Depression versus Mania- euphoric (two different problems with moods)
- People who experience depression also experience mania in their life.
DSM-IV distinguishes two general patterns:
Unipolar – depression only
Bipolar – both mania and depression.
―Normal‖ depression- why do we have depression? Anxiety that is an emotion that’s important but when it’s
excessive and uncontrollable then it becomes pathological, like depression –
―Psychological pain‖- we have pain cause its adaptive- and that pain is a signal o you to protect your
body. Depression has primarily to do with how we are social animals; small groups and we need
support for protection. Evolutionary point of view-depression is like pain when there is a break with
our social connectedness. – As a result from broken relationship.
- Major depression
- Dysthymic disorder (Dysthymia)
- Adjustment disorder with depressed mood** often used when people are experiencing a mild level
of depression following a stress hold event.
- ―Common cold‖
Depression is the leading cause of disability worldwide, according to WHO
Costs more in treatment and lost productivity than anything but heart disease
- Even cancer, depression costs more
Canada – $14.4 billion per year
Treatment, lost productivity
DSM: Major Depressive Episode- the begin by defining the criteria for saying that someone is having
a depressive episode, not a diagnosis yet.
- 5 or more symptoms lasting 2+ weeks
- Most of the day nearly every day
- Mood symptoms (one must be present):
o Depressed mood- MODNED feeling blue, hopeless, discouraged down in the dumps,
o Loss of interest or pleasure in activities (anhedonia)- markly diminished enjoyment in
- Physical symptoms: - vegetative signs
o Significant weight loss or gain- comfort food
o Insomnia or hypersomnia- no sleeping or excessive
o Psychomotor agitation (person is very fidgety, cant stop moving) or retardation (everything
slows down, no expression, no energy to move a muscle)
o Fatigue, loss of energy. —Lack of motivation doesn’t feel like do anything, vicious cycle can
- Cognitive Symptoms:
o Feelings of worthlessness or guilt- neg. feeling about themselves- can come to a point of
delusion. A real loss of contact with reality. – A belief that is clearly not true. A delusion of
guilt that they have done some terrible thing that they cant be forgiven for.
o Diminished ability to think or concentrate- distracted, their work gets inefficient,
indecisiveness o Recurrent thoughts of death, suicidal ideation
- Symptoms cause clinically significant distress or impairment in functioning
- NB – depression is a ―syndrome‖. - Number of symptoms that all go together- include mood, bodily,
biological aspect (weight gain, no sleep) and cognitive symptoms.
Major Depressive Disorder
- Presence of Major Depressive Episode- at least one major depressive episode.
- No history of manic or hypomanic episodes
- Subtypes: Single episode vs. recurrent- they can recover, or it can be recurring – that they’ll have
multiple episodes of depression from time to time, so in that case recurrent major depressive
o Mild, (still able to function daily but takes lots of effort.) moderate, severe without
psychotic features, severe with psychotic features (psychotic symptoms: delusions and
hallucination, people with depression can have a loss of contact with reality. Delusion more
common then hallucinations. )
o Atypical – oversleep, overeat, weight gain, anxiety- too typical
o With Catatonic features – very immobile, rigid curling up in a ball, shutting off the world
o With Melancholic features- high biological basis for this where the person has extreme
o With Postpartum onset- when a women because depressed after having a baby. - Within 4
weeks. Some hormonal changes? Reduction in the progesterone – has an anti-anxiety effect
in the brain.
o With Seasonal pattern. - Depressed during specific times like winter. ** Melatonin
How common is clinical depression?
- In any given year: 1,500,000 Canadians (400,000 people in Ontario)
- At any one time: approximately 6% of women and 3% of men
- Lifetime prevalence: approximately 12% of women and 6% of men
- Prevalence has increased dramatically over the past century- twice as common—western culture**
- WHO: leading cause of disability worldwide
- 2:1 ratio Women: Men some suggest that it might have to do with hormone, genetics or
sociocultural factors, women are more vulnerable to stress, caregiver, lower income
- First episodes usually adolescence or early adulthood, but can happen at any age
- Typically (episodes by depression) precipitated by a severe stressor
- Episodes typically last 6 months to 1 year – avg 9 months, but untreated.
- A person who has one episode of depression will, on average, go on to have 5 or 6 episodes
o 1 episode: 50% risk of a second
o 2 episodes: 70% risk of a third
o 3+ episodes: 90% risk of more
- Variable course: full versus partial remission between episodes.
- Elevated risk of suicide Approx. 15% of people with severe depression commit suicide
o Anxiety disorders (50%) – eg, panic, OCD
o Eating disorders
o Substance abuse
o Borderline personality disorder. - A lot of behavioral and emotional Other Unipolar Depression Diagnoses
- Depressed mood most of the day, more days than not, for at least 2 years
- Problems of appetite, sleep, energy, low self esteem, poor concentration, hopeless feelings
- Tends to be chronic and life-long
- ―Double depression‖ – dysthymia plus major depressive episodes- their mood is always though,
every now and then they’ll have major depressive episodes.
Adjustment disorder with depressed mood (in another chapter)
- Precipitated by an identifiable stressor- not severe enough to be major depression. As a clinician,
you need to have a diagnoses, so this diagnoses is often used, but still clinically significant.
- Can’t have any of the other Axis I disorders
- Lasts less than 6 months.
- Episodes of mania or hypomania
- Typically people with bipolar disorders also have major depressive episodes
DSM Diagnoses (3):
- Bipolar I Disorder – Mania
- Bipolar II Disorder – Hypomania + Major Depression episodes
- Cyclothymia. —―Bipolar‖ Equivalent to dysthymia, going on chronically.
- Abnormal, persistently elevated, expansive (opposite of withdrawal, getting involved and interacting
with people, going up to strangers on the street, animated conversations, consistently talking), or
irritable mood (can become violent) for at least 1 week. With that 3 or more symptoms:
- Three or more other symptoms:
o Inflated self-esteem, grandiosity (special about them, can be delusional)
o Decreased need for sleep
o Pressure of speech- can be very theatrical and dramatic
o Flight of ideas, racing thoughts
o Increased activity, psychomotor agitation
o High-risk pleasurable activities people in a manic state will do things that are very self-