Unipolar Depression1 in 5 Americans experience it at some point in their lives

1 in 20 Americans are severely depressed at any time.

Women more frequently depressed than men- particularly in developed world- Why? (we don’t really know), but possibly because women ruminate -focus on feelings- whereas men distract

Info about depression: http://www.med.umich.edu/depression/ipt.htm

DSM-IV Criteria for Major Depressive Episode

Present nearly every day for 2 weeks:1. Depressed mood (sad or empty)2. Loss of interest3. Significant weight change (5% in 1 month)4. Insomnia or hypersomnia5. Psychomotor agitation or retardation6. Fatigue or loss of energy7. Worthlessness or inappropriate guilt8. Loss of concentration or indecision9. Recurrent thoughts of death or suicide

→ 5 of 9 criteria required→ Rule out: drugs or medical factors→ Rule out: bereavement in 2 months

physical mental

diagnosis: mononucleosis depression

syndrome:

-symptoms fatigue sad mood

sore throat anhedonia

-signs fever weight loss

white cell count motor retard

etiology: virus ???

Course of depression

• Depression often dissipate in 5-10 months, even without treatment. – 50% will never have it again– 40% will reoccur.– 10% stay acutely depressed.

The best predictor of future depression is past depression

Copyright © Allyn & Bacon 2009

Explanations for Major Depressive DisorderExplanations for Major Depressive Disorder

• Life events – stressful events that represent loss are closely tied to depression

• Interpersonal model – depressed people seek excessive reassurance which leads them to being disliked and rejected

• Cognitive model Depressive thinking style - Negative thoughts about self, the world and one’s future

• Atttribution Bias: ‘I failed because I am stupid’ (dispositional)

- ‘I did well because the test was easy’ (situational)

• Behavioral model - Depressive spiral: While depressed, we withdraw from pleasurable activities

• Genetics: low levels of serotonin receptors (?).

Explanations for Major Depressive DisorderExplanations for Major Depressive Disorder

• Learned helplessness – tendency to feel helpless in the face of events we can’t control

Depression: Neural changes

• Change activity in– ventral frontal, – midfrontal, – dorsolateral prefrontal– amydgala

Depressive thinking style:negative cognitive triad

Negative view of the future

Negative view of the self

Negative view of the world

(developed by Aaron Beck):

Depressive thinking style: Cognitive biases

Distorted thinking:- emotional reasoning (if I feel stupid, I must be stupid),

- Personalization (self blame: “its my fault”).

Causal attribution bias for negative events– Internal (blame self)

– Globalization (see it affecting many areas of life)

– Stable (it will last forever)

People with negative cognitive style diagnosed before the first episode are at higher risk of developing depression (Alloy et al., 1999)

•

Cognitive Behavioral theory

Goal: to reduce depressive thinking style

How?• Identify the themes in negatives thoughts and their triggers; • Challenge the negative thoughts:

– what is the evidence for it?- Are there other ways to look at it? - How can you cope?

• help patient to recognize the negative beliefs/assumptions• change aspects of the environment (bad things in depressed people lives)• teach manage the mood

Depression: Treatment

First line of attack:• Cognitive behavior therapy (CBT)

- Challenge and change patient’s faulty beliefs (e.g., depressive thinking style

- Rapport between patient and therapist is very important (therapeutic alliance)

• Pharmacotherapy: SSRI, acts upon serotonin system

CBT reduces likelihood of relapse (without CBT, if stop SSRIs, highly likely there will be relapse)

* Interpersonal therapies provide an alternative to CBT (less studied)

For resistant cases: • Repeated Transcranial Magnetic Stimulation• Electroconvulsive therapy• Deep Brain stimulation

SuicideHow damaging?3rd leading cause of death among young (age 15-34) after accidents

and homicide.

Risk factors: - coming out of depression (too hard to plan when really down) - paranoid schizophrenia

Who does it? In our culture:- women attempt more than men, but- men are more succuessful women (guns vs. pills)

Why do they do it?- To escape from self (& associated pain)- Feel none needs them (less likely for single mom of little kids to commit suicide)

- Not for attention (only 15%)

What should you do if friend talks about suicide?

Most suicide victims give cues beforehand• Take it seriously. • Don’t be afraid to ask if friend is feeling suicidal – you will

not “give them idea”• Don’t leave them alone; listen unjudgmentally• You are NOT qualified to “talk them out” of it.• Call a health professional• Don’t worry about being embarrased (better safe than sorry)

Copyright © Allyn & Bacon 2009

Bipolar DisorderBipolar Disorder

• Manic episode – experience marked by dramatically elevated mood, decreased need for sleep, increased energy, inflated self-esteem, increased talkativeness, and irresponsible behavior

• Bipolar disorder – condition marked by a history of at least one manic episode– More than half the time a major depressive episode precedes

or follows a manic episode– Very heritable (perhaps around 85%)– Increased activity in amygdala (associated with emotions),

decreased activity in prefrontal cortex (associated with planning)

– Increased risk of suicide (as with major depression)