


{

Affective (Emotional)
- Loss of interest/pleasure
- Worthlessness
- Guilt
Behavioral
- Passivity
- Lack of initiative
Cognitive (Thinking)
- Difficulty concentrating
- Negative thoughts
- Misplaced blame
- Low self-esteem
- Hopelessness
- Indecisiveness
Somatic (Physical)
- Insomnia/hypersomnia
- Appetite change
- Weight loss/gain
- Loss of energy
- Low libido (sex drive)


Client must present one A list symptom and at least 4 others:

A LIST SYMPTOMS:


Depressed mood
Loss of interest in activities that used to be enjoyed

B LIST SYMPTOMS:



Insomnia/hypersomnia
Appetite change
Loss of energy



Feeling worthless
Difficulty concentrating
Suicidal thoughts


Major Depressive
Disorder
 what we normally think of!

Dystemia

‘lite’ depression

Seasonal Affective
Disorder (S.A.D.)
 winter = 

Bipolar Disorder-

½ depression, ½ mania..
Different types!


AT RISK POPULATIONS

2-3x more common in women

15% of the population is depressed at one point in their lifetime
 Higher in lower economic bracket

Higher in Jewish males (= to women)

17 million Americans a year

PROGNOSIS

Reccurent in 80% of those who experience at least one depressive episode

Average of 4 episodes


Role of Genetics

Moffit (2006): followed 1000+ NZ subjects from 1972-2006. Recorded life stressors. Looked at LONG vs SHORT serotonin transporter gene
(5-HTT)

Depression after 4+ stressful experiences in 5 years:

33% with short gene depressed


17% with long gene depressed
So… Long gene works BETTER!
 Role of Neurotransmitters

↓ serotonin = ↑ chance of depression

Role of Hormones

Diathesis Stress Model

Stress releases the hormone CORTISOL, which is linked with depression

Vulnerability (genes, prenatal effects) + STRESS = ↑ chance of depression


Role of Cognitions

Thoughts of hopelessness, pessimistic thinking, low self esteem.

Depresses cognitions, cognitive distortions, and irrational beliefs produce disturbances in mood.

Alloy (1999)

Followed Americans in their twenties. Thinking style was tested and students were placed into positive or negative thinking groups

After 6 years, only 1% of those in the positive thinking group had developed depression, 17% of the negative thinking group


Role of Culture

Individualistic Cultures: value the individual over the group

Symptoms: sad, hopeless, worthless, loss of interest

Collectivist Cultures: value the group/whole over the individual
 Symptoms: headache, tired, stomachache, backache

Drug Therapy

Types of medication

Mood stabilizers- help even out highs/lows

Antidepressants- help lift the symptoms of depression

Antipsychotics- primarily treat symptoms of mania

Thase (2003)

Meta-analysis of 7 clinical trials looking at remission of depression rates

SSRIs (Prozac) = 35%

SNRI (Effexor) = 45%

Placebo = 25%

Significance: placebo effect almost as effective! We haven’t perfected antidepressants…. 



Applies a small amount of electrical current to the brain

Causes mild seizures, which changes brain chemistry

Effective in treating SEVERE depression

Controversial!!

Side effects- confusion and memory loss

Cognitive Behavioral Therapy (CBT)

Combines cognitive and behavioral therapy

Goal: change the automatic thoughts that contribute to negative emotions

Cognitive Therapy:

Focuses on how thought affect emotions and behaviors

Behavioral Therapy:

Concentrates on changing a person’s reaction to challenging situations

Hollon (2005)

Patients relapsed when stopped meds = 76%

Patients relapsed when given CBT = 31%
 Significance:

CBT helps people learn to COPE

Medicine covers symptoms, doesn’t cure/treat the CAUSE.