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Depression (Neurobiology (Genetic vulnerability (short variant of 5-HTTLPR…
Depression
Neurobiology
Hypersensitive/Hyperactive amygdala
hypoactive prefrontal regions
genetic polymorphisms involved in the overreaction to stress
Genetic vulnerability
short variant of 5-HTTLPR ( serotonin transporter) gene
interaction with low social support, life stressors
HPA axis engaged: secretion of excessive stress hormones eg. cortisol
depletion of serotonin increases cognitive reactivity
reduced amygdala coupling with OFC & dl PFC
dysfunctional engagement of right PFC + lack of engagement of the left lateral ventral medial prefrontal circuitry (important for down-regulation of amygdala responses to negative stimuli)
Prevention
e-mental health, smart phones, internet technologies, booster sessions
incorporate economic analysis of costs & benefits
Which type of prevention is associated with the best value for money?
producing more enduring effects
universal: directed toward the whole population
indicated: directed toward those with subsyndromal symptoms
selective: directed toward high-risk groups
can reduce MDD by 25% and by 50% if done stepped-care
Risk & Prognostic Factors
Environmental: adverse childhood experiences, stressful events
40% heritability but mostly due to neuroticism trait
Temperamental: neuroticism
negative cognitive biases & dysfunctional beliefs
presence of cognitive reactivity before stressful life event
cognitive vulnerability
Cognitive model
diminished cognitive appraisal
Cross sectional model
dream content: less hostility, themes of loss, rejection etc, dreamer represented as diseased --> same themes as patient's conscious cognitions but more exaggerated
systematic cognitive bias in info processing --> selective attention to negative aspects, negative interpretations, blocking of positive events & memories
absolute negative beliefs about the self "I am a failure"
global negative perception of reality
continuous feedback loop with negative interpretations & attention biases --> symptoms reinforcing each other
Developmental model
parental loss in childhood
combination of loss in childhood + loss in adulthood
early life stress sensitizes individuals to later negative events (impact on cognitive vulnerability)
schemas become activated
"kindling effect"
mode
connections among negatively oriented schemas e.g.. motivational, behavioral etc. become strengthened over time
the fully activated --> autonomous, no longer reactive to external stimuli --> positive events don't reduce negative thinking, mood
negatively biased cognitive schemas are automatic, rapid, involuntary BUT cognitive control system is attenuated during depression (effortful)
depression occurs when negatively biased associative processing is uncorrected by reflective processing
DSM V Diagnostic Criteria: Depressive Disorders, especially Major Depressive Disorder
5 or more symptoms present during 2-week period. At least one of the symptoms is either depressed mood or loss of interest/pleasure
eg. weight loss/weight gain, insomnia, psychomotor agitation, fatigue, feelings of worthlessness, guilt, diminished ability to concentrate, thoughts of death
never a manic episode
specify: with anxious distress, mixed features, melancholic features, atypical features, catatonia etc.
associated features supporting diagnosis: tearfulness, irritability, anxiety, phobias, excessive worry about physical health, complaints of pain
Depressive symptoms can be useful?
Goal adjustment
depressive symptoms may enable people to adjust to unattainable goals --> promotes quality of life
development of goal adjustment capacities: goal disengagement (supported) & goal reengagement (not supported)
depressive mood is associated with more realistic perceptions of the environment
abandoning a desired goal can be adaptive if the goal is no longer attainable
depressive symptomatology explained ca. 21% of the variance in change in goal disengagement capacities over time
linear decline in depressive symptomatology if increases in goal disengagement
Adaptation for analyzing complex problems
Analytical rumination hypothesis: depression is an evolved response to complex problems
depressed mood promotes analytical reasoning style: greater attention paid to detail, information is processed more slowly & in smaller chunks
prioritized access to problem-related information
Prevalence: 12-month 7% mostly 18-29 years old
higher in females but lower risk for suicide completion
Treatment
Psychotherapy