3.4C A'ective Disorders
Week 1
Depression part 1
Lecture notes January 8th, 2024
Learning goals week 1 and 2:
• Identify the characteristics of Major Depressive Disorder (MDD)
• Distinguish between depressive symptoms and other emotional states
• Identify various etiologies (causes) of MDD
• Compare and distinguish diHerent features of MDD including:
• Prevalence and development of MDD
• Risk and prognostic factors in MDD
• Culture- and sex-/gender-related diagnostic issues in MDD
• Apply knowledge to clinical examples of MDD
• Evaluate, compare and distinguish various theoretical models explaining MDD
• Evaluate, compare and distinguish various treatment models for MDD
Literature can be complex. Focus on outcomes. Focus on bottom line, overarching results,
meanings/definitions of theories and concepts.
DSM-IV Criteria for Major Depressive Disorder (MDD)
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.
3. Significant weight loss when not dieting or weight gain or decrease or increase in appetite nearly
every day.
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 nearly every day.
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day.
9. Recurrent thoughts of death, 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 eHects of a substance or another medical
condition.
D. The occurrence of the episode is not better explained by another psychiatric condition.
There is a diHerence between dysthymia and MDD. Dysthymia is also a depressive disorder, but it has
a milder form, and it lasts longer (more than two years). It has less (but still significant) impact on the
person’s life, and the symptoms might fluctuate in intensity but are consistently present. MDD is
more severe. It lasts at least two weeks and then someone might go without symptoms again.
Because it is more severe it has more impact on a person’s life. Episodes can be recurrent.
Contemporary integrative interpersonal theory (CIIT) is a theory on depression. It says that humans
are social creatures with interpersonal dynamics. It is a way of understanding how people interact in
relationships by observing how they communicate, express emotions and how they relate to others
in daily life. CIIT combines ideas from diHerent ways of thinking about the mind to give us a complete
picture of how we relate to people. It figures out how to make our relationships better with others. It’s
like a map that helps us understand and improve the way we connect with people.
,The field of psychopathology is shifting from a discrete way of thinking about disorders to a more
multilayered approach. CIIT assumes that the most important expressions of personality occur in
interpersonal situations. It assumes that interpersonal functioning can be explained with terms like
agency and communion. It also says that the interpersonal circumplex model (see below) explains
interpersonal functioning across diHerent levels of experience. Lastly, it assumes that satisfying
agentic and communal motives drive interpersonal behavior.
Agency (up/down) Communion (sideways)
Values/needs Achievement Connection
Motives Control Closeness
Traits Dominance Nurturance
Behaviors Directive/assertive Friendly/agreeable
Strengths/abilities Lead Love
Problems Domineering Self-sacrificing
In short, how we behave during interpersonal situations reflects how we feel and think about
ourselves in relation to others. The interpersonal circumplex model can be used to describe
interpersonal behaviors, traits, motives, etc., along the dimension’s agency and communion.
Psychopathology is associated with problematic interpersonal behavior, which is often expressed in
predictable ways, depending on the situation.
Literature
Herrman et al. (2022) – what is depression?
The first article by Herrman et al. (2022) talks about depression and how it is a major cause of
suHering globally. It emphasizes that depression is often not well understood or acknowledged,
leading to insuHicient eHorts to address and alleviate (take the edge oH the pain) the associated
,suHering. The COVID-19 pandemic has worsened the situation, creating a "perfect storm" of factors
negatively impacting mental health.
Depression is a common health condition causing profound suHering, impairing social functioning,
aHecting economic productivity (loss of jobs), and even premature mortality. It varies in symptoms,
severity, and trajectories, and it is not limited to specific cultural groups. It is influenced by a
combination of factors, including genetic, environmental, social, and developmental aspects.
Early detection and diagnosis are crucial for recovery, and a person-centered care approach is
recommended. Most individuals with depression can recover with the right support and treatment.
Empowering people with lived experience (someone that has also experienced it) is essential to
address the high unmet need, reduce stigma, and advocate for resources.
