Breathe. Breathe.

IM USED TO IT, BES. </3

MAY TISSUE SA KIT, JUST IN

CASE.

SANAY NA KO. WALA

NAMANG BAGO.

I DONT CARE ANYMORE!

MAJOR
DEPRESSIVE
MAJOR
DISORDER

DEPRESSIV
E
DISORDER
Djanelle Mei M. San Miguel
BS Psychology 3-4

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Definition

A major depressive disorder occurs without a

history of a manic, mixed or hypomanic episode. An
affected person must experience either markedly
depressed moods or marked loss of interest in
pleasurable activities most of every day, nearly
every day, for at least two consecutive weeks.
These Major Depressive Episodes are not due to a
medical condition, medication, abused substance,
or Psychosis. If Manic, Mixed, or Hypomanic
Episodes develop, the diagnosis is changed to
Bipolar Disorder.

Predominant affect is
feelings of emptiness and
loss
The dysphoria is likely to
decreaseGRIEF
in intensity over
days to weeks and occurs in
waves, the so called pangs
of grief
The pain may be
accompanied by positive
emotions and humor
Pre occupation with
thoughts and memories of
the deceased

DEPRESSION

DEPRESSION

Predominant affect is depressed

mood
The depressed mood is more
persistent and not tied to specific
thoughts or preoccupations
Self-critical or pessimistic
ruminations
Persistent depressed mood and
the Inability to anticipate
happiness or pleasure
Self-critical or pessimistic
ruminations
Prolonged and marked functional
impairment

GRIEF VS. DEPRESSION

GRIEF
Self-esteem
is usually
Self-esteem
preserved is usually
preserved
If self-derogatory
If self-derogatory ideation
ideation is present, it
is present, it typically
typically involves
involves perceived failings
perceived
Thoughts
of failings
death are
typically
Thoughts
of death
related
to are
typically
related
to with
wanting
to be
reunited
the
deceased
loved one
wanting
to be
reunited with the
deceased loved one

DEPRESSION
Persistent isolation from
others and self
Fixed emotions and feeling
stuck
Has generalized feelings of
guilt
Feelings of worthlessness
and self-loathing are
common clouds esteem
Thoughts of death related
to feeling worthless,
undeserving of life or unable
to cope with the pain

HISTORY

The Old Testament story of King

Saul describes a depressive
syndrome, as does the story of
Ajax's suicide in Homer's Iliad.
About 400 BCE, Hippocrates
used the terms mania and
melancholia to describe mental
disturbances.
Around 30 AD, the Roman
physician Celsus described
melancholia (from Greek melan
["black"] and chole ["bile"]) in
his work De re medicina as a
depression caused by black
bile.

The first English text (Fig.

8 . 1 - 1 ) entirely related
to depression was Robert
Burton's Anatomy of
Melancholy, published in 1
62 1 .

In 1 854, Jules Falret

described a condition
called Jolie circulaire, in
which patients experience
alternating moods of
depression and mania.

HISTORY

In 1882, the German psychiatrist Karl Kahlbaum, using

the term cyclothymia, described mania and depression
as stages of the same illness
In 1899, Emil Kraepelin, building on the knowledge of
previous French and German psychiatrists, described
manic-depressive psychosis using most of the criteria
that psychiatrists now use to establish a diagnosis of
bipolar I disorder.
Kraepelin also described a depression that came to be
known as involutional melancholia,
which has since come
.
to be viewed as a severe form of mood disorder that
begins in late adulthood. (Kaplan and Sadock, 2015: 347)

MAJOR DEPRESSIVE
DISORDER

DIAGNOSTIC
STATISTICAL

DIAGNOSTIC CRITERIA
DSM-5

A.

Five (or more) of the following symptoms

have been present during the same 2-week
period and represent a change from previous
functioning; at least one of the symptoms is
either (1) depressed mood or (2) loss of
interest or pleasure.
Note:Do not include symptoms that are
clearly attibutable to another medical
condition.

1.

