Dr. Johnson Alex College of Medicine, DAU Depression Dr. Johnson Alex College of Medicine, DAU Depression 7/4/2019

Objectives At the end of the class students should be able to Define the depression disorder Explain the symptoms of depression Describe the etiology and management of depression Depression 7/4/2019

Mood Disorders Two key emotions : Depression: Low, sad state in which life seems dark and its challenges overwhelming Mania: State of breathless euphoria or frenzied energy Clinical depression is one of the most common and debilitating of the psychiatric disorders. Lifetime prevalence has been estimated at 16.2% and rates of comorbidity and risk for suicide are high. Depression 7/4/2019

How Common Is Depression? Around 8% of adults in the U.S. suffer from severe unipolar depression in any given year As many as 5% suffer from mild forms Around 19% of all adults experience unipolar depression at some time in their lives The prevalence is similar in Canada, England, France, and many other countries The rate of depression is higher among poor people than wealthier people People of any age may suffer from unipolar depression Women are at least twice as likely as men to experience severe unipolar depression Lifetime prevalence: 26% of women vs. 12% of men Among children, the prevalence is similar among boys and girls Approximately 85% of people with unipolar depression recover, some without treatment Around 40% will experience another episode later in their lives Depression 7/4/2019

Prevalence of Depression in Saudi Arabia Conducted study from 2000 to 2002 among 632 patients Frequency of depressive disorders were 19.3 % and the age group between 20-49 Female Male ratio was 1.7: 1 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3425766/ Depression 7/4/2019

What Are the Symptoms of Depression? Emotional symptoms Feeling “miserable,” “empty,” “humiliated” Experiencing little pleasure Motivational symptoms Lacking drive, initiative, spontaneity Between 6% and 15% of those with severe depression die by suicide Behavioral symptoms Less active, less productive Cognitive symptoms Hold negative views of themselves Blame themselves for unfortunate events Pessimistic Physical symptoms Headaches, dizzy spells, general pain Five main areas of functioning may be affected: Symptoms may vary from person to person Depression 7/4/2019

Depressive Disorders (Based on DSM-V Classification) Disruptive mood dysregulation disorder Major depressive disorder Persistent depressive disorder (dysthymia) Premenstrual dysphoric disorder Substance/medication-induced depressive disorder Depressive disorder due to another medical condition Other specified depressive disorder and unspecified depressive disorder Depression 7/4/2019

Disruptive Mood Dysregulation Disorder Severe recurrent temper outburst manifested verbally (e.g. verbal rages) and behaviorally (physical aggression toward people) The temper outbursts are inconsistent with developmental level. The temper outbursts occur, on average, three or more times per week. The mood between temper outbursts is persistently irritable or angry most of the day, nearly every day, and is observable by others (e.g., parents, teachers, peers). Criteria A-D have been present for 12 or more months Throughout that time, the individual has not had a period lasting 3 or more consecutive months without all of the symptoms in Criteria A-D. Criteria A and D are present in at least two of three settings (i.e., at home, at school, with peers) and are severe in at least one of these. The diagnosis should not be made for the first time before age 6 years or after age 18 years. By history or observation, the age at onset of Criteria A-E is before 10 years. There has never been a distinct period lasting more than 1 day during which the full symptom criteria, except duration, for a manic or hypomanic episode have been met. Depression 7/4/2019

Major Depressive Disorder Depression 7/4/2019

Persistent Depressive Disorder (Dysthymia) Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years. Presence, while depressed, of two (or more) of the following: 1. Poor appetite or overeating. 2. Insomnia or hypersomnia. 3. Low energy or fatigue. 4. Low self-esteem. 5. Poor concentration or difficulty making decisions. 6. Feelings of hopelessness. Depression 7/4/2019

Persistent Depressive Disorder (Dysthymia) During the 2-year period (1 year for children or adolescents) of the disturbance, the individual has never been without the symptoms in Criteria A and B for more than 2 months at a time. Criteria for a major depressive disorder may be continuously present for 2 years. There has never been a manic episode or a hypomanic episode, and criteria have never been met for cyclothymic disorder. The disturbance is not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder. The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g. hypothyroidism). The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Depression 7/4/2019

Premenstrual Dysphoric Disorder In the majority of menstrual cycles, at least five symptoms must be present in the final week before the onset of menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week postmenses. One (or more) of the following symptoms must be present: 1. Marked affective lability (e.g., mood swings: feeling suddenly sad or tearful, or increased sensitivity to rejection). 2. Marked irritability or anger or increased interpersonal conflicts. 3. Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts. 4. Marked anxiety, tension, and/or feelings of being keyed up or on edge. Depression 7/4/2019

Premenstrual Dysphoric Disorder C. One (or more) of the following symptoms must additionally be present, to reach a total of five symptoms when combined with symptoms from Criterion B above. 1. Decreased interest in usual activities (e.g., work, school, friends, hobbies). 2. Subjective difficulty in concentration. 3. Lethargy, easy fatigability, or marked lack of energy. 4. Marked change in appetite; overeating; or specific food cravings. 5. Hypersomnia or insomnia. 6. A sense of being overwhelmed or out of control. 7. Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of “bloating,” or weight gain. D. Clinically significant distress in work, school, usual social activities or relationship with others E. Not related to other disorders or attributable to physiological effects of a substance Depression 7/4/2019

Etiology of Depression Genetic factors- 37% MDD & Higher for women than men Neurotransmitters MDD- low levels of norepinephrine, dopamine, and serotonin Depression 7/4/2019

Etiology of Depression Brain structure – diminished activity of prefrontal cortex, anterior cingulate, hippocampus and amygdala Brain Imaging Structural studies- Focus on number of or connections among cells Functional activation studies- Focus on activity levels Over activity of HPA axis- release of cortisol (stress hormone) Depression 7/4/2019

Etiology of Depression Life events- death of close relative, separation, divorce, migration etc. Lack of social support from family/society Interpersonal problems and difficulties Behavior theory- learned helplessness, attributional reformulation, & Hopelessness Cognitive theory (Aron T. Beck) Negative triad (negative view of self, world, and future) Negative schema (based on the past experience) and Cognitive biases (negative automatic thoughts) Depression 7/4/2019

Cognitive biases Overgeneralization- making sweeping conclusion based on a single event. (E.g. my friend is not spoke to me yesterday, because he is hating me broke the friendship. Selective abstraction- Drawing conclusions on the basis of just one of many elements of a situation. Personalization- attributing personal responsibility for events which are not under a person’s control Minimization- downplaying the importance of positive thought, emotion or event. Magnification- blowing things out of proportion Arbitrary inference- drawing conclusion when there is little or no evidence Depression 7/4/2019

Thank you Depression 7/4/2019