Major Depressive Disorder

1. Major Depressive Disorder • In a national survey, 31% of American collegians agreed when asked if in the past year they had at some time “felt so depressed that it was difficult to function.” (ACHA, 2009) • Depression plagues 12% of Canadian adults and 17% of U.S. adults at some point during their lifetime. (Holden, 2010) • About one in four people diagnosed with depression is debilitated by a significant loss. (Wakefield et al., 2007) • Depression is a sort of psychic hibernation: it slows us down, defuses aggression, helps us let go of unattainable goals, and restrains risk taking. (Andrews & Thompson, 2009) • Even mild sadness can improve recall, make them more discerning, and help them make complex decisions. (Forgas, 2009)

2. Depression & Mania • Major depressive disorder is diagnosed when a person experiences, in the absence of drugs or another medical condition, two or more weeks of significantly depressed moods or diminished interest or pleasure in most activities, along with at least four other symptoms. • Memorize Table 49.1 (m646 c622 15.3)for the next exam. • Most depressive episodes end; however, some people bounce to the opposite extreme: mania, a mood disorder marked by a hyperactive and wildly optimistic state. • The alternation between the two states is bipolar disorder, formerly known as manic depression. • 2/3 of those so diagnosed are boys (under 19), the DSM-5 will create a new category for the depression/anger cycle in adolescent males. (Miller, 2010).

3. Mood Disorders • People trapped in a depressed mood are inactive and feel unmotivated; they are sensitive to negative happenings. (Peckham et al., 2010) • Depression is widespread = global = genetic & triggers. • Womens' risk of depression is nearly double mens'. (Pelham, 2009). However, preadolescent girls are not more depression-prone than are boys. (Hyde et al., 2008) • Factors: genetic predisosition; child abuse; low self-esteem; marital problems, similarly put men at risk. (Kendler et al., 2006) • For about 1/2 of depressives, episodes recur. (Curry et al., 2011). Only about 20% suffer from chronic depression. (Klein 2010).

4. Mood Disorders Cont'd • Recovery is more likely to be permanent the later the first episode strikes, the longer the person stays well, the fewer the previous episodes, the less stress experienced, the more social support received. (Ferguson & Woodward, 2002). • A family member's death, a job loss, a marital crisis, of a physical assault increase one's risk of depression. (Orth et al., 2009) • With each new generation, depression is striking earlier (now often in the late teens) and affecting more people, with the highest rates in developed countries among young adults. (Kessler et al., 2010). • This may be a result of a younger generation's increased willingness to disclose their feelings of depression.

5. Biological Perspective • Fig. 49.2 (linkage analysis) will be on the next exam; review heritability.(m649 c625 15.5) • The risk of major depression if one has a parent or a sibling with the disorder. (Sullivan et al., 2000) • If one identical twin suffers a major depressive disorder, 1 in 2 for the other; if one identical twin has bipolar disorder, the chances are 7 in 10. Even in if they are reared apart. (DiLalla et al., 1996) • Among fraternal twins, the corresponding odds are just 2 in 10. (Tsuang & Faraone, 1990). • Adopted who suffer a mood disorder often have close biological relatives who also suffer mood disorders, become dependent on alcohol, or commit suicide. (Wender et al., 1986).

6. Suicide & Self-Injury • The risk of suicide is at least five times greater for those who have been depressed than for the general population, usually when rebounding after an episode. (Bostwick et Pankratz, 2000). • Those with alcohol dependence are 100 times more likely; some 3% do. (Sher, 2006). • One six-year study tracked suicide cases among all 1.2 million people who lived in metropolitan Stockholm at any time during the 1990s. Men exposed to family suicide were 8 times more likely to commit the act than were nonexposed men. (Hedstrom et al., 2008) • Suicidal thoughts may also increase when people are driven to reach an unattainable goal or standard. (Chatard & Selimbegovi, 2011). • Only 1 in 25 follow through. (AAS, 2009).

7. The Depressed Brain • Fig. 49.4 (m652 c628 15.7) will be on the next exam. • The left frontal lobe and adjacent brain reward center (nucleus accumbens) are active during positive emotions, but less active during depressed states. (Heller et al., 2009). • In one study, MRI scans revealed that patients with severe depression had frontal lobes 7% smaller than normal. (Coffey et al., 1993) • With bipolar disorder, there is decreased white axonal matter or enlarged fluid-filled ventricles. (Van der Schot et al., 2009) • Many people with depression, have a history of smoking, which increases risk of an episode. (Pasco et al., 2008). This is an example of self-medication, using nicotine to temporarily increase norepinephrine levels and boost mood.

8. The Depressed Brain Cont'd • A recipe for depression is the combination of significant life stress plus a variation on the serotonin-controlling gene. Depression arose from the interaction. (Moffitt et al., 2006) • Drugs that relieve depression tend to increase norepinephrine or serotonin supplies by blocking either their reuptake or their chemical breakdown. • Aerobics, which generates serotonin, relieves depression. (Hardi et al., 2009) • Boosting serotonin may promote recovery from depression by stimulating hippocampus neuron growth. (Airan et al., 2007 • Not only the brain, but heart also: depression is associated with inflamed heart. (Tangney et al., 2011).

9. Social-Cognitive Perspective • Depressed people view life through the dark glasses of low self-esteem. (Orth et al., 2009) • Learned helplessness is more common in women than in men, and women may respond more strongly to stress. (Mazure et al., 2002) • Women may over-ruminate. Rumination or staying focused on a problem thanks to the continuous firing of the frontal lobe area that sustains attention can be adaptive; relentless self-focused rumination produces negative emotional inertia. (Kuppens et al., 2010). • Fig. 49.5: (m654 c630 15.8)Depression-prone people respond to bad events in an especially self-focused, self-blaming way. (Moor & Winquist, 2002). • 17% of pessimistic collegians had a first episode of depression. (Alloy et al., 1999) Fig. 49.6 on exam.m655 c631 15.9)