Depression
PSCI 153C Fall 2021
October 29, 2021
Kate Ryan Kuhlman, Ph.D., Assistant Professor
Department of Psychological Science
Today’s agenda
•Announcements:
• Participation assignment #5: Due 11/5
(Depression or Anxiety)
• Review: Anxiety Disorders
• Depression
• Guest Lecture: Lychee Tran
•For next week…
Quiz #5
• If you scored higher than 12.5,
you earned extra credit
• If you scored lower than 11.5:
• Read or watch everything
twice
• Take the quiz when your
brain is fresh
• Review your quiz with TA
during office hours
Course grade so far:
• Denominator: 122.5 points
• A = 110.25+
• B = 97.8+
• C = 85.75+
Mean = 14.2 ± 1.02
13.2-15
<13.2
Anxiety within a developmental context
Weems, 2008, Developmental Review Behavioral Inhibition
• Behavioral inhibition
(BI): a low threshold
for novel and
unexpected stimuli
– Places an
individual at
greater risk for
anxiety disorders
Treatment of anxiety disorders
• Most effective treatment
for anxiety is exposure;
focuses on extinction
learning
Treatment of anxiety disorders
• Most effective treatment
for anxiety is exposure;
focuses on extinction
learning
• Coping Cat (Kendall)
Nordh and colleagues (2021)
• Research question: Is internetbased CBT a clinically- and costeffective treatment for adolescent
SAD?
• N = 103 adolescents (aged 10-
17) with SAD (77% female)
• Randomized to ICBT vs
ISUPPORT
• 3 sessions with a therapist + 10
adolescent CBT training modules
and 3 parent modules
Nordh and colleagues (2021)
Nordh and colleagues (2021)
• ICBT effectively decreases SAD
symptoms among adolescents
• For up to 3 months after treatment
• ICBT was more cost-effective
• Lower medication costs
• Increased school productivity
Questions?
Mood Disorder Terms
• Major Depressive Episode (MDE)
• Major Depressive Disorder (MDD)
• Persistent Depressive Disorder P-DD (formerly dysthymia)
• Bipolar Disorder (I vs II)
• Disruptive Mood Dysregulation Disorder (DMDD)
What is mood?
• There are 6 basic human emotions: happy, sad, anger, disgust,
fear, surprise
• Unfold across minutes-hours
• Mood are affective states, less specific to situations and more
sustained over time
• Unfold across hours
to days
Day
Week
Mood Disorder Terms
• Major Depressive Episode (MDE)
• Major Depressive Disorder (MDD)
• Persistent Depressive Disorder P-DD (formerly dysthymia)
• Bipolar Disorder (I vs II)
• Disruptive Mood Dysregulation Disorder (DMDD)
Variations refers to duration, timing, presumed causes and
associated features
Why study depression?
• Account for 10% of disability-adjusted
life years (2nd leading cause)
• 1 million suicides per year (3,000 per
day) and 20 million attempts
• Worse prognosis for other conditions,
including all-cause mortality among
patients with cancer, diabetes, and
cardiovascular disease (Machado et al., 2018)
MDE is impairing co-occurrence of:
or
and 4 or more symptoms:
that persist for 2 or more weeks.
Depressed
mood
Sleep
disturbances
Psychomotor
changes
Difficulty with
concentration
Suicidal
ideation or
behavior
Excessive
guilt
Feelings of
worthlessness
Anhedonia
Weight
changes
Fatigue
MDE is impairing co-occurrence of:
or
and 4 or more symptoms:
that persist for 2 or more weeks.
Depressed
mood
Sleep
disturbances
Psychomotor
changes
Difficulty with
concentration
Suicidal
ideation or
behavior
Excessive
guilt
Feelings of
worthlessness
Anhedonia
Weight
changes
Fatigue
MDE is impairing co-occurrence of:
or
and 4 or more symptoms:
that persist for 2 or more weeks.
Depressed
mood
Sleep
disturbances
Psychomotor
changes
Difficulty with
concentration
Suicidal
ideation or
behavior
Excessive
guilt
Feelings of
worthlessness
Anhedonia
Weight
changes
Fatigue
MDE is impairing co-occurrence of:
or
and 4 or more symptoms:
that persist for 2 or more weeks.
Depressed
mood
Sleep
disturbances
Psychomotor
changes
Difficulty with
concentration
Suicidal
ideation or
behavior
Excessive
guilt
Feelings of
worthlessness
Anhedonia
Weight
changes
Fatigue
277 possible
combinations!
