Mood ch.8 psych 300 oct.30.docx

**[Mood disorder & depression: Ch.8] Oct.30** **Conceptual definitions:** 1. Emotion = effective reaction - **Physiological** - **Cognitive** - **Behavioral** 2. Mood = colours your life - **Prolonged 2 weeks** 3. Mood disorder = abnormal mood prolonged [Depressive disorders- DSM...

**[Mood disorder & depression: Ch.8] Oct.30** **Conceptual definitions:** 1. Emotion = effective reaction - **Physiological** - **Cognitive** - **Behavioral** 2. Mood = colours your life - **Prolonged 2 weeks** 3. Mood disorder = abnormal mood prolonged [Depressive disorders- DSM 5:] Symptoms are low mood Western culture: "Feeling guilty, life isn't worth it" -- cognitive Other culture: "My heart is closed", something has taken my soul" Why? Linguistic differences Male depression : irritability, anger and low mood (gender differences) **Major depressive disorders:** *What are the symptoms?* *Symptoms must last at least for 2-weeks (prolonged) not comes and goes* When diagnosed: (5 must be met) 1. Depressed mood 2. Diminished interest or pleasure in almost all activities \*\*Must have one or both first of above 3. Weight changes. (Loss of weight when depression severe at least 10lbs) 4. Insomnia/ hypersomnia (more likely insomnia) 5. Agitation= always walking around Retardation= physical slowing Psychomotor \*\* 6. Fatigue (less sleep) 7. Guilt and worthlessness (as depression more severe have extreme opinions) 8. Concentrate and indecisiveness inability (ex: I don't know what I wanna wear) 9. Recurrent thoughts of death (escape from something intolerable) Severe depression -- use of passive ideas of death ( I wish I was dead) Very severe depression -- use present ideas of death ( I wanna kill myself) *Age influence symptoms:* - *Children: in the form of physical complaints and irritability (difficult/act up)* - *Elderly: dementia (look depressed), physical changes, anxiety* severity of the symptoms: the severity level indicates the symptoms and continues to slowly change. Sub-syndromal depression (not enough to diagnose) can be painful Severe forms of depression display psychotic symptoms [Psychotic features: (highly severe form)] - **Delusions**: fixed false beliefs, hopeless - 50% severe MDD: 1. Guilt 2\. Disease (feeling of decaying) 3\. Punishment (feeling that people want to kill me) 4\. Nihilistic (feeling that the world is ending) 5\. Impoverishment (being poor, no money) - **Hallucinations** -- rare (taste, visual, auditory) Auditory (most common) Suicidal commands Hearing their name Blame Criticism - **Visual (less common)** see dead people Indigenous culture: believe its normal when you are in danger ancestors come to guide you - **Gustatory- taste** Bad taste in mouth (ex: believe someone is poisoning them) **Chronic depression:** Require fewer symptoms to diagnose - Symptoms may last short time (mood) - Severity low - Must last at least 2 years (persistence) *Impairment:* Less severity but lasts very long treatment ineffective Suicide rate higher **Double depression:** Depressive episodes (at least 2-weeks) + persistent depression At least two years of depression Recurrence of symptoms high **Epidemiology:** [General:] - Prevalence high - Adult 4-12% experience depression in their life time (affects a lot of people) - Children 2.5%. (Some infants can be depressed) How can you tell: offspring does not smile in sonography - Girls \> boys (why:puberty) Onset: - age 12-24 olds more common - average age 25 \*\* onset age decreasing in adolescent girls (younger girls tend to have depression) [Triggers]: *What causes depression?* - Interpersonal events that cause stress - Interpretation of event Ex: separation, death, social exits [ Other factors:] 1. [Gender:] children no difference Adults more women \*\*men show depression differently (anger/numbing/don't seek help) \*\*men talk to women about their emotions more than to other men 2. [Impairment ] Suicide Occupation Incapacitate (remain in hospital) **Clinical course:** - Could be recurrent - Symptoms may remain (some) - Remission (when get better) If untreated last 4-9 months Most get better by 12 months Some get better by 3 months Contributors: 1. Biological 2. Neurological 3. Biochemical A. Heritability is effective (37%) Severity: people with recurrent depression have greater heritability B. Anxiety shared heritability with depression **Neurological:** A. **Correlation** [Hippocampus:] unable to remember details Smaller hippocampus due to stress [ Anterior cingulate cortex:] decreased activity What: connect amygdala and PFC [Amygdala]: reactivity increase What: stress increase dendrite branches [Brodmann's area 25:] overactive MDD treatment resistance B. **Neurotransmitter Dysregulation:** Monoamines can be dysregulated. 