Depression

Unipolar depression is a mood disorder characterized as being depressed but not hypomanic or manic. (Depression with mania or hypomania is considered bipolar disorder.)

Depressed moods include feeling: sad, low, blue, empty, hopeless, anhedonic, or irritable.

Fast facts

• The “common cold” of mental illness
• In a year, 5.8% of men and 9.5% of women report depression worldwide (WHO, 2002)
• Depression is the most common complaint of people seeking mental health treatment

Depressive disorders

• Major depressive disorder
  • Multiple depressive episodes
  • No hypomanic/manic episodes
  • Severity specifiers - how severe was it? How recent was it? Was there psychosis?
  • Chronicity specifiers - how frequently does it happen?
  • Remission specifiers - is it in partial or full remission?
  • Considered recurrent, might become more severe over time
  • With treatment, will be fixed
  • Episodic - waxes and wanes
  • After one episode happening, likelihood of recurrence after 1st is 50%, after 2nd 70%, after 3rd 90%
  • Associated with many health risks, including elevated risk of heart attack (4x greater over 12 years)
• Dysthymic disorder/Dysthymia
  • Less severe than major depressive disorder
  • Chronic, relatively continual (instead of clear episodes)
    • Symptoms most of the day, more days than not, for minimum of 2 years
  • Can have coexisting major depression
    • Yearly, 10% of dysthymia patients have their first major depressive episode
    • Dysthymic disorder complicates treatment of depression

DSM-5 diagnostic criteria

Depressive episode

A depressive episode is defined as the following:

• Criterion A: Need to satisfy 5 or more of 9 symptoms
  • For at least two weeks and represent a change from previous functioning (observably)
  • (1) Depressed mood, most of the day, nearly every day
  • (2) Markedly diminished interest or pleasure in all or almost all activities most of the day nearly every day
  • Primary mood criterion - one symptom must be either (1) or (2) - i.e. must be either depressed mood or loss of interest/pleasure
  • (3) Significant weight gain/loss - decrease/increase in appetite almost every day
    • Around 5% weight change in a month’s time
  • (4) Insomnia or hypersomnia nearly every day
    • Lack of sleep or sleeping too much
  • (5) Psychomotor agitation/retardation nearly every day, observable by others (not just subjective feelings or restlessness or being slowed down)
    • Either being slowed down or feeling agitated
  • (6) Fatigue or loss of energy nearly every day
    • have trouble moving around
  • (7) Feelings of worthlessness or excessive/inappropriate guilt nearly every day
  • (8) Difficult to think/can’t concentrate or indecisiveness every day
    • If student has trouble focusing in class, it might be depression instead of ADHD
  • (9) Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt, or a specific plan for committing suicide
• Criterion B - the symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
  • Some part of your life feels like it’s falling apart
  • Getting in the way of how you live your life
• Criterion C - the episode is not attributable to the physiological effects of a substance or another medical condition
  • For instance, diabetes might cause depressive symptoms
  • These need to be ruled out before depressive episode

Medication

Unipolar depression can be treated with SSRIs or SNRIs. In some cases, atypical antidepressants may be used if SSRIs and SNRIs do not work well for a patient. SSRIs and SNRIs should not be used on a patient who also experiences mania or hypomania; in those cases, the patient is in fact bipolar; mood stabilizers and antipsychotics should be used instead.

Other info

Depression’s biopsychosocial influences

• Biological influences
  • Genetic predisposition
  • Changes in brain chemistry
  • Brain damage due to stress and other factors
• Psychological influences
• Sociocultural influences

Beck’s Triad of Depression - thinking about yourself, the world, and the future

When people are depressed, they will do things that keep them depressed

• Isolation
• Being social helps avoid depression

Depression after death of loved one can be considered depressive episode at discretion of clinician.

The Beck Depression Inventory (BDI) is one tool used to diagnose depression.