Trying to find a single cause for depression hasn't worked well. It's more helpful to think of depression
as having many causes, similar to how we approach other diseases. While we know there are
biological aspects to depression, understanding it as a brain illness, we also need to consider the
real and intangible things in our environment that aHect how our brains develop and work throughout
our lives.
For example, when kids experience abuse or neglect, it can aHect their chances of getting depression
not only when they're young but also when they grow up and even in the generations after them. This
shows that the path to experiencing depression can start many years before someone actually feels
depressed. The journey usually involves things in our environment influencing how our brains
develop, our mental well-being, and the complicated networks in our brains connected to
depression.
For a long time, researchers, practitioners, and people who've experienced depression have been
working together to understand this complex and diverse human experience. Depression has a
significant impact on individuals, regardless of their gender, background, social class, or age. It
comes with various challenges and can cause multi-faceted disability. When it starts early in life, it
can make it tough for individuals to function well as adults.
Some people with depression experience it repeatedly or for a long time, often alongside other health
issues, and they face a higher risk of premature death, including from suicide. Depression doesn't
just aHect individuals; it also has consequences for families, communities, and even the
development of nations. Considering the widespread suHering and its negative eHects on public
health and society, it's crucial to recognize that depression is a concern for everyone and should be a
global health priority.
We should approach depression as a public health issue, considering the social factors that
contribute to it and recognizing the serious and lasting eHects it can have. Depression often goes
hand in hand with other health problems, making them more complicated. Despite the fact that
there's plenty of evidence showing that much can be done to prevent and help recover from
depression, only a small number of people around the world benefit from this knowledge.
It's important to include strategies for preventing and treating depression in broader plans, like
universal health coverage. Those involved, such as policymakers, researchers, and healthcare
providers, should work closely with people who have experienced depression to create eHective
services, policies, and research. This collaborative approach is crucial in addressing the
complexities of depression and ensuring that solutions are practical and consider the real
experiences of those aHected.
The authors emphasize the importance of putting what we know about depression into action,
specifically using eHective methods to prevent and treat it. They stress the urgency of involving
, everyone in society and the
government to tackle depression
thoroughly. This means that not only
individuals but also the entire
community and government need to
work together to address the
challenges posed by depression.
Depression is a significant global
health crisis, and there are debates
about what it is and how to deal with
it. Some see it as a medical issue
causing disability everywhere, while
others think it's just an extreme form
of normal emotions. Critics question if
the understanding of depression from
European contexts applies to diverse
cultures and if framing it as a
biological disorder serves
pharmaceutical interests.
To address these concerns, The
Commission was formed to provide a
balanced view of the evidence on
depression. It aims to inform people
with depression, their families,
healthcare professionals, researchers,
and policymakers. The Commission
wants to clear up debates,
emphasizing that depression is more
than just sadness and can be
prevented and treated with an
approach that considers individual diHerences.
Recognizing the diversity in people's experiences and understanding how depression varies in
diHerent groups and cultures are crucial. This understanding helps share information about
depression better, reducing stigma. The Commission encourages collaborative care and prevention,
even in places with limited resources. It calls for everyone involved to work together and reduce the
global impact of depression.
Depression is a common health condition, but it often goes unnoticed and is not well understood. It
comes in various forms, including depressive disorders and symptoms causing distress or social
issues. The Commission doesn't cover depression as part of bipolar disorder. Depression is
universal, but how it's experienced can diHer based on culture and context. Prevention is crucial to
lessen the global impact of depression. Each person's experience with depression and recovery is
unique.
