Depression

Question 1

Depression as a word

Answer 1

Feeling sad or miserable, relatively common at all ages, often temporary, not necessarily part of a disorder

Question 2

Depression as a psychological disorder

Answer 2

Two varieties in DSM 5:
Major Depressive Disorder
Persistent Depressive Disorder aka dysthymia

Question 3

Major Depressive Disorder

Answer 3

Period of at least two weeks of depressed mood and significant impairment in functioning

Question 4

Persistent Depressive Disorder

Answer 4

Low-grade depression which lasts for at least a year in children and 2 in adults

Question 5

Major Depressive Disorder DSM Criteria (come back to recap)

Answer 5

5 or more of the following symptoms have been present during the same 2-week period and represent a change from previous functioning, at least one of the symptoms is either
- *Depressed mood most of the day, nearly every day, as indicated by subjective report or observation by others (in kids/adolescents, irritable)
- *Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
Other symptoms:
- Significant wait loss when dieting or wait gain (change of more than 5% of body weight in a month) (or in kids failure to make expected weight gain) or decrease/increase in appetite nearly every day
- Insomnia or hypersomnia nearly every day
- Psychomotor agitation or retardation (slow speech, shows up on neuropsych testing) nearly every day (observable by others, not merely subjective feelings)
- Fatigue or loss of energy nearly every day
- Feelings of worthlessness or excessive or inappropriate guilt
- Diminished ability to think or concentrate, indecisiveness
- Recurrent thoughts of death, passive suicidal ideation or active

Distress or impairment
Not attributable to substance
Not explained by another disorder
Never manic or hypomanic episode

Question 6

Major depressive disorder combinations

Answer 6

Over 1400 ways symptoms can be expressed

Question 7

Persistent Depressive Disorder (Dysthymia) Criteria A

Answer 7

Depressed mood most of the day, more days than not, for at least two years (in kids and adolescents, one year)

Question 8

Persistent Depressive Disorder (Dysthymia) Criteria B

Answer 8

Presence while depressed of two or more of the following:
- Poor appetite or overeating
- Insomnia or hypersomnia
- Low energy or fatigue
- Low self-esteem
- Poor concentration or difficulty making decisions
- Feelings of hopelessness

Question 9

Persistent Depressive Disorder (Dysthymia) Criteria C

Answer 9

During 2 year period, individual has never been without symptoms in Criteria A and B for more than 2 months at a time

Question 10

Persistent Depressive Disorder (Dysthymia) Criteria Rule Ours

Answer 10

No manic or hypomanic
Not better explained by psychotic disorder
Not bc of substance
Cause impairment

Question 11

Double Depression

Answer 11

When a major depressive episode occurs in an already dysthymic individual, occurs in 75% of people with PDD

Question 12

Depression in childhood

Answer 12

5% of kids 10-20% of adolescents experience major depression
For a long time believed children didn’t have cognitive or emotional level sufficient for depression
But they do experience depression, childhood depression is similar to adult depression

Question 13

What depression looks like in preschool

Answer 13

• Somber, tearful, lack of exuberance
• Excessively clingy
• Irritable or bored for no apparent reason
• Sleep disruption
• Changes in appetite

Question 14

What happens after very early depression

Answer 14

Children 3-5 w MDD are more likely to show recurrent symptoms of depression later in life
Depression as a chronic experience, not a phase

Question 15

Childhood depression prevalence

Answer 15

Relatively uncommon in early childhood
More common in middle childhood
Spikes dramatically during transition to adolescence
Average age 14
High rate persists through early adulthood then tapers

Question 16

Gender disparity in depression

Answer 16

In childhood, comparable
Profound difference- more for girls- during early adolescence and persists
By midpoint of puberty, females twice as likely to experience depression, this disparity persists into adulthood
Females also more likely to experience reccurrent episodes

Question 17

Why are females more prone to depression?