Mood Disorder Terms
• Major Depressive Episode (MDE)
• Major Depressive Disorder (MDD): MDE without any mania
• Persistent Depressive Disorder P-DD (formerly dysthymia)
• Bipolar Disorder (I vs II)
• Disruptive Mood Dysregulation Disorder (DMDD)
Variations refers to duration, timing, presumed causes and
associated features
Mania
• A distinct and sustained period of abnormally and persistently
elevated, expansive, or irritable mood and abnormally and
persistently goal-directed behavior or energy, lasting at least 1 week
and present most of the day, nearly every day
• Three or more impairing symptoms:
• Inflated self-esteem or grandiosity
• Decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
• More talkative than usual or pressure to keep talking
• Flight of ideas or subjective experience that thoughts are racing
• Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external
stimuli), as reported or observed.
• Increase in reward-motivated activity (either socially, at work or school, or sexually)
• Excessive involvement in activities that have a high potential for painful
consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or
foolish business investments).
Hypomania
• A distinct and sustained period of abnormally and persistently
elevated, expansive, or irritable mood and abnormally and
persistently goal-directed behavior or energy, lasting at least 4 days
and present most of the day, nearly every day
• Three or more impairing symptoms:
• Inflated self-esteem or grandiosity
• Decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
• More talkative than usual or pressure to keep talking
• Flight of ideas or subjective experience that thoughts are racing
• Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external
stimuli), as reported or observed.
• Increase in reward-motivated activity (either socially, at work or school, or sexually)
• Excessive involvement in activities that have a high potential for painful
consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or
foolish business investments).
Mania
• Bipolar Disorder I = MDE + Manic
Episode(s)
• Bipolar II = MDE + Hypomanic
Episode(s)
• Major Depressive Disorder= MDE
(no mania ever)
Persistent Depressive Disorder (P-DD)
• Fewer and less severe symptoms but for a sustained period
of time (1 year vs 2 weeks)
• Depressed mood for most of the day, for more days than not, for at
least 2 years (1 year for children and adolescents)
• Two or more impairing symptoms:
1. Poor appetite or overeating.
2. Insomnia or hypersomnia.
3. Low energy or fatigue.
4. Low self-esteem.
5. Poor concentration or difficulty making decisions.
6. Feelings of hopelessness.
Disruptive Mood Dysregulation
Disorder (DMDD)
• Disruptive Mood Dysregulation Disorder (DMDD): ongoing
irritability, anger, and frequent, intense temper outbursts that are
out of proportion to the situation.
• Three or more times per week for at least 1 year
• Irritability is chronic, usually daily.
Prevalence in adults
Prevalence in adults
Prevalence in adults
Prevalence among adolescents
• Depression is rare among
preschool and school-age
children (1-2%)
• Increases throughout
adolescence
• Age of onset usually between
13 and 15 years
Prevalence among adolescents
• Depression is rare among
preschool and school-age children
(1-2%)
• Increases throughout adolescence
• Sex differences emerge first in
adolescence and larger in
adolescence that any point in the
lifespan
Comorbidity is the rule, not the exception
• As many as 90% of young people with depression have one or
more other disorders; 50% have two or more
• Most common comorbid disorders include:
• Anxiety disorders (especially GAD), specific phobias, and
separation anxiety disorders
• An anxiety disorder precedes MDD 85% of youth cases
• Other common comorbid disorders:
• Dysthymia, conduct problems, ADHD, and substance-use
disorder
Prognosis for children and adolescents with
mood disorders
• Average episode lasts eight months
• Longer duration if a parent has a history of depression
• Elevated symptoms remain after remission
• Depression among young people tends to be more
recurrent
• 25% within one year, 40% within two years, and 70%
within five years
• About 1/3 develop bipolar disorder within 5 years
Stress leads to depression
Kendler, Karkowski, & Prescott (1999) The American Journal of Psychiatry
• n = 1,898 Caucasian, female, twin pairs assessed for:
• presence of a depressive episode over the past 12-months
• occurrence of 11 personal events and 4 network events
• Personal: events occurring primarily to the individual
• Network: events occurring within a person’s network
• 316 depressive episodes across 24,648 person-months
Kendler, Karkowski, & Prescott (1999) The American Journal of Psychiatry
Odds ratio:
Probability that something will happen
Probability that something won’t
OR > 1 = Depression more likely
OR = 1 Depression equally likely
OR < 1 Depression less likely
Kendler, Karkowski, & Prescott (1999) The American Journal of Psychiatry
Odds ratio:
Probability that something will happen
Probability that something won’t
OR > 1 = Depression more likely
OR = 1 Depression equally likely
OR < 1 Depression less likely
Kendler, Karkowski, & Prescott (1999) The American Journal of Psychiatry
Odds ratio:
Probability that something will happen
Probability that something won’t
OR > 1 = Depression more likely
OR = 1 Depression equally likely
OR < 1 Depression less likely
Kendler, Karkowski, & Prescott (1999) The American Journal of Psychiatry
Odds ratio:
Probability that something will happen
Probability that something won’t
OR > 1 = Depression more likely
OR = 1 Depression equally likely
OR < 1 Depression less likely
Questions?