Involving people who have lived through it is key to closing the care gap. Personalized care, through a
formulation (comprehensive and individualized understanding of a person's mental health
diHiculties, beyond a simple diagnosis and aim to capture the complexity of a person's mental
health), is important. A staged approach (step-by-step strategy that recognizes that mental health
conditions can vary in severity, symptoms, and impact) to care recognizes the diverse nature of
depression, and collaborative models are a cost-eHective strategy. Increased investment and
Week 1
Depression part 1
Lecture notes January 8th, 2024
Learning goals week 1 and 2:
• Identify the characteristics of Major Depressive Disorder (MDD)
• Distinguish between depressive symptoms and other emotional states
• Identify various etiologies (causes) of MDD
• Compare and distinguish diHerent features of MDD including:
• Prevalence and development of MDD
• Risk and prognostic factors in MDD
• Culture- and sex-/gender-related diagnostic issues in MDD
• Apply knowledge to clinical examples of MDD
• Evaluate, compare and distinguish various theoretical models explaining MDD
• Evaluate, compare and distinguish various treatment models for MDD
Literature can be complex. Focus on outcomes. Focus on bottom line, overarching results,
meanings/definitions of theories and concepts.
DSM-IV Criteria for Major Depressive Disorder (MDD)
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.
3. Significant weight loss when not dieting or weight gain or decrease or increase in appetite nearly
every day.
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 nearly every day.
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day.
9. Recurrent thoughts of death, 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 eHects of a substance or another medical
condition.
D. The occurrence of the episode is not better explained by another psychiatric condition.
There is a diHerence between dysthymia and MDD. Dysthymia is also a depressive disorder, but it has
a milder form, and it lasts longer (more than two years). It has less (but still significant) impact on the
person’s life, and the symptoms might fluctuate in intensity but are consistently present. MDD is
more severe. It lasts at least two weeks and then someone might go without symptoms again.
Because it is more severe it has more impact on a person’s life. Episodes can be recurrent.
Contemporary integrative interpersonal theory (CIIT) is a theory on depression. It says that humans
are social creatures with interpersonal dynamics. It is a way of understanding how people interact in
relationships by observing how they communicate, express emotions and how they relate to others
in daily life. CIIT combines ideas from diHerent ways of thinking about the mind to give us a complete
picture of how we relate to people. It figures out how to make our relationships better with others. It’s
like a map that helps us understand and improve the way we connect with people.
,The field of psychopathology is shifting from a discrete way of thinking about disorders to a more
multilayered approach. CIIT assumes that the most important expressions of personality occur in
interpersonal situations. It assumes that interpersonal functioning can be explained with terms like
agency and communion. It also says that the interpersonal circumplex model (see below) explains
interpersonal functioning across diHerent levels of experience. Lastly, it assumes that satisfying
agentic and communal motives drive interpersonal behavior.
Agency (up/down) Communion (sideways)
Values/needs Achievement Connection
Motives Control Closeness
Traits Dominance Nurturance
Behaviors Directive/assertive Friendly/agreeable
Strengths/abilities Lead Love
Problems Domineering Self-sacrificing
In short, how we behave during interpersonal situations reflects how we feel and think about
ourselves in relation to others. The interpersonal circumplex model can be used to describe
interpersonal behaviors, traits, motives, etc., along the dimension’s agency and communion.
Psychopathology is associated with problematic interpersonal behavior, which is often expressed in
predictable ways, depending on the situation.
Literature
Herrman et al. (2022) – what is depression?
The first article by Herrman et al. (2022) talks about depression and how it is a major cause of
suHering globally. It emphasizes that depression is often not well understood or acknowledged,
leading to insuHicient eHorts to address and alleviate (take the edge oH the pain) the associated
,suHering. The COVID-19 pandemic has worsened the situation, creating a "perfect storm" of factors
negatively impacting mental health.
Depression is a common health condition causing profound suHering, impairing social functioning,
aHecting economic productivity (loss of jobs), and even premature mortality. It varies in symptoms,
severity, and trajectories, and it is not limited to specific cultural groups. It is influenced by a
combination of factors, including genetic, environmental, social, and developmental aspects.
Early detection and diagnosis are crucial for recovery, and a person-centered care approach is
recommended. Most individuals with depression can recover with the right support and treatment.
Empowering people with lived experience (someone that has also experienced it) is essential to
address the high unmet need, reduce stigma, and advocate for resources.
