Depression Flashcards
What is Depression?
vague term for a variety of states
used everday as down mood
set of symptoms coming from unique circumstances (often involve seperation or loss)
often co-morbid
Rates of Depression
globallly over 300 million (4.4%) (WHO, 2017)
19% of adults experience a depressive episode in their lifetime (Kessler et al, 2010)
lifetime prevelenance 10-20% (Patten, 2003)
lifetime risk - women (10-15%) men (5-12%) (DSM-IV)
25% < 1 month, 50% < 3 months so can remit naturally (Amenson and Lewinsohn, 1981)
85% recover with no treatment. 40% will have at leas one other episode (Monroe, 2010)
Kindling (Kendler et al, 2000, Monroe and Harkness, 2005)
Problems with Research
studied as specific/ consistent syndrome but more than 20 symptoms (Olbert et al, 2014)
1030 unique symptom profiles in 3701 patients (Fried and Nesse, 2015)
common rating scales (Beck or Hamilton) include symptoms not in DSM (irritability, hypochondria)
gauging prevelance difficult
- rates differ across cultures
- different studies use different diagnostic tools
- sample (did they use MH records?)
- retrospective study? recall issues, under reporting
Major Depressive Disorder (DSM V)
A. 5+ in 2 weeks
1. depressed mood most/ everyday
2. diminished interest/ pleasure in activities
3. weight loss or gain
4. insomnia or hypersomnia
5. psychomotor agitation or retardation
6. fatigue or loss of energy
7. feelings of worthlessness or innappropriate guilt
8. diminished ability to think/ concentrate
9. reccurrent thoughts of death or suicide
B. symptoms cause sig distress or impairment
C. not direct effect of substance or general medical condition
D. not explained by any schizophrenic spectrum disorder or other psychotic disorder
E. no manic or hypomanic episodes
Controversy around Diagnosis
is having 5 symptoms worse than 3?
3 symptoms can have similiar levels of distress (Gotlib, Lewinsohn and Seeley, 1995)
anxiety and depression often co-morbid. 70% with depressive disorder have anviety symptoms. 40-70% meet criteria for at least on type of anxiety disorder (Spinhoven et al, 2011)
The Bereavement Exclusion
DSM IV - can’t diagnosis depression within 2 months of bereavement
omitted in DSM V
- implied last 2 months, more commonly 1-2 years (depends on culture/ other factors)
- severe stressor that can precipitate major depression in some (e.g. past depression)
- increses suffering, suicidal ideation, risk of complex bereavement but responds to same treatement (meds and verbal) as non bereavement depression
- most likely in those with previous history of major depression (kindling)
Onset and Duration
later than other conditions, early/mid 20s (Kessler and Bromet, 2013)
onset <21 linked to greater chronicity, poorer prognosis, higher family incidence (Klien et al, 1999)
80% experience second episode (Boland and Keler, 2002)
- 400 patients over 10 years
- 40% recurred in 2 years, 60% 5 years, 75% 10 years and 87% 15 years
- probaboloty of recurrence increased with number of prior episodes and co-morbidity
average duration of first episode 6-9 months when untreated (Eaton et al, 1997) but range from weeks to years
Sex Differences
women 2-3 times more likey to be depressed than men irrespectve of culture/economic status (Nolen-Hoeksema, 2002)
women in disadvantaged roles, young children and no social support especially vulnerable (Brown, 1989)
women have lower status jobs and more home/work spillover (Bird and Reicker, 1999)
lower onset age correlates with number of episodes in both genders with predicts worse course in only females (Essau, 2010)
depressive symptoms relate to reflective ruminations in women (analyse past event and behaviour). males who reminate experience depressive consequences as much as females (Just and Alloy, 1997, Shors et al, 2017)
Cultural Differences
USA (10.2%) Puerto Rico (4.3%) Korea (2.9%) (Weissman et al, 1996, Kessler and Bromet, 2013/14)
Nigeria (0.8) China Shanghai (1.7) China Bejing (2.5) USA (9.6) Ukraine (9.1) France (8.5) (WHO, 2004)
lifetime prevelance higher in high income (14.6%) compared to low/middle income countries (11.1%) (Kessler and Bromet, 2014)
reasons for differences
- stigmatised in non western societies so unwilling to report symptoms (Compton et al, 1991)
- higher levels of somatization in non western countries (Simon et al, 1999)
- lifetime prevelance always affected by recall issues expecially due to age (Patten, 2003)
Depression in Older People
affects 1 in 5 older people (MHF, 2011)
retirement, death of friends/loved ones, increased isolation, pain/medical problems
not normal/necessary part of aging
- poor appetitie or weight loss
- insomnia/ hypersomnia
- psychomotor agitation/retardation
- loss of pleasure in normal activities
- thoughts of suicide and preoccupation with death
- feelings of hopelessness/worthlessness
hypochondriasis (Starcevic, 2014)
pseudodementia (Kennedy, 2015)
depression increases perception of poor health and use of health care services (WHO, 2018)
Childhood Depression
notoriously difficult to identify
clingy, school refusal, exaggerated fears, somatic complaints
prevelance
- 2-5% of younger children (Cohen et al, 1993)
- adolescents: 4-8% (Birmaher et al, 1996) 24% (Lewinsohn et al, 1993) 15-20% and if major likely to reoccur (Avenevoll et all, 2008)
- highly comorbid. anxiety/ substance disorders in adolescents
- affects academic performance, impairs social functioning, greater conflict with parents and increased risk of suicide attempt (Lewinsohn et al, 1999)
- younger children - abuse/neglect, parental marriage partner changes, maternal anxiety (Najman, 2005)
- adolescents - stress, poor coping skills, social support, health, existing psychological problems (Lewinsohn et al, 1999)
Psychodynamic View
reaction to real or symbolic loss of and ambivalently loved object (Freud, 1917, Abraham, 1916)
introjection - regress to oral stage - integrate identity of person with their own identity.
anger turns inwards (Freud, 1917)
Behavioural View
focus on operant conditioning processes (Lewinsohn, 1979)
low rate of positive social reinforcement leads to low mood
reductions in behaviour intended to gain social rewards (i.e. social contact)
may result in short term increases in social contact (sympathy/attention)
establishes a further reinforcement schedule - secondary gain = individual is rewards for depressice behaviour but followed by reduction in attention and mood
sig more likely to elicit negative reactions in others (Joiner, 1999, 2002)
Humanist View
anything which blocks striving for self actualisation has the potential to cause depression
parents imposing conditions of worth on children
leading to denial of the true self and projection of the false self
Biological View
Genetics
- family, twin and molecular gene studies suggest some inherit a predisposition to unipolar depression (Elder and Mosack, 2011)
- MZ twins 76%, MZ dif homes 67%, DZ 19%, 20% of realtives of depressed ind depressed themself (Kamali and McInnis, 2011)
- causal? more likely influential and several genes involved
Neurotransmitters
- imbalances in serotonin, norepinephrine, dopamine
Neuroplasticity
- constant regenerate new neural pathways in certian areas (memory/emotions) but LT stress can decrease cell growth in these areas
Endocrinology
- hypothalamus releases stress hormones
- circadian/seasonal rhythms
