Psychology: Depressive disorders

a prolonged emotional state that represents the prevailing and dominant emotional tone

• social communication
• physiological arousal
• subjective awareness (how am I doing?)
• psychodynamic defense (ego defense)

The observable external expression of mood; more transient (short-lived) than mood

objective, observable

subjective, self-reported

transient

"caused by"

disorder, illness

characteristic cluster of signs/symptoms

Major Depressive Disorder

Major Depressive Episode

• 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

• 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

• 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

• Depressive disorder due to another medical condition
• minor/subsyndromal depressive disorder (depressive symptoms of clinical concern).
• Widespread in population

• substance abuse/addiction
• anxiety disorders (>50%)
• neurocognitive disorders
• Schizophrenia, Schizoaffective disorder
• personality disorders
• chronic medical conditions

Primary care providers

MDD

• Recurrent
• Can be well-managed (compared to asthma)

• prior episodes of depression (especially if severe)
• family history of depression
• prior suicide attempts (MDD is risk factor)

• genetic predisposition
• biochemical (neurotransmitter dysregulation)
• neuroendocrine
• inflammatory processes (cytokines)

• cognitive, behavioral, learned helplessness
• stressors (particularly in early life)

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.
• Resolves.

• exercis
• stress reductio
• engagement in positive pleasurable activities
• changing negative thinking patterns

• Based on severity and health history, including response to txs tried previously
• combination of medication & psychotherapy (EBP)
• Refractory depression: ECT, transcranial magnetic stimulation

During lag time between an increase in physical energy and mood improvement.  Pts can suddenly have ability to act on suicidal thoughts.

• SSRIs
• Atypical antidepressants
• Cyclic antidepressants (TCA)
• MAOIs

• inhibit reuptake of serotonin
• have long half-life; can take once a day
• first line of treatment
• anxiolytic action
• few anticholinergic, antihistaminic or adrenergic side effects
• few cardiovascular effects

• GI - nausea/vomitting
• CNS - HA, dizziness, tremors (usually short term)
• Sexual dysfunction
• Some restlessness, insomnia (take in morning)
• weight gain

• Danger with SSRIs
• Serotonergic hyperstimulation
• 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
• commonly used

• mostly TCAs
• side effects can be harder to handle - anticholinergic, cardiotoxic, cognitive effects
• usually used for pain management at lower dosages

• monoamine oxidase inhibitors
• usually last tried
• intense dietary restrictions - interactions with tyramine, which causes hypertensive crisis
• use very low dosages.

• older adults
• people who cannot tolerate medications
• co-morbidities

• 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

• mild to moderate depression
• equivalent results to antidepressant medications
• inconsistent evidence
• not regulated by FDA

exercise

• activity scheduling
• problem-solving
• stress management

• CBT
• focuses on testing hypotheses about thinking to change how stressors are perceived
• Thinking -> Feelings -> Behaviors

• negative, self-deprecating view of self
• Pessimistic view of the world
• Believe that the negative will continue in the future

• Social support
• optimism
• mastery
• self-esteem
• coping resources

• depressive symptoms
• anxiety
• neuroticism