Depressed mood most of the day, nearly every day,

as indicated by either subjective report (e.g., feels
sad, empty, hopeless) or observation made by others
(e.g., appears tearful). (Note:In children and
adolescents, can be irritable mood.)

2. Markedly diminished interest or pleasure in all, or

almost all, activities most of the day, nearly every
day (as indicated by either subjective account or
observation).
3. Significant weight loss when not dieting or weight
gain (e.g., a change of more than 5% of body
weight in a month), or decrease or increase in
appetite nearly every day.
(Note:In children, consider failure to make
expected weight gain.)

4.

Insomnia or hypersomnia nearly every

day.

5. Psychomotor agitation or retardation

nearly every day (observable by others,
not merely subjective feelings of
restlessness or being slowed down).
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 merely self-reproach or
guilt about being sick).
8. Diminished ability to think or concentrate, or
indecisiveness, nearly every day (either by
subjective account or as observed by others).
9. Recurrent thoughts of death (not just fear of
dying), recurrent suicidal ideation without a
specific plan, or a suicide attempt or a specific
plan for committing suicide.

B) The symptoms cause clinically

significant distress or impairment in
social, occupational, or other
important areas of functioning.
C) The episode is not attributable to
the physiological effects of a
substance or to another medical
condition.

Note:Criteria A-C represent a major depressive episode.

Note:Responses to a significant loss (e.g., bereavement,
financial ruin, losses from a natural disaster, a serious
medical illness or disability) may include the feelings of
intense sadness, rumination about the loss, insomnia, poor
appetite, and weight loss noted in the above criteria,
which may resemble a depressive episode.
Although such symptoms may be understandable or
considered appropriate to the loss, the presence of a
major depressive episode in addition to the normal
response to a significant loss should also be carefully
considered.
This decision inevitably requires the exercise of clinical
judgment based on the individual's history and the cultural
norms for the expression of distress in the context of loss.

D) The occurrence of the major depressive episode is not

better explained by schizoaffective disorder,
schizophrenia, schizophreniform disorder, delusional
disorder, or other specified and unspecified
schizophrenia spectrum and other psychotic disorders.
E) There has never been a manic episode or a hypomanic
episode.
Note:This exclusion does not apply if all of the maniclike or hypomanic-like episodes are substance-induced
or are attributable to the physiological effects of
another medical condition.

What Causes Major

Depressive Disorder?
Exposure to any major physical, psychological, or social
adversity.
Stressors
Recent stressful events
First-degree biological relatives
Personality Factors
Psychodynamic Factors in Depression
Cognitive Theory
Learned Helplessness

PREDICTION AND PROBLEMS

PREDICTION
Untreated:40%recover within 3
months;50%within 6 months;80%within 1 year
PROBLEMS
Occupational-Economic Problems:
- Depressive disorders account for40.5%
of the disabililtycaused by mental illness
worldwide
- Causes significant impairment in academic,
occupational and/or social functioning
- Only a minority are so chronically disabled that
they require a disability pension

Conventional, Uncreative (Low Intellect):

- Usually impairs concentration, memory, creativity and judgment
- Severe episodes can cause psychosis
-In the extreme, some become so depressed that they just sit
mute and motionless

Anxious, Easily Upset (Low Emotional Stability):

During an episode of depressed mood or loss of interest or
pleasure, nearly every day for at least 2 weeks has the majority
of the following:
Depressed mood most of the day
Markedly diminished interest or pleasure
Feelings of worthlessness or excessive guilt
Diminished ability to think or concentrate, or indecisiveness
Recurrent thoughts of death or suicide (or a suicide attempt)

Fatigue

Sleeping
Problem

Feeling tired
Sleeping
or having
much more
little energy or less than
usual

Appetite or
Eating
problem

Overall
Physical
Health

Eating
much more
or less than
usual

Extent to
which
physical
health
problems
interfere
with usual
activities

PHYSICAL SYMPTOMS

Summary:

