Major depressive disorder

Amber Gerdman, Jared Costillo,

Brianna Hoskins, Melissa Grady,

and Paula

Criteria from the DSM-IV TR1.) Presence of two or more Major Depressive Episodes

which are:Depressed mood most of the day, nearly every dayMarkedly diminished interest or pleasure in all, or

almost all, activities most of the daySignificant weight loss when not dieting or weight gain Insomnia or hypersomnia nearly every dayPsychomotor agitation or retardation nearly ever dayFatigue or loss of energy nearly every dayFeeling or worthlessness or excessive or inappropriate

guilt nearly every dayDiminished ability to think or concentrate, or

indecisiveness, early every dayRecurrent thoughts of death, suicidal ideation without a

specific plan, or suicide attempt.

DSM-IV-TR (cont)2.) There has never been a Manic Episode, a

Mixed Episode, or a Hypomanic Episode.

Discuss the interaction of biological, cognitive, and sociocultural factors in abnormal behaviors

FactorsThere are cognitive, biological, and sociocultural

factors to abnormal behavior, recently, is looked at from an integrationist perspective. This means that psychologists focus on how a combination of these factors can be involved in abnormal behavior, unlike in the past when many times a single factor would be the focus.

Biological factors look at the role of genetics and heredity in abnormal behavior, cognitive looks at the role of thought patterns and schema and such, and sociocultural factors look at the role of enviornment and culture.

Analyze etiologies of one disorder from two of the following groups: anxiety disorders, affective disorders, and eating

disorders

Etiologies of MDDBiological causes- It has been shown that

genetics may play a role in the MDD, however the main biological involvement with MDD has to do with neurotransmitters. Many times part of the cause of MDD has to do with chemical imbalances.

When certain neurotransmitters are inhibited it can result in feelings of depression. The neurotransmitters known to be associated with MDD are serotonin, norepineprhrine, and dopamine.

MDD Etiology Cont.Cognitive factor can involve a persons

schema and “outlook”. People who tend to continually have sad

thoughts or have a negative outlook are at higher risk for depression because there is a higher chance those thoughts will continue (think of the brain’s neuroplasticity and how use or disuse of neurotransmitters can cause a more or less prevalent connection).

Describe symptoms and prevalence of one disorder from two of the following groups: anxiety disorders, affective disorders, and

eating disorders

MDD-Can be diagnosed when someone experiences 2 weeks of

either a depressed mood or loss of interest and pleasure. -Also requires a person to have at least 4 of these

symptoms: insomnia, appetite disturbances, loss of energy, feelings of wothlessness, thoughts of suicide, or difficulty concentrating.

-Prevalence Rates: -2 to 3 more times common in women than in men. -Levav (1997) found prevalence rate to be above average

in Jewish males and no difference between male and female prevalance rates among the Jewish population.

-Major Depressive Disorder is a recurrent disorder with 80% having subsequent episodes.

-Average # of episodes is 4. Lasting about 3 to 4 months.

EtiologySymptoms are caused by a trigger in an

adverse social/environmental change.Biological origin=primary cause of depression.Also triggered by negative events . Ex: )

Divorce, death, fired from job, or serious accident.

*Depression is NOT caused by a single factor, but a combination of factors such as, genetic vulnerability, neureotransmitter malfunctioning, psychological problems, life events or lifestyle factors, like alcohol or drugs.

Cont.Sociocultural factors of MDD can either be

something that causes the disorder over time (such as a person who has been abused or in a stressful situation for many years).

However it can also be triggered by a single traumatic and extremely saddening event during a person’s life, such as the death of a loved. It is also important to remember that the cause can be any combination of these three causes.

Etiology and Therapeutic ApproachEtiology of a person suffering from MDD and

the approach to that person’s treatment are inextricably linked for obvious reasons. In order for a person to be treated the cause (etiology) of their symptoms must be known.

The cause of MDD may not be the same for each patient, therefore any combination of medical treatment and individual therapy and so on may be needed depending on the what the type of cause is.

Discuss the use of eclectic approaches to treatment

Eclectic approachResearch evaluating treatment has demonstrated there

is a postitive effect if people take action to cope or change a behavior.

Taking drugs, participating in group sessions in a support group, and taking part in a number of therapy sessions may all positively contribute to increase mental health.

Eclectic therapy recognizes the strengths and limitations of various therapies.

Rush et al (1977) suggests a higher relapse rates because patients in cognitive therapy learn skills to cope with depressions that the patients with drugs do not.

Evaluate the use of biomedical, individual, and group approaches to the treatment of one disorder

Biomedical approachIs based on the assumption that if the problem is based

on biological malfunctioning, drugs should be used to restore the biological system.Example: depression involves imbalance in

neurotransmission, drugs restore appropriate chemical balance.

Since 1950’s there has become a widespread, and psychoactive drug account.

