MDD Revision Cards

Depressed mood
Diminished interest
Weight loss/gain, appetite loss/gain
Insomnia/hypersomnia
Fatigue/loss of energy
Worthlessness/guilt
Indecisiveness
Suicidal thought/intention/plan

DSM-5 symptoms for MDD Diagnosis
( FIVE or more of the following, present during the same 2-week period (most of the day nearly every single day).
At least 1 symptom from (1) or (2))

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First-degree relatives of people with MDD more likely to have depression
Twin studies: about 37%
Confirmed in adoption studies
Heritability stronger in women
Abnormalities in serotonin transporter gene
Interaction with early life stress leads to depress

MDD Causes - Biological
Genetic factors

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Norepinephrine, dopamine, and serotonin strongly implicated
Low levels in MDD
But may not be as simple as that
Drugs change neurotransmitter levels immediately
But not effective for at least 2-3 weeks
Possible explanations relate to neurotransmitter rec

MDD Causes - Biological
Neurotransmitters

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Prefrontal cortex – reduced metabolic activity and grey matter volume
lower brain wave activity
Anterior cingulate – different levels of activity
Hippocampus – smaller volume and lower metabolic activity
Amygdala – enlargement and higher activity

MDD Causes - Biological
Brain – structural and functional abnormalities

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Early theories suggest MDD is due to 'self hatred" (little evidence to support early theories)

MDD Causes - Psychodynamic

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Depression due to environmental stressors and lack of personal skills

MDD Causes - Behavioural

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Aaron Beck - depression is caused by negative thoughts and generated by dysfunctional beliefs
Selectively focus on information that matches negative expectations
Magnify negative events
Minimise positive events
Over-generalise cause and effect
Arbitrary i

MDD Causes - Cognitive

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Learned helplessness (Seligman)
Depressed person has ‘learned’ to behave helplessly

MDD Causes - Cognition and reinforcement

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Stressful life events may increase risk for MDD
Relationship problems
Loss
Loneliness
Sudden life change
Early childhood trauma or abuse
Health problems – including life-changing diagnosis
Lack of social support

Environmental factors

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Unable to concentrate
Problems sleeping
Constantly distracted
Blaming self
Feeling guilty all the time
Low self worth, self-esteem
Poorer quality of life
MDD pts showed significantly poorer outcome at 5 year follow-up

Impact of MDD

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Antidepressants
Antipsychotics

Biological treatment for MDD

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ECT (electroconvulsive therapy)
New treatment: transcranial stimulation, vagal nerve stimulation, deep brain stimulation

Physical treatment for MDD

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Monoamine oxidase inhibitors (MAOIs) The original antidepressants (c. 1950s)
Tricyclic antidepressants (TCAs)
Also first used in late 1950s
Selective serotonin reuptake inhibitors (SSRIs)
Selective serotonin-norepinephrine reuptake inhibitors (SNRIs)
Anti

Medication for MDD

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Behavioural Activation (BA)
BA reverses cycle of depression by increasing engagement in valued activities
Cognitive Behavioural Therapy (CBT)
CBT adds cognitive and behavioural therapies
Mindfullness

Behavioural Therapy

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Depressed mood for most of the day…
…for more days than not… for at least 2 years
Presence, while depressed, of two (or more) of the following
1.Poor appetite or overeating
2.Insomnia or hypersomnia
3.Low energy or fatigue
4.Low self-esteem
5.Poor concen

DSM-5 symptoms for Persistent Depressive Disorder
(dysthymia)

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MDD Revision Cards

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