lecture 9 * PDD*

depression on a continuum as we cannot empirically define it

" normal state"

being sad and gloomy

one out of two core symptoms ( 2 weeks )

1. depressed mood
2. loss of interest
3. at least 4 other symptoms

1. problems with appetite
2. problems with sleeping
3. agitation or inhibition
4. tired , loss of eenrgy
5. felling worthless , blame
6. loss of focus , indeciveness
7. thinking about deaths

poor focus , indiciseveness , low slef esteem , hoplesness, suicidal thoughts , delusions

disturbed sleep and apetite , psychomotor problems , catatonia , fatiuge , amesia

sadness , depressed moods , loss of interests, irritability

1. Majour depressive disorder
2. Persistant depresive disorder ( dysthamia)
3. Minor depression
4. Bipolar disorder

1. MDD → at least 2 weeks, at least 5 symptoms
2. PDD → at least 2 years, 2-4 symptoms
3. MD → at least 2 weeks , 2-4 symptoms
4. BD→ additional manic episodes

1. with vital characteristics
2. with psychotic charateristics
3. with katatonic characterisitcs
4. with atypical charcteristics
5. with postpartrum begining
6. with seasonal pattern

not expirincing plesure, different qulity dperession, worse in morning, wake up early, psychomotor inhibition/agitation, anorexia or extreme weightloss, feeling guilty

dellusions or halluciantions ( blame, illness, deathdeseve punsiment)

motioric immobility, hypermobility, bizare postures, resistence to movement

positive mood after event, larger appetite or wainweight, too much sleep, tired, sensitivity towards rejection

within 4 weeks after chilfbirth

reccuring depression during 2 years in a specific season ( winterdepression )

depression is the most important predictor of sucide

the majority of people with depression are not suicidal

sucicdaly is associated with most mental disorders ( borderline )

suicidality can best be seen as a separate problem that often co occurs

suicidality is an important clinical indicator for treatment

4.4 % - 5% of the world's population had MDD in the past 12 months
the average duration of an episode in 6 months

lifetime prevalence 10.6%most disorders remit within a year , but 12 - 34% have chronic disorder

higher recurrence rates 27% about twice as much women than in men

high comorbidity : especially anxiety disorders , substance use personality disorders

help seeking is low ( 7%-28%) )

toddlers → 1%

promary school age → 1% to 2%

adloescence → 5%

younf adults → 7.2%

median age of onset : 26 (17-37) in high income countries and 24( 17-35) in low and middle income countries )

genetics

prenatal factors

early life trauma

parental depression

cognitive styles

stresfull life events

vulnerability : psychological and biological

1. behavioural theroies
2. psychologcal theories
3. stress vulnerability theories

1. genetics
2. dysregulation of neurothranmitters
3. brain abnormaities
4. hormonal factors

1. behaviourla theory
2. cognitive theory
3. psychodynamic theory
4. interpersonal theoruy

reduce symptoms

improve quality of life, reduce impairment

shorten episodes

prevent recurrence

1. watchful waiting
2. supportive management
3. psycholocal treatments
4. medication
5. other treatments

*electroconvusive therapy (ECT)

*transcranial magnetic stimulation (TMS)

*light therapy ( in seasonam mood disorder )

*complementary and alternatice medicine (CAM)

*exercise

1. several types :

*SSRI ( selctive serotinine reuptake inhibitor)

*SNRIs ( serotonine and neopinephrine reuptake inhibitor )

*TCAs ( tricyclic antidepressants )

1. storng placeo effect ( 38% respond after placebo , 52% after medication )
2. not advised in children and adolescence ( may increase suicidal rates )
3. combination with psuchotherapy is more effective and reduce drop out)
4. some side effects : sucicidality, agitation , irritability , sleep problems , weight gain, gastorintestinal , sexual problems

cognitive behavioural therapy

interpersonal hterapy

behavioural activation

problem solving therapy

effects are moderate to large

considerably overestimated behacuse of problems of randomaized trials examining effects

effects are measured in "Standardized Mean Difference " (SDM) indicating the difference between treatment and untreated control group in terms of standard deviations : 0.2 is small, 0.5 is moderate, 0.8 is large

331 trials with 34.285 patients

BT,IPT, psuchodynamics, PST, behavioural activation , life review, 3rd wave therapies, counsling vs each other and or versus CAU, waitlist, pill placeo

Hedes'g varies from 0.32 to 0.81 (CAU as refernece )

no significant difference between therapies ( except counsiling )

also in studies with low risk of bias

significant effect as 12 month follow up comparend to care as usual

PST had somewhat higher longer efficacy

most patients prefer psychotherapy ( 75%)

at the short term the effects are comparable

combined treatment is more effective then either psychopherapy or pharmacotherapy alone

at the longer term, probably psychotherapy is better

psychotherapy at least (CBT) works also in severe depression

1. depression is the msot important mood disorder

1. high prevalance, cost , burden of dieses
2. etiology is largely unknown
3. prevention may be possible in some cases
4. effective tretments are available but effect are modest
5. psychological interventions ar eimportant first line tratments