Depressive Disorders

Depressive Disorders 150 150 Tony Guo

Depressive Disorders

  • Depression is the oldest and one of the most frequently diagnosed psychiatric illnesses.
  • Transient symptoms are normal, healthy responses to everyday disappointments in life.
  • Pathological depression occurs when adaptation is ineffective.
  • Depression is an alteration in mood/affect that is expressed by feelings of sadness, despair, and pessimism.

 

Epidemiology 

  • 6.7% of persons aged 18 or older had at least one major depressive episode in the previous year.
  • Gender prevalence
    • Depression is more prevalent in women than in men by about 2 to 1.
  • Age and gender
    • Lifetime prevalence of depressive disorders is higher in those aged 45 years or younger.
  • Social class 
    • There is an inverse relationship between social class and the report of depressive symptoms.
  • Race and culture
    • No consistent relationship between race and affective disorder has been reported.
    • Problems have been encountered in reviewing racial comparisons.
  • Marital status
  • Single and divorced people are more likely to experience depression than are married persons or persons with a close interpersonal relationship (differences occur in various age groups).
  • Seasonal interaction
  • There is evidence that supports a seasonal decrease in social interactions during Fall and Winter seasons which may result in the development of Seasonal Affective Disorder (SAD)

 

Types of Depressive Disorders

  • Major depressive disorder
  • Characterized by depressed mood
  • Loss of interest or pleasure in usual activities
  • Symptoms present for at least 2 weeks
  • No history of manic behavior
  • Cannot be attributed to use of substances or another medical condition
  • Persistent depressive disorder (dysthymia)
    • Sad or “down in the dumps”
    • No evidence of psychotic symptoms
    • Essential feature is a chronically depressed mood for 
      • Most of the day 
      • More days than not 
      • At least 2 years
  • Premenstrual dysphoric disorder
    • Depressed mood
    • Anxiety 
    • Mood swings 
    • Decreased interest in activities
    • Symptoms begin during the week prior to menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week post-menses.
  • Substance- or medication-induced depressive disorder
    • Considered to be the direct result of physiological effects of a substance
  • Depressive disorder associated with another medical condition
    • Attributable to the direct physiological effects of a general medical condition

 

Predisposing factors to depression

  • Biological theories
    • Genetics 
      • Hereditary factor may be involved
  • Biochemical influences 
    • Deficiency of norepinephrine, serotonin, and dopamine has been implicated.
    • Excessive cholinergic transmission may also be a factor.
  • Neuroendocrine disturbances
    • Possible failure within the hypothalamic-pituitary-adrenocortical axis
    • Possible diminished release of thyroid-stimulating hormone
  • Physiological influences
    • Medication side effects
    • Neurological disorders
    • Electrolyte disturbances
    • Hormonal disorders
    • Nutritional deficiencies
    • Other physiological conditions
    • The role of inflammation
  • Psychoanalytical theory 
    • A loss is internalized and becomes directed against the ego.
  • Learning theory
    • The individual who experiences numerous failures learns to give up trying.
  • Object loss theory
    • Experiences loss of significant other during first 6 months of life
    • Feelings of helplessness and despair
    • Early loss or trauma may predispose client to lifelong periods of depression.
  • Cognitive theory
    • Views primary disturbance in depression as cognitive rather than affective.
    • Three cognitive distortions that serve as the basis for depression.
      • Negative expectations of the environment
      • Negative expectations of the self
      • Negative expectations of the future

 

Development Implications

  • Childhood depression
    • Symptoms
      • < Age 3: Feeding problems, tantrums, lack of playfulness and emotional expressiveness
      • Ages 3 to 5: Accident proneness, phobias, excessive self-reproach
      • Ages 6 to 8: Physical complaints, aggressive behavior, clinging behavior
      • Ages 9 to 12: Morbid thoughts and excessive worrying
    • Precipitated by a loss
    • Focus of therapy: Alleviate symptoms and strengthen coping skills
    • Parental and family therapy
  • Adolescence
    • Symptoms include
      • Anger, aggressiveness
      • Running away
      • Delinquency
      • Social withdrawal
      • Sexual acting out
      • Substance abuse
      • Restlessness, apathy
    • Best clue that differentiates depression from normal stormy adolescent behavior
      • A visible manifestation of behavioral change that lasts for several weeks.
    • Most common precipitant to adolescent suicide 
      • Perception of abandonment by parents or close peer relationship
    • Treatment with
      • Supportive psychosocial intervention
      • Antidepressant medication

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