Emotional Problems
Depressed
mood

Frequent,
persistent
and intense
feelings of
being down,
depressed,
sad, or
hopeless

Guilt or
Shame

Frequent,
persistent,
and intense
feeling s of
guilt or
shame

Self-harm

Loss of
pleasure and
motivation

Suicidal
thoughts OR
risk of
harming self
by self-injury
or severe
self-neglect

Inability to
feel pleasure
or take
interest in
things; lack
of motivation
to do
expected
tasks

COGNITIVE PROBLEMS
Inattentiveness

Impaired Executive
Functioning

Difficulty
concentrating and
focusing on tasks ;
attention easily
diverted by
extraneous stimuli

Impaired judgment,
planning, or
problem-solving ;
lack of creativity or
curiosity

Low self-esteem

Pessimism

Loneliness

Having a poor opinion

of ones self and
abilities; believing that
one is worthless or
useless

Having a negative
outlook on life;
expecting the worst
outcome

Lacking relatives or
friends one can count
on for help in times of
trouble; lacking
companions

Submissiveness

Difficulty having
conflict

Social
Withdrawal

Humble obedience and

unassertiveness;
frequent advice and
reassurance seeking

Difficulty handling
conflict with others

Preference for being

alone; avoidance of
close relationships and
intimate sexual
relationships

Identity Confusion

Impaired Usual
Activities

Not knowing who am I?

and where am I going?
lacking meaning and
purpose in life

Difficulty with work

(job/study /housework)
,love (family and
friends), play (leisure
activities

SOCIAL
PROBLEMS

Problems When Severe

Need for Institutional Care

Phobia (Excessive Fear of Specific Things)
Brief, Unprovoked Attacks of Panic
Drug or Medication Abuse
Alcohol Abuse
Prolonged Anxiety, Attention or Worry
Overly Dependent Behavior
Poor Physical Health
Delusions or Hallucinations
Poor Memory or Learning Ability
Poor Grooming and Hygiene

Complications

Completed suicide occurs in up to 15% of individuals

with severe Major Depressive Disorder. There is a
fourfold increase in deaths in individuals with this
disorder who are over age 55. Individuals with this
disorder have more pain and physical illness and
decreased physical, social, and role functioning.

Comorbidity
Alcoholism and illicit drug abuse dramatically
worsen the course of this illness, and are frequently
associated with it. Persistent Depressive Disorder
often precedes the onset of this disorder for 10%25% of individuals. This disorder also increases risk
of also having Panic Disorder, Obsessive-Compulsive
Disorder, Anorexia Nervosa, Bulimia Nervosa, and
Borderline (Emotionally Unstable) Personality
Disorder.

Associated Laboratory Findings

No laboratory test has been found to be diagnostic of

this disorder.

Prevalence

The US 12-month community prevalence rate for this

disorder is 7%. The prevalence in 18- to 29-year-old
individuals is threefold higher than the prevalence in
those aged 60 or older. The prevalence rates for this
disorder appear to be unrelated to ethnicity,
education, income, or marital status. In childhood,
boys and girls are equally affected. However, in
adolescence and adulthood, the prevalence is 1.5- to 3fold higher in females compared to males

TREATMENT GOALS:

Goal: prevent her depressed mood.

If this problem persists: She will feel sad, hopeless,
discouraged, "down in the dumps", or "blah". She may
emphasize somatic complaints (e.g., bodily aches and pains)
rather than reporting feelings of sadness. She may exhibit
increased irritability (e.g., persistent anger, a tendency to
respond to events with angry outbursts or blaming others, or
an exaggerated sense of frustration over minor matters).
Goal: prevent her loss of interest or pleasure.
If this problem persists: She will feel less interested in
hobbies, "not caring anymore," or not feeling any enjoyment
in activities that were previously considered pleasurable.
There may be a significant reduction in her sexual interest
or desire.

Goal: prevent her appetite or weight disturbance.

