Psychology: Depressive disorders
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Psychology: Depressive disorders
Mood disorders, cognitive restructuring, depression
a prolonged emotional state that represents the prevailing and dominant emotional tone
What are the four adaptive functions of emotions
subjective awareness (how am I doing?)
psychodynamic defense (ego defense)
The observable external expression of mood; more transient (short-lived) than mood
Characteristics of a depressive sign
Characteristics of a depressive symptom
Characteristics of a depressive emotional state
Characteristics of a depressive reaction
Characteristics of a depressive disease
Characteristics of a depressive clinical entity
characteristic cluster of signs/symptoms
What is MDD?
Major Depressive Disorder
What is MDE
Major Depressive Episode
What is dysthymia?
Persistent Depressive Disorder
"milder" but chronic form of depression with a significant impact on functioning and QOL
Risk factor for MDD
Lack of pleasure in activities
Diagnostic requirement for MDD
Two weeks or more of either depressed mood and/or anhedonia with symptoms occurring nearly every day for a 2-week consecutive time period.
Represents a change from previous functioning
Most specific symptoms are
: feelings of worthlessness, excessive or inappropriate guilt, recurrent thoughts of death or suicidal ideation
Diagnostic requirements for Persistent Depressive Disorder (Dysthymia)
Depressed mood for most of the day, for more days than not, for at least 2 years
Has at least two symptoms on the list. The most associated are low self-esteem and feelings of hopelessness
What types of depression are most likely to be seen in primary care? Why?
Depressive disorder due to another medical condition
minor/subsyndromal depressive disorder (depressive symptoms of clinical concern).
Widespread in population
Depressive disorders are commonly seen with these co-morbidities
anxiety disorders (>50%)
Schizophrenia, Schizoaffective disorder
chronic medical conditions
Who are the main providers of mental health services?
Primary care providers
What is the leading cause of disability in the US and worldwide?
What form of depression is most common?
Can be well-managed (compared to asthma)
Factors that are relatively strong risk predictors for depression
prior episodes of depression (especially if severe)
family history of depression
prior suicide attempts (MDD is risk factor)
Endogenous causes of depression
biochemical (neurotransmitter dysregulation)
inflammatory processes (cytokines)
Exogenous causes of depression
cognitive, behavioral, learned helplessness
stressors (particularly in early life)
What is the diathesis-stress pathway?
stressors -> neurophysical/neurochemical changes -> neuronal loss/dysfunction -> vulnerability to subsequent stressors
the process of grieving the death of a loved on or other types of significant loss (e.g. job).
NOT the same as MDD.
Non-pharmacological interventions for mild depression and anxiety
engagement in positive pleasurable activities
changing negative thinking patterns
Treatment for MDE
Based on severity and health history, including response to txs tried previously
combination of medication & psychotherapy (EBP)
: ECT, transcranial magnetic stimulation
What is the relaively most dangerous time during treatment for MDD?
During lag time between an increase in physical energy and mood improvement. Pts can suddenly have ability to act on suicidal thoughts.
Types/Classes of antidepressants
Cyclic antidepressants (TCA)
Benefits of SSRIs
inhibit reuptake of serotonin
have long half-life; can take once a day
first line of treatment
few anticholinergic, antihistaminic or adrenergic side effects
few cardiovascular effects
Drawbacks of SSRIs
GI - nausea/vomitting
CNS - HA, dizziness, tremors (usually short term)
Some restlessness, insomnia (take in morning)
Serotonin (Toxicity) Syndrome
Danger with SSRIs
may occur quickly
can be caused by interactions with MAOIs, tryptophan, and St. John's Wort
Tachycardia, restlessness, seizures, confusion, malaise, mania, hyperthermia, profuse diaphoresis, respiratory and CV collapse, death
used at much lower dosages for
pain, sleep management
side effects can be harder to handle - anticholinergic,
, cognitive effects
usually used for pain management at lower dosages
monoamine oxidase inhibitors
usually last tried
intense dietary restrictions - interactions with
, which causes
use very low dosages.
Electroconvulsive Therapy is best option for these types of people
people who cannot tolerate medications
transcranial magnetic stimulation
use of MRI-strength magnetic pulses to stimulate focal areas of the cerebral cortex
Vagus nerve stimulation
pacemaker implant to electrically stimulate teh vagus nerve to increase NTs
Deep brain stimulation
electrodes implanted in brain to electrically stimulate focal areas of the brain
first-line treatment for SAD
suppresses nocturnal melatonin secretion
can be as effective as medication
St. John's Wort
mild to moderate depression
equivalent results to antidepressant medications
not regulated by FDA
Best random trial evidence states that this is as effective as medication n mild to moderate depression
Behavioral techniques for depression
Define cognitive restructuring (reframing)
focuses on testing hypotheses about thinking to change how stressors are perceived
Thinking -> Feelings -> Behaviors
What is the cognitive triad of depression?
negative, self-deprecating view of self
Pessimistic view of the world
Believe that the negative will continue in the future