked at how pessimistic attributional styles combine with unfavourable life circumstances to predict the onset of depression using prospective designs, neuroticism is the main personality trait that increases one’s susceptibility to depression.
  • Individuals experience depression when either their actions no longer result in positive reinforcement or when the frequency of negative reinforcement rises.