1 Depression Symptoms of Depression o Anhedonia Losing interest in everything In life o Change in sleep Others want to sleep all day Some suffer from insomnia o Change in appetite Do not eat Binge Eat and quietly fidget aimlessly o Psychomotor retardation They walk more slowly gesture more slowly and talk more slowly o Lack Energy and feel chronically fatigued o Psychomotor agitation They feel psychically agitated cannot sit still and may move around or o Trouble concentrating and making decisions o Thoughts are filled with themes of suicide guilt hopelessness and worthlessness o Lose touch with reality Experience delusions beliefs with no basis in reality Hallucinations seeing hearing or feeling things that are not real Diagnosing Depressive Disorders Two types of unipolar depression 1 Major Depression 2 Dysthymic disorder Major Depression o Must experience either depressed mood or loss of interest in usual activities plus at least four other symptoms of depression chronically for at least two weeks People who experience only one depressive episode receive diagnosis of major depression single episode Two or more episodes sepearted by at least 2 months without symptoms merit the diagnosis of major depression recurrent o Symptoms must be severe enough to interfere with the person s ability to perform everyday functions Dysthymic disorder less severe than major depression but more chronic o A person diagnosed with dysthymic disorder must experience depressed mood plus two of the following symptoms for at least 2 years A Poor appetite or overeating Insominia or hypersomnia B C Low energy or fatigue D Low self esteem 2 Subtypes of depression their lives prominent E Poor concentration or difficulty making decisions F Feeling of helplessness o During these two years the person must never have been without the symptom of depression o Double Depression When individuals with dysthymic disorder also experience episodes of for longer than a 2 month period major depression intermittently Major Depression Dysthymic disorder o Lasting more than two years may fall under the proposed diagnosis chronic depressive disorder o 70 of people diagnosed with either have another psychological disorder at the same time in Substance abuse eating disorders panic disorders and anxiety disorders 1 Depression with melancholic features the physiological symptoms of depression are particularly 2 Depression with psychotic features people experience delusions and hallucinations during a major depressive episode 3 Depression with catatonic features show the strange behaviors collectively known as Catatonic which can range from a complete lack of movement to excited agitation 4 Depression with atypical features odd assortment of symptoms 5 Depression with postpartum onset given to women when the onset of a major depressive episodes occurs within 4 weeks of delivering a child 6 Depression with seasonal pattern Seasonal affective disorder or SAD they become depressed when the daylight hours are short but recover when the daylight hours are long a In order to be diagnosed the person s mood changes cannot be a result of psychological events b More common in latitudes with fewer daylight in the winter months 7 Premenstrual dysphonic disorder describe women who frequently have significant increase in distress symptoms prior to menstruation Prevalence and Course of Unipolar Depressive Disorders o 16 of Americans experience episodes of major depression o In the U S 18 29 yr olds are most likely to have major depressive episodes in the past year o Depression is low among adults over age 60 The diagnosis is difficulty with older adults They are less willing to report symptoms because they grow up in a time where depression was less accepting Depressive symptoms often occur in the context of a serious medical illness interfering with the diagnosis Older people are more likely to have mild to severe cognitive impairment and it is often difficult to distinguish between a depressive disorder and an early stage of a cognitive disorder 3 Explanation Older people learn how to cope and have a psychologically healthier outlook on life o Less common among children than among adults o 24 percent of youth will experience an episode of major depression before the age of 20 o 75 percent of people who experience a first episode of depression will experience subsequent episodes symptoms alone o People who are depressed lose an average of 27 days of work per year because of their o Depression in workers cost employers an estimated 37 billion per year in lost productivity o Most people with depression never seek care They may lack insurance or the money to pay for care They expect to get over their symptoms on their own They believe that the symptoms are simply a phase that will pass with time and won t affect their lives over the long term Theories of unipolar depression Biological Theories 1 Genetic factors o Family history studies find that first degree relatives of people with unipolar depression are two to three times more likely to also have depression o There is higher concordance rates for monozygotic twins than dizygotic o Depression that begins early in life appears to have a stronger genetic base than depression that begins in adulthood o Studies suggest that the types of genes responsible for depression may differ in women o Abnormalities on the serotonin transporter gene could lead to dysfunction in the and men regulation of serotonin Could affect the stability if individuals moods Abnormalities in the STG were at increased risk for depression when they faced 2 Neoutransmiter Theories negative life events o The NT that are often implicated in depression are monoamines Norepinephrine serotonin and to a lesser extent dopamine o These NT are found in the limbic system Brain area associated with regulation of sleep appetite and emotional processes o Abnormalities in the synthesis of serotonin and norepinephrine may contribute to o The release process of the pre synaptic cell regulated by the serotonin transporter gene may be abnormal in depression o The receptors for these two NT may be less sensitive than normal people or may depression malfunction 3 Brain abnormalities 4 o Prefrontal cortex attention short term memory planning and problem solving Many studies show reduced metabolic activity and a reduction in volume of gray matter in the prefrontal cortex Lower brain activity in the left side of the PFC which is involved in
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