1. Norepinephrine 2. Serotonin 3. Dopamine 4. Secondary messengers (modulate other chemical circuits) **Biochemical models:** - Unknown biochemical processes (broad idea of neurotransmitter imbalance) - Monoamine theory: better model - Balance of neurotransmitters essential (serotonin lower than dopamine & norepinephrine) - The state of mind and body change neurotransmitter levels Depression is a result of stressful events Stress builds a reactive HPA activation system - Dysregulation of glutamate circuits - BDNF (brain-derived neurotropic factor) and other biochemicals that maintain hippocampus down regulate - Thinning of dendrites to hippocampus (erosion) - Worsen memory collection and recall **Biological Treatments: (first line treatment)** 1. TCAs -- antidepressants Problem: many side effects. (Sexual desire low, shakiness, dryness of mouth, drowsiness) \*\*it has positive effects for some but studies don't know who it is more effective for 2. MAO-inhibitors Problem: overlap with tyramine-aged food (wine, cheese...) which cause blood pressure increase 3. SSRIs (Prozac, Paxil, Effexor) Similar to TCAs with less side effects 4. Ketamine infusion: Increase glutamate, neuronal growth Problem: short-term help, dosage must be low to avoid killing brain cells (excitotoxicity) **Exercise:** Effective for mild to moderate MDD May enhance impact of medication (strong compound) **Overall effectiveness:** Reality is that they are not as effective as people believed. 1. Pharmaceutical companies: research - Trials are funded by pharmaceutical companies so negative results hidden - Publishing of results controlled 2. Placebos and antidepressants have limited differences in effectiveness **EST-electroshock therapy (ECTs)** What? Stimulation/ alteration of monamines (how it works is unknown) Under anaesthetics. Side effects: Short term memory loss and confusion. (2-weeks) It prevents deep depression but does not stop episodes of depression (high relapse rate) - If after 10 sessions does not work will stop - Shorter duration of treatment - Safer **Transmagnetic stimulation:** What: run magnetic coils to generate electromagnetic pulse to brain areas. - Limited side effects Results: - Not permanent cure (deep depression but not prevent episodes of depression) - EST works better - Has some good results (lower in Canada) **Contributions:** 1. [Social contributions: ] a. Stressful/ traumatic event occurred within the year (interpersonal) b. Self-generated (choosing problematic romantic partners) c. Inter-generational transmission of depression (behavior of family/caregiver passed on to children not necessarily genetically) Ex: depressed mothers do not care for their offspring by positive emotional expressions or verbally \*\*children of these caregivers have higher chance of divorce [Interpersonal psychotherapy (IPT): treatment ] What: target problems of individuals for interacting with other How: find solutions to improve \*\*more effective than CBT (controversial but data confirms) - Ex: marital conflicts, relationship loss, relationship initiation, social skills 2. [Cognitive processes: ] Psychodynamic approach-Beck Believed that depressed individuals have internal aggression towards objects that they care for. Ex: if their loved ones leave them, they show their anger towards oneself and not the person Depressed people: mentality [Cognitive content:] 1. Self-criticism- believe they should do things better 2. Engage in social comparisons [Cognitive processes:] 1. Arbitrary inference: assumption of negative criticism Ex: people don't like me (no evidence) 2. Overgeneralization: Magnify negative things Generalize positive things Selective abstraction (judging whole event by one factor only) 3. Negative schema activation Research: 1. Dysfunctional attitudes 2. Negative memory recall high (biased recall) 3. Mood priming in recovered depressives (ex: recovered depressed people have higher chance of depressive recovery by listening to a sad music) [Cognitive treatment:] Help person decenter from negative thoughts. Modification of cognitive processes. **Behavioral models:** Dependent on positive reinforcement. Generate positive social feedback by goal-directed activities. *How depression occurs?* Usual positive rewards/reinforcement gone or reduced. [Research]: - Less effective social skills - Negative verbal behaviour (ex: complaining more than others looking for others to make them feel better but exhausting) - Behavioural avoidance (avoid engaging in positive activities) [Treatment:] Behavioural treatment: 1. Behavioral activation (stepwise process) 2. Pleasant event scheduling 3. Exercising/being active [Study:] Behavioral treatments are as effective as cognitive therapy. [Summary of treatments: in MDD] Medication has high effects and high relapse rates Cognitive therapy- longer but lower relapse rates Combination therapy -- a boost to treatment Sequential treatments -- 1. Antidepressants 2. Psychotherapy after