-Low mood

-Extraordinary sadness

-Dejection

-Elevated mood

-Intense, unrealistic feelings of excitement and euphoria

-A period of at least 2 weeks

-Five or more of the following:

SIGECAPS

-(loss of) Interest

- (disturbance in) Sleep

-(feeling of) Guilt

-(loss of) Energy

- (diminished) Concentration

-(weight loss or gain) Appetite

- (change in) Psychomotor

-(thoughts of) Suicide

-Period of at least 1 week

-Three or more of the following:

-Inflated self-esteem or grandiosity

-Des need for sleep

-Excessively talkative or pressured speech

-Flight of ideas or racing thoughts

-Distractibility

-Inc goal-directed activity or psychomotor agitation

-Excessive involvement in pleasure activities w/ high potential for painful consequences (sex, spending sprees)

-Period of at least 4 days

-Similar Sxs (at least 3)

-Less impairment than manic episode

Major Depressive Disorder

-Prevalence

-Gender difference

-17% prevalence

-66% women

Bipolar Disorder

-Prevalence

-Gender diff.

2-3% prevalence

no gender difference

-Prescence of a MDE

-No history of maniac, hypomanic, or mixed episode

-Less severe, more chronic unipolar depressive disorder

-Depressed mood most of the day, more days than not for 2 years or more (1yr for child/adol)

Two or more:

-poor appetite or overeating

-insomnia or hypersomnia

-low energy or fatigue

-low self esteem

-poor concentration or indecision

-hopelessness

No periods of 2 months w/o Sxs

No MDD during first 2 years

No history of manic, hypomanic, or mixed episode

Posited low levels or reduced activity or serotonin or norepinephrine

-long term data has NOT supported this

-No compelling alternative theory

-moderate genetic predisposition

-more severe forms of depression have stronger genetic influence

-Early experiences lead to formation of dysfunctional beliefs

-Late in life current stressors activate dysfunctional beliefs

-Leads to development of negative automatic thoughts centering on the negative cognitive triad

-Leads to symptoms of depression

"If everyone does not love me, then my life is worthless"

"If I am not perfectly successful, then I am a nobody"

The Self

The World

The Future

-When animals or humans consistently have little or no control over aversive events, they learn that they are "helpless"

-The become passive and exhibit depressive Sxs.

-Later, they are very slow to learn to behave differently even when they do have control over aversive events.

-Based on attributions

-Those experience relatively little control over events in life, develop a pessimistic attributional style

Internal vs. External

Global vs. Specific

Stable vs. Unstable

Negative Events: internal, global, stable

Positive Events: external, specific, unstable

Alternating periods of:

-Milder depressive episodes that do NOT meet criteria for MDE

-Hypomanic episodes

-Never symptom free for over two months

Norepinephrine: increased activity during manic phases. Not lower during depressive phases.

Dopamine: increased activity during manic phases.

Serotonin: activity is low during both manic and depressive phases.

- Antidepressant

-Increase both norepinephrine and serotonin activity

-Potentially dangerous/fatal side effects from interaction with foods rich in tyramine (amino acid - beer, wine, aged cheese)

-Monoamine Oxidase Inhibitor

-Tricyclic antidepressants (TCAs)

-Selective Serotonin Reuptake Inhibitors (SSRIs)

-Increase norepinephrine and serotonin activity (to a lower extent)

-examples: Elavil (amitriptyline), Anagranil (clomipramine), Tofranil (imipramine), Pamelor (nortriptyline)

-Increase serotonin activity

-examples: Prozac(fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Celexa (citalopram), Lexapro (escitalopram)

-Lithium

-Anticonvulsants

-Electroconvulsive Therapy

-Mood stabilizer

-Naturally occuring salt

-Cannot be tolerated by a lot of people because it causes nausea and vomitting

-mood stabilizers

-examples: Depakote, Lamictal, Tegretol, Topamax, Gabapentin

-Mood stabilizer

-Used with severe cases having vegetative and melancholic sxs, who do not respond to medication

-Effective for unipolar depression

-Brief 10-20 sessions

-Focus on present

-Evaluate, challenge and change

Similarly effective

CBT has lower relapse rate

Age of:

-Completers

-Attempters

-Completers: 65+

-Attempters: 18-24

Gender:

Attempters

Completers

attempters: 3:1 women

completers: 3:1 men