Trying to find a single cause for depression hasn't worked well. It's more helpful to think of depression
as having many causes, similar to how we approach other diseases. While we know there are
biological aspects to depression, understanding it as a brain illness, we also need to consider the
real and intangible things in our environment that aHect how our brains develop and work throughout
our lives.
For example, when kids experience abuse or neglect, it can aHect their chances of getting depression
not only when they're young but also when they grow up and even in the generations after them. This
shows that the path to experiencing depression can start many years before someone actually feels
depressed. The journey usually involves things in our environment influencing how our brains
develop, our mental well-being, and the complicated networks in our brains connected to
depression.
For a long time, researchers, practitioners, and people who've experienced depression have been
working together to understand this complex and diverse human experience. Depression has a
significant impact on individuals, regardless of their gender, background, social class, or age. It
comes with various challenges and can cause multi-faceted disability. When it starts early in life, it
can make it tough for individuals to function well as adults.
Some people with depression experience it repeatedly or for a long time, often alongside other health
issues, and they face a higher risk of premature death, including from suicide. Depression doesn't
just aHect individuals; it also has consequences for families, communities, and even the
development of nations. Considering the widespread suHering and its negative eHects on public
health and society, it's crucial to recognize that depression is a concern for everyone and should be a
global health priority.
We should approach depression as a public health issue, considering the social factors that
contribute to it and recognizing the serious and lasting eHects it can have. Depression often goes
hand in hand with other health problems, making them more complicated. Despite the fact that
there's plenty of evidence showing that much can be done to prevent and help recover from
depression, only a small number of people around the world benefit from this knowledge.
It's important to include strategies for preventing and treating depression in broader plans, like
universal health coverage. Those involved, such as policymakers, researchers, and healthcare
providers, should work closely with people who have experienced depression to create eHective
services, policies, and research. This collaborative approach is crucial in addressing the
complexities of depression and ensuring that solutions are practical and consider the real
experiences of those aHected.
The authors emphasize the importance of putting what we know about depression into action,
specifically using eHective methods to prevent and treat it. They stress the urgency of involving
, everyone in society and the
government to tackle depression
thoroughly. This means that not only
individuals but also the entire
community and government need to
work together to address the
challenges posed by depression.
Depression is a significant global
health crisis, and there are debates
about what it is and how to deal with
it. Some see it as a medical issue
causing disability everywhere, while
others think it's just an extreme form
of normal emotions. Critics question if
the understanding of depression from
European contexts applies to diverse
cultures and if framing it as a
biological disorder serves
pharmaceutical interests.
To address these concerns, The
Commission was formed to provide a
balanced view of the evidence on
depression. It aims to inform people
with depression, their families,
healthcare professionals, researchers,
and policymakers. The Commission
wants to clear up debates,
emphasizing that depression is more
than just sadness and can be
prevented and treated with an
approach that considers individual diHerences.
Recognizing the diversity in people's experiences and understanding how depression varies in
diHerent groups and cultures are crucial. This understanding helps share information about
depression better, reducing stigma. The Commission encourages collaborative care and prevention,
even in places with limited resources. It calls for everyone involved to work together and reduce the
global impact of depression.
Depression is a common health condition, but it often goes unnoticed and is not well understood. It
comes in various forms, including depressive disorders and symptoms causing distress or social
issues. The Commission doesn't cover depression as part of bipolar disorder. Depression is
universal, but how it's experienced can diHer based on culture and context. Prevention is crucial to
lessen the global impact of depression. Each person's experience with depression and recovery is
unique.
Involving people who have lived through it is key to closing the care gap. Personalized care, through a
formulation (comprehensive and individualized understanding of a person's mental health
diHiculties, beyond a simple diagnosis and aim to capture the complexity of a person's mental
health), is important. A staged approach (step-by-step strategy that recognizes that mental health
conditions can vary in severity, symptoms, and impact) to care recognizes the diverse nature of
depression, and collaborative models are a cost-eHective strategy. Increased investment and
