PPSY 558 - Depressive Disorders

• 1. Depressive Disorders
• 2. Bipolar Disorders

• Disruptive Mood Dysregulation Disorder
• Major Depressive Disorder
• Persistent Depressive Disorder (Dysthymia)
• Premenstrual Dysphroic Disorder
• Substance/Medicaion-Induced Depressive Disorder
• Mood Disorder Due to Another Medical Condition
• Unspecified Depressive Disorder

• Bipolar I Disorder
• Bipolar II Disorder
• Cyclothymic Disorder 
• Bipolar and Related Disorder Due to Another Medical Condition
• Other Specified Bipolar and Related Disorder
• Unspecified Bipolar and Related Disorder

• Sad, Empty or Irritable Mood
• Accompanying Somatic and Cognitive changes decreasing capacity to Function

Five or more of the following symptoms have been present during the same 2 week period and represent achange from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss ofinterest or pleasure

• 1) Depressed mood most of the day nearly ever day
• 2) Marked diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
• 3) Significant weight loss or weight gain or decrease or increase in appetite nearly every day
• 4) Insomnia or hypersomnia nearly every day
• 5) Pscyhomotor agitation or retardation nearly every day
• 6) Fatigue or loss of energy nearly every day
• 7) Feelings of worthlessness or excessive or inappropriate guilt nearly every day

The first essential feature of MDD is either a depressed mood or anhedonia.

• Biological (or vegetative) signs and symptoms
• Appetite loss, unintentional weight loss or gain, sleep disturbance, change in energy, psychomotor retardation oragitation, and diminished libido.
• “Diurnal mood variation” – person feels worse in the morning and slightly better at night.

• Individuals with depression see the world through grey-tinted glasses.
• Ruminations over personal failures (real or imagined)
• Whereas the unhappiness of everyday life comes and goes, the dysphoria of MDD never leaves.

• A. The presence of a Major Depressive Episode.
• B. The Major Depressive Episode is not better accounted for by Schizoaffective Disorder and is not superimposed on Schizophrenia or any other psychotic disorder
• C. There has NEVER been a Manic, Mixed or Hypomanic Episode.

• Single Episode or Recurrent?
• Mild
• Moderate
• Severe with Psychotic Features
• In Partial Remission
• In Full Remission

• Monozygotic twins have a greater concordance rates for depressive disorders than dizygotic twins.
• Family studies also find that onset of depression is more likely in people with depressed relatives than those who do not have depressed family members.
• This genetic and familial propensity can be offset by learning and environmental influences.

• The lifetime prevalence estimate for a mood disorder is 20.8%.
• 12 month prevalence estimate for depressive disorder 9.5%
• Early age of onset tends to be before age 20
• Greater association with family history of depression and other mood disorders
• Late onset in the mid-30s and is associated with fewer recurrent episodes.
• Depression increases the risk of heart attacks and is a serious complicating factor in stroke, diabetes and cancer
• MDD is the leading cause of disability in the United States

• Learned helplessness (Seligman)
• Loss and separation
• Stress
• Cognitive distortions

• Interpersonal PT of depression
• Nonreciprocal role expectations
• Unresolved grief
• Life-role transition
• Interpersonal skill deficits