Changes in the structure of
the brain associated with
depression
Changes in
hormones and
inflammatory
responses
Sleep
Some evidence
suggests sleep
problems precede
depression
Cognitive
Depressive schemas
Maladaptive beliefs
Information
processing (attention/memory)
negatively biased
Rumination
Negative
automatic
thoughts
Pessimism
Social
Early experiences
developing schema
(negative triad - self,
world, future
Attachment and temperament
Social support (family
experiences, intimate
relationships)
Assessment and Diagnosis
Cognitive Behavioural Theory
Conducted on immediate experience
Identify affective
responses, cognitions
during events, and
behavioural responses
Further assessment
may be conducted on
past events
Context for developing schemas
Patterns of thinking established early in life
Behavioural responses
based on past experiences
Clinical Tools
DSM5
Interviews and
questionnaires
ICD-10
Case history
and context
BIPOLAR AND RELATED DISORDERS
Bipolar I disorder: manic preceded or followed by MDE
Bipolar II disorder: hypomania preceded or followed by MDE
Substance induced Bipolar and related disorders
Bipolar and related disorders due to medical condition
Depressive Disorders
Disruptive dysregulation mood disorder
Severe recurrent
temper outburts
manifested
verbally and/or
behaviourally that
are grossly out of
proportion in
intensity or
durations to the
situation ("rages")
Major Depressive Disorder
Five or more of the following
symptoms present for two
weeks and present a major
change in functioning
Depressed mood
Diminished
interest in pleasure
Significant weight
loss/change
Sleep distrubance
Psychomotor
agiitation (noticed
by oithers
Feelings of worthlessness or guilt
Dimiinished ability to think
Recurrent thoughts of death/suicidal ideation
Suicidal ideation is a fearture of a number of disorders
Suicidal behaviours can result from symptoms other
than depressed mood
Psychotic symptoms (delsuions and hallucaintions)
Persistent Depressive
Disorder (Dysthymia)
Depressed mood for most of
the day, more days than not,
for at least 2 years
Double depression
Post Natal Depression
Affects 14% of women
who give birth
Neuroticism and
introversion associated
with 4-6x risk
Severe repercussions for mother
and baby if left untreated (long
term implications)
Special populations
Adolescents
Critical period for
vulnerability to
depression 15-18
years
Risk of depressed
symptoms rises
14-15 years
Low mood or
dysthymic
disorder prior to
age 21 lasts
longer/ more
treatment
resistant
Symptoms similar to
adult presentation
Risks at this time: bullying,
peer group isolation, problems
at home, illness
Men
Lower rates than women but less
likely to seek help
Higher risk for
suicide
Australian men in rural settings
have higher rates of suicide
compared to metro men
Elderly
6-15% suffer from MDD
and more from milder
forms
Aypical
presentations inc.
somatic
symptoms
Depression and Relationships
Interactional
Nature of
Depression (Coyne)
Negative reassurance
seeking behaviours place
strain on interpersonal
relationships
Self-verification Theory
Individuals with negative
views solicit negative
information about themselves
Confirming feedback more comforting this nonconfirming feedback
Treatment
IPT
Three stages
History of links b/w
depressive symptoms
and interpersonal
problem areas
Identify
interventions
focusing on
problem areas
Maintenance and
preparing for
independence from
treatment
Efficacy
In 16 weeks IPT as effective as antidepressants
More effective than CBT in severely depressed individuals