Psychology Column | Psychopathology | Chapter 5 | Mood Disorders I: Major Depressive Disorder and Dysthymia

This is an informative chapter about mood disorders (major depressive disorder and dysthymia). None of this information in here or other chapters can be used to diagnose people. Only psychiatry professions are obligated to diagnose. Psychopathology chapters are review and summary of Textbook “David H. Barlow, V. Mark Durand (2014) Abnormal Psychology: An Integrative Approach” and lecture notes.

Major Depressive Disorder and Dysthymia

Depression is a worldwide mental health problem with high prevalence, high suicide risk, and low consultation. The number of undiagnosed and undertreated patients is extremely high.

Symptoms of Depression

Normal vs Abnormal Depression;

Feelings of sadness, grief, disappointment are parts of human existence. Depth and duration of depression are important criteria.

Major Depressive Disorder

A. Depressed mood.
B. Diminished interest or pleasure in activities.

1. Weight loss.
2. Sleep disturbance.
3. Psychomotor retardation or agitation.
4. Fatigue or loss of energy.
5. Feelings of worthlessness or guilt.
6. Diminished ability to concentrate/indecisiveness.
7. Recurrent thoughts about the death and suicide.

primary depression
secondary depression

Dysthymic disorder

A. Depressed mood.

1. Poor appetite or overeating.
2. Sleep disturbance.
3. Fatigue or loss of energy.
4. Low self-esteem.
5. Diminished ability to concentrate/indecisiveness.
6. Feelings of hopelessness.

Depression with Postpartum Onset

• Anxiety, irritability, loss of appetite, sleep disturbance, tearfulness, emotional instability.
• Maternal blues “baby blues” (2-4 days) (50%-80%).

Major depressive disorder with postpartum onset (0.5-1.0%)

• Not related to the age of the mother.
• Not related to the number or the order of pregnancies.
• In women with a history of depression.
• In women with a history of other psychiatric disorders.
• Predictive of future depression.

Depression with Seasonal Pattern - Seasonal Affective Disorder (SAD)

• Depression during the winter months.
• Elevation in mood during spring and summer.
• Levels of sunlight.

Demographic Informations

Gender;

Women:men ratio = 2:1

• Women report more depression and seek more help.
• Women are exposed to more stressors or higher levels of stressors.
• Women have personality traits that predispose them to depression.
• Physiological factors predispose women to depression.

Age;

• Depression more prevalent among older than among younger

Socioeconomic class;

• Depression more prevalent among lower socioeconomic classes.

Explanations of Depression

Psychodynamic Explanation;

Conflicts-stress: Stress ->lowered levels of neurotransmitters ->depression.
Factors reduce the stress-depression link,
* Social support: The number and the quality company reduce misery.
* Individual differences in coping styles and passive strategies/active strategies.

Cognitive Explanation;

1. Incorrect Negative Beliefs.

   *Depressed individuals have more negative beliefs than nondepressed individuals.
   *Depressed individuals are more likely than nondepressed individuals to focus on and recall negative things.
   *No consistent evidence that negative beliefs per se cause clinical levels of depression.
   *Negative beliefs can predispose depression.
   *Negativee beliefs can prolong depression.

2. Learned Helplessness.

   *Individuals learn that they cannot control future negative events, so they feel helpless, and the feelings of helplessness lead to depression.

   Negative beliefs= Self-blame. "I am no good"
   Learned Helplessnes= Lack of control. "There is nothing I can do"

Physiological Explanations;

1. Low levels of neurotransmitters:
   Serotonin
   Norepinephrine
   Metabolites
   -Changing their levels by drugs
   -Changing their levels by diet

    Tryptophan --> serotonin
    sleep, appetite, sex
   

   Low levels of neurotransmitters influence hypothalamus.
   Hypothalamus: A structure in the midbrain that regulates mood, sleep, appetite, sex

2. Low Levels of Brain activity

   • Left prefrontal cortex is underactive (integration of emotional information, analytic thinking).
   • Cingulate gyrus (transportation of information).
   • Basal ganglia (a role in motor activity).

3. Genetic and Prenatal factors.

   • Community studies.

   • Monozygotic / dizygotic twins. (identical twins / non-identical twins)

   • Biological parents / adoptive parents.

      The overall heritability of depression is 33% - 45%.
     

Prenatal illness in pregnancy (in the second trimester) can disrupt brain developement in the fetus, and the resulting problems in the brain can cause psychiatric disorders.

Treatments of Depression

Psychodynamic Approach;

Interpersonal Psychotherapy (IP): First, help to identify interpersonal problems (stress) that cause depression, and then work to resolve these problems

Cognitive Approach;

Replacing negative beliefs:
* Identify the negative beliefs
* Test to determine whether the hypotheses are valid.
* Replace the incorrect beliefs with more accurate beliefs.

Physiological Approach;

1. Drug treatment: TCA MAOI, SSRI, Lithium, Atypical ones.

2. Electroconvulsive treatment (ECT).

3. Light therapy.

Table of Contents

1. Introduction and Historical Issues
Normality and Abnormality in Clinical Psychopathology

1. Diagnostic Systems and Techniques
   Interviews, Observations and Tests
   3. Anxiety Disorders I
   Symptoms of Anxiety, Phobic Disorders, Generalized Anxiety Disorders, Panic Disorder
   4. Anxiety Disorders II
   Obsessive-Compulsive Disorders, Post-Traumatic and Acute Stress Disorders.
2. Mood Disorders I
   Major depressive disorder and dysthymia
3. Mood Disorders II
   Bipolar disorder
4. Schizophrenia I
   Symptoms and issues
5. Schizophrenia II
   Explanations and treatments
6. Disruptive Behavior Disorders-I
   Attention Deficit/Hyperactivity Disorder
7. Disruptive Behavior Disorders-II
   Conduct Disorder and Oppositional Defiant Disorder
8. Pervasive Development Disorders
   Autistic Disorder, Asberger`s and other Developmental Disorders
9. Elimination Disorders and Tic Disorder
10. Mental Retardation
11. Cognitive Disorders
    Amnesia Disorders, Dementia Disorders, Delirium Disorders
12. Suicide
13. Substance-related disorders
14. Sexual Dysfunctions