If this problem persists: She will have either
abnormally decreased or increased appetite. This
may progress to significant loss or gain in weight.
Goal: prevent her insomnia or hypersomnia.
If this problem persists: She will sleep too little or
too much. Typically she will have middle insomnia
(i.e., waking up during the night and having
difficulty returning to sleep) or terminal insomnia
(i.e., waking too early and being unable to sleep).
Initial insomnia (i.e., difficulty falling asleep) may
also occur. Less frequently, she may have
oversleeping (hypersomnia).

Goal: prevent her psychomotor agitation or slowing.

If this problem persists: She will have agitation (e.g.,
the inability to sit still, pacing, hand-wringing; or
pulling or rubbing of the skin, clothing, or other
objects) or psychomotor retardation (e.g., slowed
speech, thinking, and body movements; increased
pauses before answering; speech that is decreased in
volume, inflection, amount, or variety of content, or
muteness).
Goal: prevent her fatigue or loss of energy.
If this problem persists: She will experience decreased
energy, tiredness, and fatigue. Eventually, even the
smallest tasks will seem to require substantial effort.
She may find that washing and dressing in the morning
are exhausting and take twice as long as usual.

Goal: prevent her inappropriate self-reproach or

guilt.
If this problem persists: She will have unrealistic
negative evaluations of her worth or guilty
preoccupations or ruminations over minor failings.
She may often misinterpret neutral or trivial dayto-day events as evidence of her defects and have
an exaggerated sense of responsibility for untoward
events. This may progress to delusional proportions.
Goal: prevent her poor concentration or
indecisiveness.
If this problem persists: She will have an impaired
ability to think, concentrate, or make decisions.

Goal: prevent her recurrent thoughts of death or

suicide.
If this problem persists: She will be at risk of
suicide. Many studies have shown that it is not
possible to predict accurately whether or when a
particular individual with depression will attempt
suicide. Motivations for suicide may include a desire
to give up in the face of perceived insurmountable
obstacles or an intense wish to end an
excruciatingly painful emotional state that is
perceived by the person to be without end.

TREATMENTS
Psychotherapy
The major psychological treatments for depression
[cognitive behavior therapy (CBT), mindfulness-based
cognitive therapy (MBCT), interpersonal therapy (IPT),
short-term psychodynamic psychotherapy (STPP)] when
compared to each otherareequally effective.

The addition ofpsychological treatment(CBT, MBCT, IPT,

STTP) to antidepressant medication results in an
improvement in outcome.St John's wortand regular
exercise appear mildly effective in the treatment of
depression (but their effect size is small).

Pharmacotherapy

Research on antidepressant medication has made

startling findings: (1) all second-generation
antidepressant medications areequally effective, (2)
treatment with a
combination of antidepressant medications (especially
TCA + SSRI) is much more effective than treatment
with a single antidepressant medication, (3) only60%
of individuals with major depression respond to
antidepressant medication, and (4) antidepressant
medications have relatively modest effects when
compared with an active placebo - such as patients
seeing their GP for brief counselling.

Electroconvulsive Therapy (ECT)

When given ECT, 55% of individuals with major
depressive disorder will go into remission.
Unfortunately, there is avery high relapse rate6
months after ECT. Of those going into remission with
ECT, at 6 months posttreatment: (1) on placebo 84%
relapse, and (2) on antidepressant medication plus
lithium 39% relapse. Thus ECT is effective during the
acute treatment phase in hospital, but steadily loses
its benefit after hospital discharge. The effectiveness
of ECT vs sham ECT atoneormoremonths
posttreatment is still controversial.

OTHER THERAPY

Cognitive-Behavioral Therapy
Behavioral Activation Treatment
Interpersonal Therapy.
Psychoanalytically Oriented Therapy
Family Therapy

Ineffective Therapies
Vitamins, dietary supplements, and
acupuncture are all ineffective for
depression.
Summary
Although almost two-thirds of individuals
with major depressive disorder respond to
current therapies; at least one-third of those
entering remission relapse back into
depression 18 months posttreatment.

CASE STUDY

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