Notes on Depressive Disorders from Abnormal Psychology

Historical references: Depression has long been recognized, termed ‘melancholia’ in ancient Greece, indicating a state marked by fear and sadness.
Emil Kraepelin’s contribution (1896): Identified 'manic depressive insanity' as a classification for both bipolar and depressive disorders, which faced criticism for merging diverse mood disorders.
Development of modern definitions: Karl Leonhard (1957) differentiated between depressive disorders and bipolar disorders.
Current classification (DSM-5): Major depressive disorder (MDD) defined by a minimum two-week depressive episode with specific criteria and symptoms.

Major Depressive Disorder (MDD) requirements:
- Depressed mood or loss of interest/pleasure (anhedonia) for two weeks.
- At least four additional symptoms:
- Significant weight changes
- Sleep disturbances (insomnia/hypersomnia)
- Fatigue or loss of energy
- Psychomotor changes (agitation or retardation)
- Diminished concentration
- Feelings of worthlessness or excessive guilt
- Suicidal thoughts or behavior.
Impact on functioning: Symptoms must cause distress or impairment in social, occupational, or other important areas.

Prevalence:
- In Australia: 3.1% men, 5.1% women diagnosed with MDD annually. Dysthymia prevalence is 1% for men and 1.5% for women.
- Depression incidence: 1 in 10 Australians affected by someone with a mood disorder.
Gender differences: Women are approximately twice as likely to experience depression than men due to various social, biological, and psychological factors.

Biopsychosocial model: Depression results from an interplay of biological, psychological, social, and environmental factors.
Biological factors: Genetics play a significant role in vulnerability, particularly in recurrent forms of depression. Neurotransmitter imbalances (serotonin, norepinephrine, dopamine) are implicated.
Psychological factors:
- Cognitive theories: Propose depression stems from negative thought patterns and learned helplessness.
- Behavioral theories: Focus on the lack of reinforcers and poor coping skills that may lead to depressive behaviours.
Social factors: Interpersonal issues, family communication styles, and life stressors can contribute to depressive episodes.

Psychotherapeutic Approaches:
- Cognitive Behavioral Therapy (CBT): Focuses on altering negative thought patterns and increasing engagement in pleasant activities.
- Effective in reducing symptoms of depression, promoting better coping strategies, and preventing suicide.
- Interpersonal Psychotherapy (IPT): Addresses interpersonal relationships and their impact on depression, helping individuals improve social skills and resolve conflicts.
Pharmacological Treatments:
- Antidepressants: SSRI, TCA, and MAOI medications increase neurotransmitter availability and receptor sensitivity in the brain.
- ECT: Applied for severe cases, effective but involves risks like memory loss.
Innovative treatments: rTMS, vagus nerve stimulation, and light therapy are under investigation for their effectiveness.

Strategies include:
- Continuing psychological treatments and antidepressants post-remission.
- Utilizing relapse prevention training that focuses on recognizing early signs and developing coping strategies for triggers.
Mindfulness-based cognitive therapy (MBCT): Promising for preventing relapse due to its focus on relationship with thoughts rather than changing thoughts themselves.

Anhedonia: Loss of pleasure in previously enjoyable activities.
Psychotic features: Hallucinations or delusions accompanying depression.
Dysthymia: Chronic mild depression lasting over two years.
Expressed emotion (EE): High criticism and over-involvement in the family dynamic related to depressive relapse.

Major depressive disorder is a significant mental health issue characterized by emotional distress and various physical symptoms affecting life functioning. It is treatable through multiple approaches, yet prevention of recurrence remains a critical concern for long-term management of the disorder.