Depression/Depressive Disorders - Chapter 8

Major Depressive Disorder (MDD)

• emotional

  • depressed mood

  • anhedonia (lack of interest or pleasure)

• behavioral

  • appetite change

  • sleep disturbance

  • psychomotor disturbance

    • moving slow, slow speech

  • fatigue

• cognitive

  • feeling guilt OR worthless

  • concentration difficulty

  • thoughts of death or suicide

• *need 5 or more symptoms for at least 2 weeks

• symptoms must be cause of significant distress or impair functioning

• not attributable or explained by something else

• never experienced a manic or hypomanic episode

• “normal & expected” depressive response to a negative event such as a loss should not be diagnosed as MDD unless other, more atypical symptoms are present (e.g., worthlessness, suicidal ideas, psychomotor disturbance)

• some specifiers

  • with anxious distress - prominent anxiety symptoms

  • with mixed features - presence of at least 3 manic/hypomanic symptoms but does not meet criteria for a manic episode

  • with melancholic features - inability to experience pleasure; distinct depressed mood; depression worse in morning; psychomotor retardation or agitation; significant weight loss; excessive guilt

  • with atypical features - positive mood reactions to some events, significant weight gain or increase in appetite, hypersomnia, longstanding pattern of sensitivity to interpersonal rejection

  • with psychotic features - mood-congruent or incongruent delusions or hallucinations

  • with catatonia - not actively relating to environment, mutism, posturing, agitation, mimicking another’s speech or movements

Specifier - Major Depressive Disorder with Seasonal Patterns (seasonal affective disorder)

• occurs mostly in the winter months & generally lifts during spring and summer

  • same time every year

• 2-year period

• responds to antidepressants, psychotherapy & light therapy

Specifier - Major Depressive Disorder with Peripartum Onset (formerly postpartum depression)

• why did it change?

  • 50% of postpartum episodes begin prior to delivery

• prevalence

  • 10-22% of adult women

    • 60% of women have their first depressive episode in the postpartum period

  • ~10% of fathers without a prior history of depression

• risk factors

  • low income, sleep disturbances, low social support

    • mothers → stressful pregnancy, complicated birth, previous miscarriage or stillbirth

    • fathers → increased risk when mother is depressed or relationship problems present

• prevention factors

  • home visits, peer support, therapy - mothers

  • paternal involvement - fathers

Persistent Depressive Disorder (PDD) - aka Dysthymia

• over 2 years, individual has never been without symptoms for more than 2 months at a time

• never had a manic or hypomanic episode

• not attributed to or better explained by something else

• clinically significant distress or impairment

• symptoms

  • 2 or more symptoms (including depressed mood or lack of interest & pleasure) for at least 2 years

Biological Etiology of Depressive Disorders

• neurotransmitters: serotonin & norepinephrine

• ~50% heredity - most evident after puberty

• cortisol (stress hormone) - interacts with experiences

• hippocampus - smaller in people with depression

• circadian rhythm disturbance

Psychological Etiology of Depressive Disorders

• behavioral explanations

  • limited opportunities to engage in reinforcing activities

  • a person’s behavior reduces the likelihood of positive social interactions

• cognitive

  • aaron beck → negative self-schema

    • 6 types of faulty thinking

      • arbitrary inference - drawing conclusions without sufficient evidence

      • personalization (and blame) - take others’ behaviors personally and take total responsibility for external events occurring

      • overgeneralization - holding extreme beliefs on the basis of a single incident and applying these inaccurate beliefs to other situations

        • always, never, etc.

      • magnification & exaggeration - overestimating the significance of negative events

      • polarized thinking - all or nothing, good or bad, either/or, black and white thinking

      • selective abstraction (mental filtering) - only focusing on the negative aspects of a situation

  • learned helplessness

  • negative attributional style - on causes that are internal, stable, global

Social Etiology of Depressive Disorders

• adverse childhood experiences (ACEs)

  • abuse, neglect, poverty, divorce, exposure to substance abuse, exposure to violence, family member in prison, death of a parent

• parental depression

• stressful life experiences0

• social rejection

Sociocultural Etiology of Depressive Disorders

• women more likely to be diagnosed with MDD than men, across all ages, ethnic/racial groups, and nationalities

Biological Treatments of Depressive Disorders

• tricyclics, monoamine oxidase inhibitors (MAOIs), and serotonin-norepinephrine reuptake inhibitors (SNRIs) - block the reuptake of norepinephrine and serotonin

• SSRIs

• lots of side effects - off-putting

  • cannot abruptly get off meds

  • less side effects with Wellbutrin (but can exacerbate anxiety symptoms)

• omega-3 fatty acid supplements reduce depressive symptoms + can boost effectiveness of antidepressants

• best outcome = therapy + treatment

Psychological Treatments of Depressive Disorders

• cognitive-behavioral therapy (CBT)

  • challenge dysfunctional thinking

  • evaluate thoughts, not emotions

  • very effective

• behavioral activation

  • replace behaviors that lead to depression with behaviors that are reinforcing

• acceptance & commitment therapy (ACT)

  • acceptance

  • cognitive defusion

  • contact with the present moment - mindfulness

  • values

  • committed action

  • self-as-context

• interpersonal therapy

  • depression occurs within an interpersonal context

  • focus on the present relationships

  • 12-16 weeks → role dispute, role transition, interpersonal challenges

• mindfulness-based cognitive therapy

  • techniques → present moment awareness, mediation, breathing exercises

  • group setting - 8 weeks

    • utilizes homework

    • good for preventing relapse of depressive symptoms

  • sadness → trigger for relapse of depression

  • accept sadness rather than try to change it

  • you are not your thought patterns

Premenstrual Dysphoric Disorders

• at least 5 symptoms present in the final week before menstruations begins

• symptoms start to improve within a few days of onset of menstruation and become minimal or absent in the week following

• A) one of these must be present

  • marked affective lability

  • marked irritability or anger or increases interpersonal conflicts

  • markedly depressed mood, feelings of hopelessness, self-deprecating thoughts

  • marked anxiety, tension, and/or feelings of being keyed up or on edge

• B) one or more of the following symptoms - additionally present, total of 5 when combined with A

  • decreased interest in usual activities

  • subjective difficulty in concentration

  • lethargy, easy fatigability, marked lack of energy

  • marked change in appetite; overeating or specific food cravings

  • hypersomnia or insomnia

  • a sense of being overwhelmed or out of control

  • physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of “bloating” or weight gain

• clinically distressing or impairment

• not merely an exacerbation of the symptoms of another disorder

• not attributable to something else

• criterion A should be confirmed by prospective daily ratings during at least 2 symptomatic cycles