DEPRESSION
Dysthymic disorder: persistent poor mood for 2 years.
Cyclothymic disorder: 2 years of alternating withdrawal / exuberance
Endogenous/psychotic: severe symptoms (especially physical), onset originally not linked to a life event -
comes from within the person - but research now suggests a life event can be found for most people
Neurotic/reactive: onset linked to an unpleasant event
Clinical depression is the ‘common cold of psychiatry’ (Seligman, 1975)
Everyone experiences low mood at some point in their life, so how do we distinguish between everyday
sadness and clinical depression? A specific cluster of symptoms with impact on everyday life and
functioning
Symptoms = emotional/affective, physical/somatic, cognitive, behavioural
Consequences on social life, relationships, work, everyday activities
Hard to get overall prevalence – can’t pool across studies as they use different measures of depression or
different populations
But lifetime prevalence for major depression is around 5.2-17.1%
rd
It’s the 3 most common reason to visit your GP
Women more prone than men - or are women more likely to report symptoms? Maybe men distract
themselves? Women more stressed? Men cant admit to being depressed? Hormone differences?
Women have earlier onset and a greater likelihood of recurrent depression
Severe depression is life threatening, 15% commit suicide, 40% attempt suicide
Co-morbidity with other mental illnesses - anxiety - specifically PTSD, GAD, specific phobias
Alcohol/drug use associated with depression
Common age of onset - adolescence or early adulthood
Duration:
- Most episodes recover within 4-6 months
- Recurrence common
- 25% last less than one month, 50% less than 3 months, 15-39% continue to one year, 22% two years
(Williams, 1997)
- Relapse - 20% 2 months, 30% 6 months, 40% in first year, 50% by second year
Classification of Depression
- Use DSM-IV or ICD-10
- Either unipolar / bipolar
- Major depressive episode / dysthymic disorders
- Major depression: A psychological problem characterised by relatively extended periods of clinical
depression which cause significant distress to the individual and impairment in social or occupational
functioning.
, Carr & McNulty (2006):
Risk factors: childhood adversity, loss of a parent, personality traits, attributional style
Maintenance factors: once depressed, make depression persist - environmental stress, low activity,
low social interactions or relationships
Protective factors: positive early relationship with adult in childhood, high IQ, social support,
problem solving, functional coping strategies
Strongest predictor of depression is past depression
Assessment
Types:
1) Screening - a large number of people to see who is at risk and who should be studied further
2) Diagnosis - clinical
3) Measures from which to monitor change
4) Determine suitability of patient for treatment
5) Assess suicide risk
DSM-IV:
5 or more symptoms for at least 2 weeks, include depressed mood or loss of interest/pleasure:
• Depressed mood most of the day nearly every day
• Loss of interest or pleasure
• Significant weight loss or weight gain
• Insomnia or hypersomnia
• Psychomotor agitation or retardation
• Fatigue or loss of energy
• Feelings of worthlessness or excessive guilt
• Diminished ability to think or concentration
• Recurrent thoughts of death or suicidal ideation
Types of assessment:
1. Clinical interviews
2. Self report
3. Observations
4. Functional analysis
Clinical interview and self report most commonly used
Structured Interview:
- DSM-IV or ICD
Dysthymic disorder: persistent poor mood for 2 years.
Cyclothymic disorder: 2 years of alternating withdrawal / exuberance
Endogenous/psychotic: severe symptoms (especially physical), onset originally not linked to a life event -
comes from within the person - but research now suggests a life event can be found for most people
Neurotic/reactive: onset linked to an unpleasant event
Clinical depression is the ‘common cold of psychiatry’ (Seligman, 1975)
Everyone experiences low mood at some point in their life, so how do we distinguish between everyday
sadness and clinical depression? A specific cluster of symptoms with impact on everyday life and
functioning
Symptoms = emotional/affective, physical/somatic, cognitive, behavioural
Consequences on social life, relationships, work, everyday activities
Hard to get overall prevalence – can’t pool across studies as they use different measures of depression or
different populations
But lifetime prevalence for major depression is around 5.2-17.1%
rd
It’s the 3 most common reason to visit your GP
Women more prone than men - or are women more likely to report symptoms? Maybe men distract
themselves? Women more stressed? Men cant admit to being depressed? Hormone differences?
Women have earlier onset and a greater likelihood of recurrent depression
Severe depression is life threatening, 15% commit suicide, 40% attempt suicide
Co-morbidity with other mental illnesses - anxiety - specifically PTSD, GAD, specific phobias
Alcohol/drug use associated with depression
Common age of onset - adolescence or early adulthood
Duration:
- Most episodes recover within 4-6 months
- Recurrence common
- 25% last less than one month, 50% less than 3 months, 15-39% continue to one year, 22% two years
(Williams, 1997)
- Relapse - 20% 2 months, 30% 6 months, 40% in first year, 50% by second year
Classification of Depression
- Use DSM-IV or ICD-10
- Either unipolar / bipolar
- Major depressive episode / dysthymic disorders
- Major depression: A psychological problem characterised by relatively extended periods of clinical
depression which cause significant distress to the individual and impairment in social or occupational
functioning.
, Carr & McNulty (2006):
Risk factors: childhood adversity, loss of a parent, personality traits, attributional style
Maintenance factors: once depressed, make depression persist - environmental stress, low activity,
low social interactions or relationships
Protective factors: positive early relationship with adult in childhood, high IQ, social support,
problem solving, functional coping strategies
Strongest predictor of depression is past depression
Assessment
Types:
1) Screening - a large number of people to see who is at risk and who should be studied further
2) Diagnosis - clinical
3) Measures from which to monitor change
4) Determine suitability of patient for treatment
5) Assess suicide risk
DSM-IV:
5 or more symptoms for at least 2 weeks, include depressed mood or loss of interest/pleasure:
• Depressed mood most of the day nearly every day
• Loss of interest or pleasure
• Significant weight loss or weight gain
• Insomnia or hypersomnia
• Psychomotor agitation or retardation
• Fatigue or loss of energy
• Feelings of worthlessness or excessive guilt
• Diminished ability to think or concentration
• Recurrent thoughts of death or suicidal ideation
Types of assessment:
1. Clinical interviews
2. Self report
3. Observations
4. Functional analysis
Clinical interview and self report most commonly used
Structured Interview:
- DSM-IV or ICD
