Depression Notes:
A. Definition
1. Major Depressive Disorder:
a. a mental disorder characterized by a pervasive and persistent low mood that is
accompanied by low self-esteem and by a loss of interest or pleasure in normally
enjoyable activities. (Wikipedia)
b. Feelings of severe despair over an extended period of time
c. Every aspect of life can be affected (emotions, physical health, work, relationships)
d. No ‘light at the end of the tunnel,’ just a long dark tunnel
B. Symptoms
1. Effects are holistic: impact a person's family and personal relationships, work or school life,
sleeping and eating habits, and general health
2. Specifically:
a. Sadness throughout the day, nearly every day
b. Loss of interest in or enjoyment of one’s favourite activities
c. Feelings of worthlessness
d. Excessive or inappropriate feelings of guilt
e. Thoughts of death or suicide
f. Trouble making decisions
g. Trouble concentrating
h. Feelings of irritability
i. Fatigue or lack of energy
j. Aches and pains (such as headaches, stomach pain, joint pains or other pains)
k. Sleeping too much or too little
l. Change in appetite or weight
m. Feelings of restlessness or being slowed down
3. AND,
a. Symptoms must be either new or noticeably worse compared to what they were
prior to the episode
b. Have to persist for most of the day, nearly every day, for at least two consecutive
weeks
c. Must be accompanied by clinically significant distress or impaired functioning
C. Subtypes
1. Postpartum depression, refers to the intense, sustained and sometimes disabling
depression experienced by women after giving birth. Postpartum depression has an
incidence rate of 10–15% among new mothers. The DSM-IV mandates that, in order to
qualify as postpartum depression, onset occur within one month of delivery. It has been
said that postpartum depression can last as long as three months.
2. Seasonal affective disorder (SAD) is a form of depression in which depressive episodes
come on in the autumn or winter, and resolve in spring. The diagnosis is made if at least
two episodes have occurred in colder months with none at other times, over a two-year
period or longer.
D. Assessment
1. Clinical assessment is required by:
a. Trained general practitioner
2. http://depressionhurts.ca/en/depression/
E. Causes
1. Biological
a. Monoamine hypothesis
i.
A deficiency of certain monoamine neurotransmitters (serotonin,
norepinephrine, and dopamine) is responsible for the feature of depression.
 Depression arises when low serotonin (a monoamine (this is a class)
neurotransmitter that contributes to feelings of well-being and
happiness; helps to regulate mood, appetite, and sleep) levels
promote low levels of norepinephrine (a neuro transmitter which
mobilizes the brain and body for action; low during sleep, high during
wakefulness, highest during the fight-or-flight response; increases
arousal and alertness). And also low levels of dopamine (effects
attention, motivation, pleasure and reward)
 The proponents of this theory recommend the choice of an
antidepressant with mechanism of action that impacts the most
prominent symptoms. Anxious and irritable patients should be
treated with SSRIs or norepinephrine reuptake inhibitors, and those
experiencing a loss of energy and enjoyment of life with
norepinephrine- and dopamine-enhancing drugs.
ii. Criticism
 Studies have challenged the idea that monoamine deficiency is the
cause of depression.
 The mood-enhacning effect of drugs that manipulate
monoamines takes weeks, however the boost in available
monoamines (from the medication) is available in hours.
 Deliberately reducing monoamines slightly lowers the mood
of unmedicated depressed patients, but does not affect the
mood of healthy people.
 “chemical imbalance” is an oversimplified but massmarketed explanation of depression.
b. Other hypotheses have been made focussing on the performance of other
molecules (cytokines: responsible for overall cellular functioning), the role of
estrogen (a hormone; due to the increase in risk of depressive episodes after
pubery, the antenatal period, and reduced rats after menopause), an overactivity
in the hypothalamic-pituaitary-adrenal axis (HPA axis) (implicating the endocrine
system (glands that release hormones) and increased levels of cortisol (hormone
released in response to stress)).
2. Psychological
a. General ideas
i. Aspects of personality and personality development appear to be integral to
the occurrence and persistence of depression
 E.g. negative emotionality is a common precursor (pessimism)
ii. Depressive episodes are linked to adverse events, however, a person’s
characteristic style of coping mat be correlated with her/his resilience
iii. Low self-esteem and self-defeating/distorted thinking is linked
iv.
Interestingly, depression is less likely to occur and quicker to remit among
those who are religious.
b. Cognitive model of depression: Aaron T. Beck’s theory (1960s)
i. Three concepts underlie depression
 Negative thoughts created from cognitive errors about oneself, one’s
world, and one’s future
 Recurrent patterns of depressive thinking (schemas)

ii.
iii.
Distorted information processing (exaggerated or irrational thought
patterns)
This is similar to learned helplessness in lab animals who remain in
unpleasant situations when they are able to escape because they initially
learned they had no control
From this theory he developed Cognitive Behavioural Therapy
c. Developmental theory of depression: Attachment theory
i. Predicts a relationship between depressive disorder in adulthood and the
quality of the earlier bond between the infant and the adult caregiver.
ii. Connected the Beck’s model – early loss, separation and rejection by the
parent or caregiver (conveying the message that the child is unlovable) may
all lead to insecure internal working models ... Internal cognitive
representations of the self as unlovable and of attachment figures as unloving
[or] untrustworthy
d. Psychoanalytic model
i. Depression, or melancholia, may be related to interpersonal loss and early
life experiences
e. Humanistic model
i. Depression connected to the lack of both meaning in the present and vision
of the future
WATCH: https://www.youtube.com/watch?v=-eBUcBfkVCo : Depression, the Secret We Share | Andrew
Solomon | TED Talks
3. Social
a. Social risk factors
i. Poverty and social isolation = increased risk of mental health problems in
general
ii. Child abuse (physical, emotional, sexual, or neglect) = increased risk of
developing depressive disorders
 (Again, development tied to MDD)
iii. Disturbances in family functioning: parental (particularly maternal)
depression, severe martial conflict or divorce, death of a parent, etc.
iv.
v.
vi.
For adults, life events connected to social rejection are particularly related
Lack of social supports maybe a contributing factor (less resilience) or a
cause in and of itself
Prejudice
 Negative self-stereotypes
 Group membership: Me-Gay-Bad
 Not: Me-Bad
 Prejudicial beliefs about a group and then become a member of that
group – internalize the prejudice
 Indian Residential School System