Questions?
Guest Lecture: Biopsychosocial Model
of Depression with Lychee Tran
What if we tried approaching depression
the way we approach the flu?
• When we feel like we might be coming down with
the flu, we change our behavior:
• Go to bed early and sleep more than usual
• Take vitamins (e.g., zinc and C) that aid the immune
system
• Drink more fluids
• Stay home from work or school
• Expect less of ourselves
What if we could make a list like this for depression?
What is stress anyway?
Resources
Stress:
When the demands of a situation
exceed the resources to meet
them.
Demands
Resources
Financial
Biological
Psychological
Social
Take the PHQ-9
1
.
What was your score?
Minimal to mild
concerns (0-9)
Have you
experienced a
stressor in the past
month?
No
Reassess next
month
Yes
Engage depression
prevention plan
Moderate to
severe (10+)
Seek mental health
services
Mobile app (See
PsyberGuide)
UCI Student Health
Center
National Lifeline
(800-273-8255)
1Kroenke, K. & Spitzer, R.L., 2002, Psychiatric Annals
Take the PHQ-9
1
.
What was your score?
Minimal to mild
concerns (0-9)
Have you
experienced a
stressor in the past
month?
No
Reassess next
month
Yes
Engage depression
prevention plan
Moderate to
severe (10+)
Seek mental health
services
Mobile app (See
PsyberGuide)
UCI Student Health
Center
National Lifeline
(800-273-8255)
1Kroenke, K. & Spitzer, R.L., 2002, Psychiatric Annals
Photo credit: https://med.uth.edu/psychiatry/2019/11/27/what-is-cbt/
Cognitive
reappraisal
Resources
Financial
Biological
Psychological
Social
Photo credit: https://glassempty.wordpress.com/2014/07/09/15-common-cognitive-distortions/
Cognitive
reappraisal
Resources
Financial
Biological
Psychological
Social
Treatment of Adolescent Depression Study (TADS)
Treatment of Adolescent Depression Study (TADS)
Adolescents and SSRI medications:
Common misconceptions
Hopelessness in adolescence
Passive
ideation
(very
common)
Plan (19%)
Intent
Attempt
(8.9%)
Hopelessness in adolescence
Combination of a plan (access to means)
and developmentally appropriate
impulsivity place adolescents at very high
risk
Take the PHQ-9
1
.
What was your score?
Minimal to mild
concerns (0-9)
Have you
experienced a
stressor in the past
month?
No
Reassess next
month
Yes
Engage depression
prevention plan
Moderate to
severe (10+)
Seek mental health
services
Mobile app (See
PsyberGuide)
UCI Student
Health Center
National Lifeline
(800-273-8255)
1Kroenke, K. & Spitzer, R.L., 2002, Psychiatric Annals
Resources
• How to know your score (PHQ-9):
https://thinkcbt.com/patient-health-questionnaire-phq-9
• Resources at UCI: http://bit.ly/wiseresources (thanks to
Wellness Initiative in Social Ecology)
• One Mind PsyberGuide: an online resources that curates
mental health applications based on the rigor of the science
supporting them https://onemindpsyberguide.org/apps/
• UCI Student Health Center: https://shc.uci.edu/psychiatrymental-health-services/mission
• National Suicide Hotline: 800-273-8255 or
https://suicidepreventionlifeline.org/
Looking ahead:
• Please read:
• Chapter 10 of Mash & Wolfe
• Copeland et al. (2021) (PDF available on
CANVAS)
• Please watch:
• Dixon Chibanda TEDTalk
• Please do:
• Quiz #6
• Opens on CANVAS at 10am on Thursday 11/4
and is due by 10am on Friday 11/5)
• Participation assignment #5
• Due on CANVAS by 10am on Friday 11/5
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