The drugs typically operate by affecting transmission in the nervous system of neurotransmitters such as dopamine, serotonin, noradrenalin, or GABA.The outcome is to increase or decrease the levels of

available neurotransmitters in the synaptic gap.

Biomedical approach (cont)Antidepressant drugs are used to elevate the

mood of people suffering from depression.The most common group of drugs used today is

selective serotonin re-uptake inhibitors, which increase the level of available serotonin by preventing its re-uptake in the synaptic gapExamples: Prozac (fluxetine)

Side effects: vomiting, nausea, insomnia, sexual dysfunction, or headaches.

Individual approachesAaron Beck developed the idea of congitive

restructuring. The principles are:Identify negative, self-critical thoughts that

occur automaticallyNote the connection between negative thought

and depressionExamine each negative thought and decide

whether it can be supportedReplace distorted negative thoughts with

realistic interpretations of each situation.

Cognitive-behavioral therapy (CBT)CBT is a brief form of psychotherapy with around

12-20 weekly sessions, with practice exercises.First aim: identify and correct faulty cognitions

and unhealthy behaviorClient finds out thoughts identified with

depressed feelingsSecond aim: encourage people to increase

gradually any activities that could be rewarding

Group approachesMost group therapy is “couple therapy” because

of the strong link with depression and marital problems.

Marital therapies focus of teaching the couple to communicate and problem solve.

Toseland and Siporin reviewed 74 studies comparing individual and group treatment.

75% was found to be just as effective as individual treatment

25% was found to be more effective as individual treatment

Explain cultural and gender variations in disorders

Gender variationsBrown and Harris(1978) discovered that 29 out of 32 women

who become depressed had experienced a severe life event, but 78 percent of women that did experience a severe life event did not become depressed.

One out of five women said that they became depressed from: 1.Lacking employment away from home. 2.absence of social support. 3.having several young children at home. 4.loss of mother at an early age. 5.history of childhood abuse.-Women are two to three more times more likely to become

depressed than men. Also more likely to go through more episodes of depression as well.

Cultural variationsWorld Health Organization (1983) looked at depression

from a cultural perspective and they found that in Iran, Japan, Canada, and Switzerland all had common symptoms of depression. Which were sad affect, loss of enjoyment, anxiety, tension, lack of energy, loss of interest inability to concentrate, and ideas of sufficiency, inadequacy, and worthlessness.

Marsella(1979) found that sadness, loneliness, and isolation are typical symptoms of depression in individualistic cultures. Cultures that are more collectivists.

Ex- have larger and more stable social networks to support the individual, and where one’s identity is more linked to the group.

Evaluate psych research relevant to the study of abnormal behavior

Research and theoriesDepartment of Health (1990):

depression accounted for about one quarter of all psychiatric hospitals in UK

two or three times more common in womenoccurs frequently among members of lower socio-

economic groups, and young adultsLevav (1997):

prevalence rate above average in Jewish malesno difference in prevalence btw Jewish men and womensuggest some groups are more vulnerable to depressionCan be hard for a clinician to diagnose depression

because it could just be a case of “the blue”

Research and theories cont. Nurnberger and Gershon (1982):

reviewed the results of seven twin studies found that the concordance rate for major depressive disorder was

consistently higher for MZ twins then for DZ twins Average concordance rates

MZ= 65% DZ=14%

The evidence from twin studies does not contradict the view that environmental events and psychological characteristics play a role

long term stress may result in depression b/c people who have a predisposition are more vulnerable and more likely to develop depression

Duenwald (2003) a short variant of the 5-HTT gene may be associated with a higher risk

of depression The gene plays a role in the serotonin pathways which are thought to

control moods, emotions, aggression, sleep, and anxiety

Dunewald

Research and theories cont. Catecholamine hypothesis (1965)

this theory says depression is associated with low levels of noradrenalin. Serotonin is the neurotransmitter responsible.

Delgado and Moreno (2000) found abnormal levels of noradrenalin and serotonin in patients suffering from major depression. abnormal levels of neurotransmitters might not cause depression but

indicate that depression influences production o neurotransmitters. Rampello et al. (2000)

Found patients with depressive disorder have an imbalance of several neurotransmitters---adrenaline, serotonin, noradrenalin, dopamine

Burns (2003) says there is no evidence that depression results from a deficiency of brain serotonin.

Lacasee and Leo (2005) argue that contemporary neuroscience research has failed to provide evidence that depression is cause by a simple neurotransmitter deficiency. They believe the brain is complex and poorly understood.

Catecholamine hypothesis

Examine biomedical, individual, and group treatment approaches

BiomedicalDrugs:

Drugs decrease level of noradrenalin tends to produce depression-like symptoms.

Jankowsy (1972) participants were given a drug called physostigimine

They became very depressed and experienced feelings of hate and suicide within minutes of taking drug.

Image: effect of physostigimine on the brain

The End