Level of analysis
Depression as a symptom
Depression as a syndrome
Depression as a disorder
Dimensions of Depressioncognitive
Categoriesmajor depressive disorder major depressive episode dysthymic disorder depressive disorder NOS bipolar disorder manic episode cyclothymic disorder hypomanic episode bipolar disorder NOS mood disorder due to a general medical condition substance-induced mood disorder mood disorder NOS
DepressionA.At least one of the following three abnormal moods which significantly interfered with the person's life:1. Abnormal depressed mood most of the day, nearly every day, for at least 2 weeks.2. Abnormal loss of all interest and pleasure most of the day, nearly every day, for at least 2 weeks.3. If 18 or younger, abnormal irritable mood most of the day, nearly every day, for at least 2 weeks.
Major Depressive Disorder Persists for two weeks and causes significant personal distress or functional impairment.
Major Depression: 5 of 9 symptoms, which must include either: 1. Depressed mood or 2. Anhedonia.
Major Depression Diagnostic Criteria (contd)B.At least five symptoms have been present during the same 2-week period.1. Abnormal depressed mood (or irritable mood if a child or adolescent) .2. Abnormal loss of all interest and pleasure.3. Appetite or weight disturbance, either:Abnormal weight loss or decrease in appetite.Abnormal weight gain or increase in appetite.
Major Depression Criteria (contd)4. Sleep disturbance, either abnormal insomnia or abnormal hypersomnia.5. Activity disturbance, either abnormal agitation or abnormal slowing (observable by others).6. Abnormal fatigue or loss of energy.7. Abnormal self-reproach or inappropriate guilt.8. Abnormal poor concentration or indecisiveness.9. Abnormal morbid thoughts of death (not just fear of dying) or suicide.
Major Depression Criteria (contd)C.The symptoms are not due to a mood-incongruent psychosis.D.There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode.E.The symptoms are not due to physical illness, alcohol, medication, or street drugs.F.The symptoms are not due to normal bereavement.
Essential FeaturesNot due to rule-outsAbnormal depressed mood Persists continuously for at least 2 weeks.Causes marked functional impairment.Causes disabling physical symptoms.Causes disabling psychological symptoms.
Essential Features (contd)Abnormal loss of interest and pleasure mood:Reduced capacity to experience pleasure (anhedonia).Result=lack of motivation.Abnormal irritable mood:May present primarily with irritable, rather than depressed or apathetic, mood. Unfortunately, irritability=alienating loved ones with their cranky mood and constant criticisms.
Essential Features (contd)Physical symptoms
Fatigue or loss of energy
Agitation or slowing
Essential Features (contd)Cognitive symptoms
Abnormal self-reproach or inappropriate guiltThe "negative thinking" Abnormal poor concentration or indecisivenessMarked forgetfulness Abnormal morbid thoughts of death (not just fear of dying) or suicide
Comorbidity40-70% meet criteria for another disorder; 20-50% have 2 or more comorbid disordersMost common:Anxiety DisordersDisruptive Behavior DisordersSubstance Abuse Disorders
Chronic at least 2 years in adults, 1 year in children. Milder depression than Major Depressive Disorder.
Dysthymia Diagnostic CriteriaA.Depressed mood for most of the day, for more days than not, as indicated either by subjective account or observation by others, for at least 2 years. Note: In children and adolescents, mood can be irritable and duration must be at least 1 year.
Dysthymia Diagnostic Criteria (contd)B.Presence, while depressed, of two (or more) of the following:1. poor appetite or overeating2. insomnia or hypersomnia3. low energy or fatigue4. low self-esteem5. poor concentration or difficulty making decisions6. feelings of hopelessness
Dysthymia Diagnostic Criteria (contd)C. The person has never been without the symptoms in Criteria A and B for more than 2 months at a time.D. No Major Depressive Episode has been present during the first 2 years of the disturbance (1 year for children and adolescentsNote: There may have been a previous Major Depressive Episode provided there was a full remission before development of the Dysthymic Disorder. After the initial 2 years (1 year in children or adolescents) of Dysthymic Disorder, there may be superimposed episodes of Major Depressive Disorder, in which case both diagnoses may be given when the criteria are met for a Major Depressive Episode.
Dysthymia Diagnostic Criteria (contd)E. There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode, and criteria have never been met for Cyclothymic Disorder.F. The disturbance does not occur exclusively during the course of a chronic Psychotic Disorder.G. The symptoms are not due to the direct physiological effects of a substance.H. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Bipolar DisorderIndividual experiences depressed episode followed by manic episode.
Lifetime prevalence ~1%Male=FemaleAge of onset: Usually late teens to mid 30sExtremely controversial in children
Manic EpisodeManic Episode=period (at least 1 week) of elevated, expansive, or irritable mood including 3 of 7 symptoms. 1. inflated self-esteem or grandiosity2. decreased need for sleep 3. more talkative than usual or pressure to keep talking4. flight of ideas or subjective experience that thoughts are racing5. distractibility 6. increase in goal-directed activity or psychomotor agitation7. excessive involvement in pleasurable activities that have a high potential for painful consequences
Manic Episode (contd)C. The symptoms do not meet criteria for a Mixed Episode.D. The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.E.The symptoms are not due to the direct physiological effects of a substance or a general medical condition.
Child Assessment Methods for DepressionClinical interviews (parent, child)Meet diagnostic criteria?Assess associated features (e.g., social funct.)Suicidal and/or homicidal ideation?Check for rule-outsSelf-report measuresChildrens Depression InventoryBroadband measures (e.g., BASC-2, ASEBA)Projective testingRefer for medical evaluation?Direct Observations
Adolescent Assessment Methods for DepressionClinical interviews (adolescent, parent)Ditto childSelf-report measuresReynolds Adolescent Depression Scale-2Broadband measures (e.g., BASC-2, ASEBA)Projective testingRefer for medical evaluation?Lab testingObservations
Child Treatment Methods for DepressionCognitive-behavioral therapy(e.g., Primary and Secondary Control Enhancement Training)Interpersonal therapyFamily therapy
Psychodynamic therapyPsychopharmacological intervention
Adolescent Treatment Methods for DepressionCognitive-behavioral therapyInterpersonal therapyFamily therapyMilieu therapyIntegrated treatment (Adolescent Coping with Depression Course)Inpatient treatment
Psychodynamic therapyPsychopharmacological intervention