Depression

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• Depression

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Depression

• Defining depression
• Major Depression
• Dysthymia (Minor Version)
• Bipolar disorder (Manic-Depressive)
• Cyclothymic (Minor-Version)
• Seasonal Affective Disorder (SAD)

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DSM Criteria for Major Depression

• Symptoms must include
• Sad mood
• Loss of interest in previously pleasurable
  activities

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And four minimum of

• Fatigue
• Insomnia or hypersomnia
• Diminished cognitive capacity
• Self-denunciation
• Changes in appetite/weight
• Slowing-down of mental/physical activity
• Preoccupation with death and suicide

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Sleep pattern in depression
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Suicide and Depression

• depression implicated in about 50 of all
  suicides.
• 7th leading cause of death.
• suicide rates differ considerably depending on
  sociocultural factors

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Figure 12.3 Suicide Rates
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Predicting Suicide

• Suicidal Thoughts
• 6 of all adults per year
• 10 of college students
• males, especially those older than 45, single or
  divorced, and living alone.
• mood disorder, anxiety disorder, or schizophrenia
  increase risk

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Gender
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Psychological Causes

• Stress and worry (HPA)
• Negative view of self (Beck, 1960s-70s)
• Loser schema, self-critical
• Learned helplessness (Seligman, 1970s)
• Negative uncontrollable events
• Explanatory style (Seligman, 1980s)
• Stable, global, internal

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Phase 1
Uncontrollable Shocks
No Shock

Controllable Shocks
Test
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Test
Uncontrollable Shock
Controllable And No Shock
DV How long does it take the dog to jump to the
safe side of the shuttle box?
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Learned Helplessness

• Deficits
• Motivational deficits
• Cognitive deficits
• Affective deficits

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Attributional/Explanatory Style Model of
Depression

• Extension of Learned Helplessness model
• We make attributions about events that happen in
  our lives
• Negative Event Why?
  Attribution
• Susceptibility to depression depends on the types
  of attributions we use

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The I.S.G. Formula

• Attributions can be
• Internal/External
• Person/situation
• Stable/Unstable
• Long term/short term
• Global/Specific
• General, not general

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Explanatory Style IllustrationWhy didnt he
call?

• Internal Im unattractive
• External He didnt have time to call
• --------------------------------------------------
  -------------
• Stable I never get called
• Unstable Ill bet the next hunk will call
• --------------------------------------------------
  -------------
• Global Ill never get a man, or anything else I
  really want
• Specific Im not a great man-catcher, but I am
  a thoroughly decent human being

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Optimistic vs. Pessimistic Styles

• Optimistic explanatory style
• Good event internal/stable/global
• Bad event external/unstable/specific
• Pessimistic explanatory style
• Good event external/unstable/specific
• Bad event internal/stable/global

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Biological Causes

• genetic vulnerability
• HPA Axis
• neurotransmitters

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Genetics of Depression
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Anxiety and Depression
A reminder
Hypothalamus -- CRH
-

Pituitary Gland -- ACTH
Adrenal Gland -- Cortisol

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Daily Cycle
There is a normal daily (circadian) rhythm of
cortisol secretion
Cort in plasma
12 noon
12 midnight
Depressed patients show elevated cortisol, with
less cycling
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Dex Test
Dexamethasone (DEX) Nonsuppression Test
DEX
Cort in plasma
Time
About 70 of depressed patients show DEX
nonsuppression
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Neurotransmitters?

• Transmitters are functioning
• at below normal

• Serotonin (5HT)
• Norepinephrine (NE)
• Dopamine (DA)

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A Crazy Psychiatrist

• 1950 - 10 of people taking reserpine for
  hypertension became depressed
• 1952 Tuberculosis patients treated with
  Iproniazid show elevated mood
• 1956 Iproniazid blocks resperine-induced
  depression in lab rats
• Kline discovers iproniazid helps depressed
  patients
• Why is he crazy? Iproniazid is chemically
  similar to rocket fuel.

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PET Scans

• energy consumption rises and falls with emotional
  swings

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It Worked!

• Kline published a 70 86 success rate
• How does it work?
• Its a Monoamine Oxidase Inhibitor

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MAO inhibitor the 1st Antidepressant
Postsynaptic Neuron
NT
Presynaptic Neuron
R
NT
NT
NT
NT
NT
R
NT
Inactive metabolites
MAO
MAOI
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Tricyclic Antidepressants

• Named for chemical structure
• Not as dangerous as MAO inhibitors (eating cheese
  MAO DOA), but there is significant overdose
  danger

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How do TCAs Work?
Postsynaptic Neuron
NT
Presynaptic Neuron
NT
R
NT
NT
NT
NT
R
TCA
NT
Re-uptake receptor
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Newer Antidepressants

• Specific Serotonin Reuptake Inhibitors or SSRIs
• Prozac and many others
• More specific for serotonin reuptake than TCAs

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Atypical Antidepressants

• Zyban (for quitting smoking) inhibits DA
  reuptake
• Serzone selective NE reuptake inhibitor (pulled
  from market)
• Effexor - SNRI (serotonin and norepinephrine
  reuptake inhibitor)

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Depletion Studies

• 2 groups of recovered patients

Discontinued Drug
Serzone
Prozac
ok
relapse
Sero
Depleted Transmitter
Norep
relapse
ok
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Question?

• Neurotransmitter levels increase the first day of
  taking the drug, but symptoms disappear after 6
  weeks. Why?

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Alternative hypothesis

• Depressed people have hyper-responsive receptors.
  So, your brain might reduce its manufacture of
  serotonin in response to Prozac.
• Tianeptine works just as well as other drugs by
  decreasing serotonin at the synapse

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Other Therapies

• Cognitive Behavioral Therapy
• Ultraviolet Light Box for seasonal depression
• ECT or electroconvulsive shock for suicidal
  depression in drug unresponsive patients
• Lithium for Bipolar (newer Divalproex)

Next
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Problematic Thoughts
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Cognitive-Behavior Therapy

• Rational-Emotive Behavior Therapy identify
  self-defeating thoughts and replace them with
  more realistic and beneficial ones.
• cognitive restructuring
• stress inoculation training
• Becks Cognitive Therapy Goal is to identify and
  critically evaluate learned cognitive distortions.

Back
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Phototherapy for SAD
Electroconvulsive Therapy
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Transcranial Magnetic Stimulation