1. Unipolar Depression 1 in 5 Americans experience it at some point in their lives 1 in 20 Americans are severely depressed at any time. Women more frequently depressed than men - particularly in developed world - Why? (we don’t really know), but possibly because women ruminate -focus on feelings- whereas men distract Info about depression: http://www.med.umich.edu/depression/ipt.htmhttp://www.med.umich.edu/depression/ipt.htm

2. DSM-IV Criteria for Major Depressive Episode Present nearly every day for 2 weeks: 1.Depressed mood (sad or empty) 2.Loss of interest 3.Significant weight change (5% in 1 month) 4.Insomnia or hypersomnia 5.Psychomotor agitation or retardation 6.Fatigue or loss of energy 7.Worthlessness or inappropriate guilt 8.Loss of concentration or indecision 9.Recurrent thoughts of death or suicide → 5 of 9 criteria required → Rule out: drugs or medical factors → Rule out: bereavement in 2 months

3. physicalmental diagnosis: mononucleosis depression syndrome: -symptomsfatiguesad mood sore throatanhedonia -signsfeverweight loss white cell countmotor retard etiology: virus ???

4. Course of depression Depression often dissipate in 5-10 months, even without treatment. –50% will never have it again –40% will reoccur. –10% stay acutely depressed. The best predictor of future depression is past depression

5. Copyright © Allyn & Bacon 2009 Explanations for Major Depressive Disorder Life events – stressful events that represent loss are closely tied to depression Interpersonal model – depressed people seek excessive reassurance which leads them to being disliked and rejected Cognitive model Depressive thinking style - Negative thoughts about self, the world and one’s future Atttribution Bias: ‘I failed because I am stupid’ (dispositional) - ‘I did well because the test was easy’ (situational) Behavioral model - Depressive spiral : While depressed, we withdraw from pleasurable activities Genetics: low levels of serotonin receptors (?).

6. Explanations for Major Depressive Disorder Learned helplessness – tendency to feel helpless in the face of events we can’t control

7. Depression: Neural changes Change activity in – ventral frontal, –midfrontal, –dorsolateral prefrontal – amydgala

8. Depressive thinking style: negative cognitive triad Negative view of the future Negative view of the self Negative view of the world (developed by Aaron Beck):

9. Depressive thinking style: Cognitive biases Distorted thinking: -emotional reasoning (if I feel stupid, I must be stupid), -Personalization (self blame: “its my fault”). Causal attribution bias for negative events –Internal (blame self) –Globalization (see it affecting many areas of life) –Stable (it will last forever) People with negative cognitive style diagnosed before the first episode are at higher risk of developing depression (Alloy et al., 1999)

10. Cognitive Behavioral theory Goal: to reduce depressive thinking style How? Identify the themes in negatives thoughts and their triggers; Challenge the negative thoughts: –what is the evidence for it? - Are there other ways to look at it? -How can you cope? help patient to recognize the negative beliefs/assumptions change aspects of the environment (bad things in depressed people lives) teach manage the mood

11. Depression: Treatment First line of attack: Cognitive behavior therapy (CBT) -Challenge and change patient’s faulty beliefs (e.g., depressive thinking style -Rapport between patient and therapist is very important (therapeutic alliance) Pharmacotherapy: SSRI, acts upon serotonin system CBT reduces likelihood of relapse (without CBT, if stop SSRIs, highly likely there will be relapse) * Interpersonal therapies provide an alternative to CBT (less studied)Interpersonal For resistant cases: Repeated Transcranial Magnetic Stimulation Electroconvulsive therapy Deep Brain stimulation

12. Suicide How damaging? 3rd leading cause of death among young (age 15-34) after accidents and homicide. Risk factors: - coming out of depression (too hard to plan when really down) - paranoid schizophrenia Who does it? In our culture: -women attempt more than men, but -men are more succuessful women (guns vs. pills) Why do they do it? -To escape from self (& associated pain) -Feel none needs them (less likely for single mom of little kids to commit suicide) -Not for attention (only 15%)

13. What should you do if friend talks about suicide? Most suicide victims give cues beforehand Take it seriously. Don’t be afraid to ask if friend is feeling suicidal – you will not “give them idea” Don’t leave them alone; listen unjudgmentally You are NOT qualified to “talk them out” of it. Call a health professional Don’t worry about being embarrased (better safe than sorry)

14. Copyright © Allyn & Bacon 2009 Bipolar Disorder Manic episode – experience marked by dramatically elevated mood, decreased need for sleep, increased energy, inflated self-esteem, increased talkativeness, and irresponsible behavior Bipolar disorder – condition marked by a history of at least one manic episode –More than half the time a major depressive episode precedes or follows a manic episode –Very heritable (perhaps around 85%) –Increased activity in amygdala (associated with emotions), decreased activity in prefrontal cortex (associated with planning) –Increased risk of suicide (as with major depression)