Answer 17

• Hormones aren’t sufficient to explain this
• Stressful experiences- trauma (higher population level bc SA and DV) and chronic strain (expectations placed on you, inequities in life, sexual objectification, etc erode quality of life and change how women think about themselves and their place in society)- ties in with the HPA access
• Cognitive style- patterns of thinking that predispose people to depression, women’s marked more by rumination- a risk factor for depression

Question 18

Rumination

Answer 18

Way of responding to situations by repetitively focusing on distress, its causes, and consequences

Question 19

Rumination and depression

Answer 19

Indicator of future depression
Rumination exacerbates and worsens depression
In lab, inducing rumination increases negative affect, even in short term

Question 20

Rumination and gender

Answer 20

Women more likely to ruminate

Question 21

Why does the gender difference emerge in early adolescence?

Answer 21

Affective- time of heightened emotional reactivity
Biological- pubertal transition, developmental stage (neuroendocrine changes + hormonal changes) activates genetic vulnerabilities (ie predispositions to depression)
Cognitive- cognitive style such as rumination that exacerbates A and B

Question 22

Co-rumination

Answer 22

Extensively and repetitively discussing and revisiting problems and negative emotions with friends, especially prevalent among adolescent girls

Question 23

Support Trap

Answer 23

Co-rumination associated with feeling close and connected to friends, it is emotionally fulfilling, but doesn’t outweigh the cost of ruminating
Adolescents with high baseline co-rumination show increased onset of depression during adolescence and shorter time to depressive onset
Girls more likely to co-ruminate than boys, explaining gender differences

Question 24

Depression contagion

Answer 24

Girls with friends who have high levels of depressive symptoms are more likely to become depressed, party bc of co-rumination

Question 25

Co-Rumination-Rumination Trap

Answer 25

Co-ruminating with friends can lead to ruminating in isolation Hard to disengage with rumination

Question 26

Depression in nonbinary youth

Answer 26

Depends on stigma and discrimination Youth supported in gender identity show comparable rates of depression and don't show spikes at puberty Stigma and lack of support for gender identity increase risk for depression and suicidality

Question 27

Monoamines

Answer 27

Dopamine, serotonin, norepinephrine

Question 28

Monoamine hypothesis of depression

Answer 28

People w depression have depleted monoamines in brain's symptoms Studies over 70 years show these involved in symptoms of depression Antidepressant meds work on monoamines Genes associated with depression code for secretion or metabolism of monoamines Prevailing biological model of depression

Question 29

Monoamine holes

Answer 29

Monoamines change with first dose of antidepressant but takes 4-6 weeks to take effect Meds don't work for some people

Question 30

Other biological mechanism

Answer 30

HPA axis Glutamate- another neurotransmitter Brain structures like hippocampus and amygdala

Question 31

Glutamate

Answer 31

- Excitatory neurotransmitter- increases likelihood a neuron will fire, has an indirect role in monoamines - Helps transmit nerve impulses quickly and efficiently - Involved in formation and retrieval of memories

Question 32

Ketamine

Answer 32

- New treatment for depression, works on glutamate - Works quickly- hours or days

Question 33

Is depression chronic? (come back to this and before)

Answer 33

For some people, chronic and recurrent 50% youth with MDD will have another depressive within 5 years and 75% in next several decades Stress plays a role in recurrent MDD

Question 34

Stress Sensitization Model

Answer 34

Stress and depression are connected First episodes of MD are more likely to come after significant life stressors Later episodes are more likely to come after minor stressors As stress and episodes of depression accumulate over time, it takes smaller levels of stress to tip someone into a depressive episode

Question 35

HFAD

Answer 35

High functioning after depression

Question 36

HFAD details

Answer 36

10-20% people w MDD show this One episode They thrive not just compared to other people who have had single episodes of depression but also compared to people who have never been depressed Report more life satisfaction, greater self-acceptance, better relationships, autonomy, self-direction, confidence, productivity Subsets of people experience MDD and go on to show thriving

Question 37

Cognitive style

Answer 37

A particular way of thinking

Question 38

Hopelessness Theory

Answer 38

People with depression make attributions that are internal, stable, and global to explain why negative events happen Internal- believe they are responsible for it Stable- the reason they are to blame will not change with time Global- this reason applies to most things in most situations For positive situations- attribute it to External- something outside self Unstable- unlikely to happen again Specific- seen as unique to the event

