Transcript Major Depressive Disorder

Major Depressive
Disorder
Mood Disorders
Extremely disabling, second only to heart
disease
 Associated with Suicide; 15% w/ MDD
complete suicide
 MDD most serous and widely studied
depressive disorder
 Individuals must have anhedonia or
depressed mood for at least two weeks
period of time

Epidemiology
Lifetime prevalence for any mood disorder
is 20.8%
 Lifetime prevalence for MDD is 16.6%
(Kessler et al., 1994)
 Dysthymia is less common (2.5%-6%)

Depression and etiology

20 year old female college student presenting to
the clinic. She was just released from an
inpatient facility for attempting suicide. This has
not been her first attempt. In addition to her
frank suicide attempts she has engaged in a
number of nonlethal self harm behaviors. She
presents with major depression, severe and has
nearly all of the melancholic features. Her
speech is labored, her affect is blunted, her
movements appear slow. Prior to her diagnosis
of mdd she had a diagnosis of dysthymia.
Signs and Symptoms of MDD
Vegetative: loss of satisfaction, loss of
interest in sex, early morning awakening,
loss of appetite, loss of weight, social
withdrawal
 Cognitive Signs: Difficulty concentrating,
indecisiveness, low self esteem, negative
thoughts about the self, world and others,
guilt, suicidal ideation and in more severe
cases psychosis

Signs and Symptoms of MDD

Mood signs: feeling sad, empty, worried,
hopeless and irritable
Dysthymia
Chronic low level depression lasting 2
years or more
 Symptoms can not be absent more than 2
months at a time
 Can not have MDD within the first 2 years
of the disorder

Etiology
Twin Studies and Family studies
Heritability and specific environmental
factors such as stress affecting one twin
but not the other appear to be important.
--Correlation between MZ twins is .46,
compared with DZ twins is .20.
Genetic propensity exists but learning and
environmental factors play an important
role

Medical Illness
Endocrinological Disorders
 Stroke
 Parkinson’s Disease
 Pancreatic Cancer
 Coronary Heart Disease
 Myocardial Infaction
 Cerebrovascualr disease

Neuropsychology and
Psychopharmacology

MRI studies revealed MDD have evidence
structural differences compared with
controls:
– ventricular enlargements and sulcal space
compared with control patients. Areas of
impact include the frontal lobes, subcortical
white matter and caudate nuclei
Neurotransmitters, Hormones and
Depression
Monoamines
 Norepinephrine
 Serotonin
 Dopamine
 Cortisol

Personality
Prospective Studies and Temperament
 Neuroticism

Stressors
Prolonged exposure to psychosocial stress
 Most episodes are preceded by a severe
life event or difficulty in the 6 months
before the onset of the episode;
 Increased rates of childhood abuse
 Themes of loss
 Maternal loss

Diathesis/Personality/Stress:
Unipolar Depression
Diathesis
Personality
Stressor
Females more at risk
than males
Neuroticism
Interpersonal Loss
Behavioral
Inhibition
Threats to economic
security
Family history of
unipolar depression
Monoamine Deficits
Diminished
Norepinephrine
Diminished
Serotonin
Diminished
Dopamine
Anxiety
Social reticence
Fearful in presence
of strangers
Lower sensation
seeking
Cummulative
Negative Events
Traumatic Events
(defined by Criterion
A)
Heterogeneity of Depression

Haslam and Beck
– Examined empirical research for evidence of
distinct subtypes of depression
– Subtypes
 Endogenous
 Sociotropic
 Autonomous
 Self-critical
 Hopelessness
Criteria for Analysis
Indicators must be dichotomous
 Items were standardized
 Was it a taxon?

– Do the symptoms hang together?
– Which elements appear important
– Were they discrete or continuous?
Findings

Discrete subtype for endogenous
depression
Heterogeneity of Depression: Male
Presentations
http://www.nimh.nih.gov/health/publicatio
ns/real-men-real-depression.shtml
 http://www.nimh.nih.gov/health/topics/de
/
pression/men-and-depression/

The Masculine Depression Scale
Depression is twice as common in women
as in men;
 Perhaps men evidence depression
symptomatology that is differerent from
that of women and that these differences
lead to disparate prevalence rates;

The Masculine Depression Scale
Developed a self-report instrument
designed to assess ‘masculine depression’
 Examined the correlation between men
who adhere to masculinity hegemonic
norms and masculine depression

Sample items
Anger, aggression, irritability
 Substance abuse
 Withdrawal from family/social interactions
 Overfocus on work/school
 Inability or unwillingness to display soft
emotions
 Self-criticism of self/sense of failure

Findings

Men who adhered to masculine norms were
more likely to endorse externalizing symptoms
of depression than prototypic symptoms of
depression
–
–
–
–
–
–
–
I’ve yelled at peoplor or things
I’ve had a short fuse
I got so angry I smashed or punched something
I don’t get sad I get mad
I’ve been drinking a lot
I’ve been under constant pressure
I’ve needed to handle my problems on my own