Hippocrates
Humoral Theory: Mania caused by warmth and dampness in brain, depression is an excess of black bile
Romans
Recognized emotional factors in depression
Cicero
Psychotherapy for melancholia
Robert Burtons Anatomy of Melancholia
Psychological and social causes of depression
Emil Kraepelin
Coined term manic depression
Psychodynamic View
Those who can’t get over grief turn their anger inwards
Freud and Abraham
Imagined loss: Unconsciously interpret normal events as severe losses which is a catalyst for depression
Duration of MDD symptoms
Depressed for 2 weeks with 4 additional symptoms
Cost of MDD
14.4 billion/ year
Atypical depression
Oversleep, over eat, weight gain, anxiety– most common
Prevalence of MDD
6% women, 3% men
Lifetime: 12%, 6%
of Canadians with MDD
1,500,000
% of people who will experience a second MDD epsiode
50%
70% third
90% 3+
Average length of MDD episode
6-9 months
% of MDD people with a comorbid anxiety disorder
50%
% of MDD die of suicide
15%
Persistent Deppressive Disorder
Chronic low mood lasting 2 years
Lifetime prevalence of dysthymia
3%
Double depression
Dysthymia plus MD episodes
Mania
Distinct period of elevated, expansive or irritable mood lasting at least one week and accompanied by 3 symptoms
Hypomania
Less severe form of mania, only 4 days
Bipolar 1
Mania
Bipolar II
Hypomania and major depressive episodes
Mixed State
Manic/hypomanic and depressive symptkms at the same time
Which bipolar type is harder to diagnose
II- hypomania is harder to detect than mania
Length of manic episodes
2 weeks- 4 months
Bipolar suicide rates
10-15%
Bipolar lifetime prevalence
I- 0.8%
II- 0.5%
MDD gender ratio
2:1 women
Bipolar gender ratio
=
Bipolar age of onset
20
Rapid cycling
10-20% of cases
cyclothymia
Continuous periods of hypomanic symptoms and periods of depressive symptoms– lasts 2 years
Cyclothymia gender ratio
=
Cyclothymia prevalence
less than 1%
Rapid Cycling specifier
4 or more manic or depressive episodes within a year– episodes seperated by at least 2 months
SAD
Recurrent depressive episodes tied to the changing seasons
% of MDD with SAD
11%
Prevalence of SAD
2-3%
% of women with modd swings after child birth
70%
% of new mothers with MD or mani episode
10-15%
Mother suicide and infantcide rates
5% suicide
4% nfantcide
Hormone implcated inpost-partum depression
Progesterone
Psychological level
Temperament, personality, dysfunctional thinking and maladaptive behaviour contribute to mood disorder
2 psychodynamic personality patterns increase risk for depression
Dependant
Self-critical
Dependant
Rely on relationships for sense of identity
Blatt
Personality styles developed in childhood render people vulnerable to depression when they experience a stressor
Beck
Emotional repsonse to as situation is determined by how it is appraised
Schema
Structures in mind containing core beliefs about self, world and future
Negative Feedback Seeking
Actively seek critiscim and negative feedback from others
Reassurance Seeking
Repeatedly seek reassurance of worth and lovability from others
Stress Generation hypothesis
Depressed people generate stressful life events in interpersonla domain and contribute to events due to maladaptve behaviors
Life Stress perspective
Stresful events tax our psychological and physical resources
Chance of first degree relatives of MDD and BP patients to develop disorders
MDD- 2-5x
BP- 7-15x
Heritability estimate for MDD and BP
MDD- 0.36
BP- 0.75
HTT
Serotonin transporter gene on chromosome 17– shorter allele in MDD
2 neurotransmitter systems in depression
Catecholamine: Norepinephrine
Indoleamine: Serotonin
Origin of serotonin
Raphe nucleui of pons and medulla
Serotonin effects
arousla, mood, anxiety, aggression, eat, sleep, dreams, pain, sex drive, memory
Norepinephrine
Regulates arousal, energy, activity and appetite
Dopamine
pleasure, reward, mood attention, activity
Sleep stages
First 4 are slow wave, 5th is REM
Brain differences in depressed people
Reduced activity in prefrontal cortex, anterior cingulate and basal ganglia
Brain lesions in depression
Left anterior lesions
of CBT depression sessions
16-20
Behavioural experiments
Test negative beliefs in real-life situations to disconfirm them
MBCT
Midfulness-based: Promote awareness of the here and now to reduce ruminative thinking patterns
of IPT sessions
12-16
4 dysfunctions addressed in IPT
Interpersonal disputes
Role transitions
Grief
Interpersonal deficits
Tricyclics
Block reuptake from synpse of norepinephrine– most effective but many side effcets
MAOI’s
Inhibit enzyme that breaks down monoaminergic neurotransmitters so more monoamines are released into synpase
Response rate for antidepressants
50-70%
CANMAT
Guidelines to choose medications for patents
Lithium
Mental illness linked to excess of uric acid– deactivates enzyme that disrupts circadian clock
% of BP that dont respond to lithium
40%
Anticonvulsants
Increase synthesis of GABA– inhibitory effect
Severe depression treatment
Meds and IPT
Persistent depression treatment
Meds and CBT
Interpersonal and Social Rhythm therapy
Disruptions in daily routines and conflicts n relationships cause relapses of BP
Treatmnt resistant depression
Failure to achieve remission after 2 trials of meds
Vagnus Nerve Stimulation
Vagnus nerve runs from brain stem to abdomen– pulse generator surgically implantes and wire attaches to nerve
Deep brain stimulation
Surgically implanted wires and ulse generators in brain regions
Suicide completion gender ratio
3x more men complete suicide
Suicidal Ideation
Thoughts of death and plans of suicide
Suicidal gestures
Behaviours that look like suicide but are clearly not life threatening
Gender ratio for attempted suicide
Women 3x mor likely
Strongest risk factor for suicide
being male
Regions with lowest suicide rates
Catholic countries
Durkheim
Suicide caused by sense of anomie– feeling rootless and lack of belonging