Question 39

Result of hopelessness theory

Answer 39

Negative attributional style results in individuals taking personal blame for negative events that would have been difficult for them to control, which produces helplessness Helplessness contributes to hopelessness, which promotes further depression

Question 40

Beck's Theory of Depression

Answer 40

People with depression or at risk for it make negative interpretations of life events bc they have information processing biases

Question 41

Cognitive Model

Answer 41

Situation- in response to any situation, our minds make steady stream of - Automatic Thoughts- these produce an - Emotional Response - we notice emotional responses but not nec thoughts Fundamentally different than how many people think about experiences and emotions, Beck says we don't have emotional responses to situations, we have emotional responses to our interpretation of situations Automatic thoughts produce emotional responses

Question 42

Example of cognitive model

Answer 42

Situation: lower test grade than anticipated Automatic thoughts: lots of options Emotional response: diff based off of these

Question 43

Beck's Cognitive Triad

Answer 43

People w depression or at risk for it hold negative automatic thoughts about self, world, future

Question 44

Negative automatic thoughts in children

Answer 44

Grow as children do, more prominent in older children and adolescents than preschoolers, similar in content to adult negative cognitions - perceived incompetence, low self-worth, inaccurate inferences or explanations for events

Question 45

Beck thinks negative thoughts are important

Answer 45

Because they are responsible for producing symptoms of depression, they are malleable so can help w treatment

Question 46

Connection bw thoughts, feelings, behavior

Answer 46

Way we think is directly connected to emotions we have and way we act; all linked, mutually influence each other, if we modify one we can change the others

Question 47

Cognitive Behavioral Therapy

Answer 47

Most consistently supported treatment for depression Short-term, 12-20 sessions Very focused on learning to identify negative automatic thoughts and modifying them, will in turn modify emotional experiences, and adding behaviors that bring feelings of pleasure and accomplishment

Question 48

Common CBT misconception

Answer 48

CBT doesn't mean a more positive thought, but a more balanced or nondistorted one, identifying cognitive distortions

Question 49

Meds for youth

Answer 49

No significant efficacy at younger ages Black box warning- risk of a suicidal event doubles relative to placebo- 4% teens taking SSRIs reported suicidal thoughts and behaviors, 2% w placebo

Question 50

Treatment for Adolescents with Depression Study

Answer 50

RCT w Prozac and CBT Coincided w concerns about increasing suicidal thoughts CBT/Prozac/Combo- started same, all successful, more gradual decline w CBT, after week 18 CBT and fluox not significantly different, all same at end Fluox more rapid improvement CBT Teens taking only fluox were more likely to have a suicidal event than CBT Meds + therapy is best, not bc it worked better, but more rapid improvement buffered by decrease in suicidal events

Question 51

Treatment for Adolescents with Depression Study 2

Answer 51

Most 12-20 sessions, usually 25-50% relapse, so did 36 It did More improvement in 36 weeks than 12, lower relapse rate, combined treatment still better for rate of improvement and minimizing suicide risk

Question 52

If brain changes in responses to experiences we have and therapy and medication are experiences, we can expect

Answer 52

Neural changes in response to treatment

Question 53

Neuroimaging + treatment

Answer 53

Pre/post fMRIs show reduced limbic system activation w/meds Not w CBT, this shows changes in frontal lobe activation Both neural changes but different mechanisms of action, similar end results but achieve symptom reduction differently

Question 54

Scalable interventions

Answer 54

Tested pragmatic, brief, single-session interventions for adolescent depression, online, 30 minutes long Include core elements of empirically supported treatments focused on growth mindset and behavioral activation ? Compared to supportive intervention, growth mindset and behavioral activation interventions show declines in depressive symptoms and hopelessness @ 3mo follow up Growth mindset showed increases in perceived agency, decreased generalized anxiety and COVID-related trauma symptoms, higher discontinuation rate Effect sizes statistically significant but small relative to traditional interventions

Question 55

Scalable intervention advantages

Answer 55

Free/cheap Brief Widely accessible Doesn't require a practitioner or physical clinic Can be done at any time Minimize drop out observed in longer term treatment ?