5 or more episodes during a 2 week period.  At least one symptom must be depressed mood or loss of interest/pleasure.

-Depressed mood most of the day, nearly every day.  Diminished interest or pleasure in all or most activities most of the day, nearly every day. 

-Appetite/weight changes nearly every day

-Insomnia or hypersomnia - can't sleep very well normally.  Psychomotor retardation/agitation - moving slowly

-Fatigue or loss of energy, feelings of worthlessness/guilt, diminished ability to think or concentrate, thoughts of death, or suicide ideation.  Distress/Impairment

-Never manic or hypomanic.

-Psychotic symptoms - hallucinations/delusions, disorganized/confused thoughts.

being depressed due to fall and winter time.  Dark/cold. 

not associated with individual traumas or experiences.  Also need a pattern to be diagnosed with this. 

"common cold of mental disorders"

women > men.

average age of onset = 27 (decreasing; can experiecne at any age)

5-10%, 1 year

about 17%, lifetime

26% women

12% men

about 10-15% die by suicide

about 50% recover within 6 weeks

about 90% recover within 1 year

Untreated episodes last approx. 6 months 

-50-60% will have second episode

-odds of future episode increase with more episodes. 

longer lasting depression (2 years +)

never without for 2 months +

less disabling/intense.  Not full major depressive episodes and never psychotic. 

3-5%, one year

about 6%, lifetime 

Someone who experiences manic episodes for a week or longer.  Feel high, elated, self esteem is up.  Think they have special skills. 

1+ manic episodes ("high"): decreased sleep, talkative/pressured speech, thoughts race, distractibility, increased activity/agitation, excessive pleasurable activity, may have psychotic symptoms.

Manic is the only thing that is required for Bipolar I. 

50-60-%, depression follows, the rest just have manic episodes and thats all 

About 1%, lifetime

women = men

average age of first manic experience = 20 years old.  Onset early 20's 

Hypomanic episodes (miny episodes - not full blown mania).  4 days, shorter don't get out of control)

-never psychotic, hospitalized, or full manic episode

-depressive episodes is what makes it a mental disorder. 

0.5%, lifetime

women > men (some evidence) 

2 years + (long periods)

Hypomania and depressive symptoms cycle.  Not without for 2 months +.  Don't experience full blown mania or full blown depression.

No depressive episodes, no manic episodes.

0.4 - 1%, lifetime (lifetime disorders)

women = men 

Depression is 2-3 times higher risk among first-degree relatives.

Risk of unipolar (not bipolar)

Bipolar is 2-3 times higher risk among first-degree relatives. 

Depression in monozygotic twins =46% concordance

Depression in dizygotic twins = 20% concordance

Bipolar in monozygotic twins = 60-70% concordance

Bipolar in dizygotic twins = 10-15% concordance  

Monoamine neurotransmitters (serotonin, norepinepherine, dopamine) important in the functioning of the limbic system.

-regulation of sleep, appetite, and emotion.

-pathways link with other parts of the brain.   

Not just deficit or excess.  Greater focus on receptors, synchronization, reactivity, and interaction between neurotransmitters.

-Through the hypothalamus exert control over the endocrine and autonomic nervous systems 

HPA (hypothalamic-pituitary-adrenal) axis involved in reactions to stress.  Person perceives stress.

-HPA axis increases activity.  Increases cortisol (stress hormone).

-Depression: chronic HPA activity; difficulty returning to baseline following stressor.

Cortisol and Depression:

Elevated in depressed people compared to nondepressed people.  Cortisol levels return to normal when not depressed.  May impact levels of and/or receptors for neurotransmitters.  May damage hippocampus (memory, learning) 

stress -> decreased reinforcers -> depression -> depressed individuals report more negative experiences than non-depressed during year before episode.

-stressors often precipitate episodes of depression

-mood improves among depressed individuals when reinforcements increase 

-stress and mania associated with onset of manic episodes.  Associated with length of time to recover.  High expressed emotion in families (critical and hostile family environment) associated with onset, episode length, and relapse 

Learned Helplessness: a psychological condition in which a human being or an animal has learned to believe that it is helpless in a particular situation. 

psychoanalytically trained.  Depression = self-punishment; punishment of love "objects"

-observed negative thinking in patients, self-criticism and blame, exaggeration of misfortune, beliefs about helplessness and futility, dysfunctional though process. 

