Depression Psychopathology

Learning objectives Describe the clinical characteristics of depression

Background The term ‘depression’ covers a range of experiences Clinical depression is a collection of physical, mental, emotional and behavioural experiences that are prolonged, severe and damaging. Depression is one of several disorders known as ‘mood’ or ‘affective’ disorders.

Two major mood disorders in the DSM-IV Major depressive disorder Bipolar I disorder

How to apply the diagnostic criteria for major depressive disorder According to the DSM-IV Five (or more) of the following symptoms have to be present for the same two-week period (and this must represent a change of behaviour). At least one of the first two symptoms (depressed mood or loss of interest or pleasure is included in these).

Diagnostic criteria Depressed mood for most of the day, nearly every day Reported by the person or by others In children and adolescents, this can be an irritable mood.

2 Markedly diminished interest or pleasure in all (or almost all) activities most of the day, nearly every day Reported by the person or by others

3 Significant weight loss, when not dieting, or weight gain (e.g. change of more than 5% of body weight in a month), or a decrease in appetite nearly every day. In children, failure to make expected weight gains.

4 Insomnia or hypersomnia.

5 Psychomotor agitation or retardation nearly everyday Observable by others, not just subjective report.

6 Fatigue or loss of energy nearly every day.

7 Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day Not just self reproach or guilt about being sick.

8 Diminished ability to think or concentrate, or indecisiveness, nearly every day Either by subjective account or by others.

9 Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan or attempt to commit suicide.

10 In addition, the symptoms: Cause clinically significant distress or impairment in social, occupational or other important areas of functioning Are not due to the direct physiological effects of a substance or medication Are not better accounted for by bereavement.

The DSM-IV includes Dysthymic disorder Fewer, milder symptoms present for over two years. As well as the symptoms of major depression, there are symptoms of pessimism: Low self-esteem Low energy Irritability Decreased productivity

Depressive disorder not otherwise specified Premenstrual dysphoric disorder – depressive symptoms occur regularly towards the end of the menstrual cycle – severe enough to interfere with work, school or other usual activities. Minor depressive disorder- episodes of at least two weeks of depressive symptoms, but with fewer than five of the items Recurrent brief depressive disorder- episodes lasting from two days to two weeks and occurring at least once a month for a year (but not associated with the menstrual cycle).

About the disorder Smith and Weissman (1992) Reviewed a sample of studies Rates of depression in Europe range from 4.6. – 7.4% US survey found 4.9% in the US If dysthymic disorder included this rises by 2 – 4 %. This makes depression the most common mental disorder

About the disorder Most common age of onset Late adolescence or early adulthood On the increase in young people Not clear why More common in women 2:1 Considerable variation in length of depressive episodes. Most major depressions disappear eventually whether treated or not. Most individuals recover within a period of 4 -6 months Relapse and recurrence are fairly common Coryell et al. 1994

3 main areas of impaired functioning Work Parent/child relationship Marital relationships Even relatively mild depression can interfere in these areas. Can be potentially fatal. 10 -15% kill themselves (Clark and Fawcett, 1992) But the high mortality rate can be due to accidents or other medical problems…maybe because depressives do not seek treatment and are more accident prone. Depression may also affect the immune system (Evans et al. 1992)

KEY POINTS Depression is a mood disorder found with similar frequency all over the world. Major depressive disorder is characterised by sadness and lack of interest or pleasure in everyday activities. Individual have to show a range of symptoms for a prolonged period for a diagnosis. Depression can affect all ages, but is on the increase in young people. A number of issues surround the classification and diagnosis of depression. There is overlap with some other disorders and it is also likely that there are different sub-types but not all are seen as valid. There are slight cultural and gender differences which can get in the way of accurate diagnosis.

Summary questions 1. What is meant by the term ‘unipolar disorder’? 2. Briefly outline the main clinical characteristics of major depressive disorder. 3. Why can depression be seen as a potentially fatal disorder?