Major Depressive Disorder

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Major Depressive Disorder
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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

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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)

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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.

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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

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Signs and Symptoms of MDD

• Mood signs feeling sad, empty, worried,
  hopeless and irritable

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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

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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

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Medical Illness

• Endocrinological Disorders
• Stroke
• Parkinsons Disease
• Pancreatic Cancer
• Coronary Heart Disease
• Myocardial Infaction
• Cerebrovascualr disease

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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

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Neurotransmitters, Hormones and Depression

• Monoamines
• Norepinephrine
• Serotonin
• Dopamine
• Cortisol

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Personality

• Prospective Studies and Temperament
• Neuroticism

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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

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Diathesis/Personality/Stress Unipolar
Depression

• Diathesis
• Females more at risk than males
• Family history of unipolar depression
• Monoamine Deficits
• Diminished Norepinephrine
• Diminished Serotonin
• Diminished Dopamine

• Personality
• Neuroticism
• Behavioral Inhibition
• Anxiety
• Social reticence
• Fearful in presence of strangers
• Lower sensation seeking

Stressor Interpersonal Loss Threats to economic
security Cummulative Negative Events Traumatic
Events (defined by Criterion A)
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Heterogeneity of Depression

• Haslam and Beck
• Examined empirical research for evidence of
  distinct subtypes of depression
• Subtypes
• Endogenous
• Sociotropic
• Autonomous
• Self-critical
• Hopelessness

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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?

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Findings

• Discrete subtype for endogenous depression

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Heterogeneity of Depression Male Presentations

• http//www.nimh.nih.gov/health/publications/real-m
  en-real-depression.shtml
• http//www.nimh.nih.gov/health/topics/depression/m
  en-and-depression/

/
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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

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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

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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

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Findings

• Men who adhered to masculine norms were more
  likely to endorse externalizing symptoms of
  depression than prototypic symptoms of depression
• Ive yelled at peoplor or things
• Ive had a short fuse
• I got so angry I smashed or punched something
• I dont get sad I get mad
• Ive been drinking a lot
• Ive been under constant pressure
• Ive needed to handle my problems on my own