Content of thought. 

-self (defective) - not worth anything

-world (depriving) - world not worth anything

Future (futile) - negative

"Automatic" (spontaneous, not motivated)

process of thought: the way they take in info. is not rational. 

All or nothing thinking - If something doesn't go as well as you hoped, you blame everying on yourself "i'm just stupid"

Selective attention to negative

-Magnification - magnifying the negative

-Minimization - minimization - minimizing the positive.

Overgeneralization - "I didn't do well on this exam so I won't do well on any exams" 

Cohort effect - younger generations at greater risk for depression.  Life styles - poverty, divorced, exercise.  E.g. Amish: 1/10 rate of depression compared to U.S. rates.  More open to diagnosis?

Socioeconomic status - negatively correlated with depression overall 

1. Tricyclic AQntidepressants - "older" - Imipramine (more info on this drug than any other drug)

2. Selective Serotonin Reuptake Inhibitors (SSRI's)

    -thought to alter serotonin activity specifically . Prozac, Paxil, Zoloft 

    -SSRI's used more frequently than tricyclics becasue there arent as many side effects, and they are safer for suicidal patients.

3. Placebo affect - controls for your expectations.

4. MAO (monoamine oxidase) Inhibitors - Phenelzine, Tranylcypromine.

        -MAO = enzyme (breaks things down)

        -MAO breaks down norepinepherine

        -MAO inhibitors block MAO from destroying norepinepherine

food and medication restrictions - Tyramine which is in cheese, bananas, some windes, medicatoins can give you high blood pressure 

"shock treatment"

history - "calm" after epileptic seizures.  Historically used to "control" patients (not anymore)

unclear how ECT works.  May change neurotransmitters.  Effectiveness for nearly 85% of people who have sever forms of depression who haven't responded to other meds. 

High intensity magnetic pulses.  Focused on certain brain areas (e.g. prefrontal cortex)

-awake

-Minor side-effects (e.g. headaches) 

Seasonal mood disorders.  Circadian rhythm dysfunction with diminished exposure to light during winter.  Bright light, 1 hour per day, morning or evening, regular same time every day.  70% response rate.

Temporary effects - need to continue therapy during low light months.

Unclear mechanisms - may reset circadium rhythms. 

Based on Beck's cognitive model of depression - cognitions, lewinsohn's behavioral model of depression.  About 20 sessions/16 weeks.  HW is given.

Behavioral Activation: Increase activity - mastery - something they can master.  Pleasure. Identify and challenge thoughts that may interfere.  Build upon (graded task assignments) to tackle problems.  (e.g. unrewarding job, relationship difficulties)

Skills: social skills, assertiveness skills - practicing real life situations where they can stand up for themselves.

Thought catching - clients taught to observe links: Thoughts, feelings, situations.

Challenging "Irrational" Thoughts - what is the evidence for the thought? Is there a distortion? Magnification or minimization? Selective attention? Overgeneralization?  Is there another way to look at it?  What if it's really true? so what, not a huge deal.

Assumption that depression can result from, and lead to, difficulties in interpersonal relationships.

-Individual treatment

-12-16 weeks

-Encourage expression of affect

-Insight

-Skills (communication, role playing) 

-Ideation - thinking about it - 40-80% think about it

-Attempts - Ratio of attempts to completions = 200:1.  3x's more women than men

-Completion - U.S.: 31,000 per year; 85 per day.  4x's more men than wome.  Guns most common means.  White males 85+ (highest rates).  3rd leading cause of death (15-24 y.o.)

-Family history

-Serotonin (lower levels)

-Personality: impulsivity

-Stressors - economic hardship, loss, abuse, exposure, interpersonal relationships

-mental illness - mood disorders, drug abuse/dependence, schizophrenia

-cognitive rigidity - all or nothing thinking, rigid thinking.

-low social support

-hopelessness - predicts more than depression

-no treatment

-Event - desire to escape

-Lack of perceived alternatives - substances

-Availability of method - gun control?