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3.4 Affective Disorders Summary
Elaborate notes for all 4 problems of the 3.4 Affective Disorders course of the clinical psychology specialization.
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1Depression part 1
Source: World Health Organization. (2017). Depression and other common mental
disorders: global health estimates (No. WHO/MSD/MER/2017.2). World Health
Organization.
What is depression?
Feeling low? Lethargic? Not your day? We all know how this feels, to one extent or another.
But is this depression? How often does depression actually occur and in whom? How does it
develop? And does it ever pass?
Globally, the total number of people with depression was estimated to exceed 300
million in 2015, which is equivalent to 4.4% of the worlds population.
Depression is ranked by WHO as the single largest contributor to global disability
(7.5% of all years lived with disability in 2015);
Depression is also a major contributor to suicide deaths, which number close to
800000 per year.
Who is more likely to get depressed?
Although depression can and does affect people of all ages, from all walks of life, the
risk of becoming depressed is increased by poverty, unemployment, life events such
as the death of a loved one or a relationship break-up, physical illness and problems
caused by alcohol and drug use.
Introduction
Common mental disorders refer to two main diagnostic categories: depressive disorders
and anxiety disorders.
Data sources
Definitions
Depressive disorders are characterized by sadness, loss of interest or pleasure, feelings
of guilt or low self-worth, disturbed sleep or appetite, feelings of tiredness, and poor
concentration. Depression can be long-lasting or recurrent, substantially impairing an
individual’s ability to function at work or school or cope with daily life at its more severe,
depression can lead to suicide. Depressive disorders include two main sub-categories:
Major depressive disorder/ depressive episode, which involves symptoms such as
depressed mood, loss of interest and enjoyment, and decreased energy, depending on the
number and severity of symptoms, a depressive episode can be categorized as mild,
moderate, or severe; and
Dysthymia, a persistent or chronic form of mild depression; the symptoms of dysthymia
are similar to depressive episode, but tend to be less intense and last longer.
A further important distinction concerns depression in people with or without a history of
manic episodes. Bipolar affective disorder typically consists of both manic and depressive
episodes separated by periods of normal mood. Manic episodes involve elevated mood
and increased energy, resulting in over-activity, pressure of speech and decreased need
for sleep.
Global and regional estimates of prevalence
,2
2015: 4.4% of the population.
Depression is more common
among females (5.1%) than
males (3.6%)
Prevalence varies by WHO
Region, from a low of 2.6%
among males in the Western
Pacific Region to 5.9% among
females in the African Region.
Prevalence rates vary by age,
peaking in older adulthood
(above 7.5% among females
aged 55-74 years, and above
5.5% among males). Depression
also occurs in children and
adolescents below the age of 15
years, but at a lower level than older age groups.
The total number of people living with depression in the world is 322 million. Nearly
half of these people live in the South-East Asia Region and Western Pacific Region,
reflecting the relatively larger populations of those two Regions (which include India
and China, for example).
The total estimated number of people living with depression increased by 18.4%
between 2005 and 2015 [5]; this reflects the overall growth of the global population,
as well as a proportionate increase in the age groups at which depression is more
prevalent.
Global and regional estimates of health loss (depressive disorders)
Depressive disorders led to a global total of over 50 million Years Lived with
Disability (YLD) in
2015. More than 80%
of this non-fatal
disease burden
occurred in low- and
middle-income
countries. Rates vary
across WHO Regions,
from 640 YLD per
100,000 population in
Western Pacific
Region to over 850 in
low- and middle-
income countries
of the European
Region. Globally,
depressive disorders are ranked as the single largest contributor to non-fatal health
loss (7.5% of all YLD).
DSM-5
Major Depressive Disorder
Diagnostic Criteria
,3
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 attributable to another medical condition.
1. Depressed mood most of the day, nearly everyday, 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 everyday.
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 everyday.
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.
• The symptoms cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
• 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 Criterion A, 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 manic-like or hypomanic-like episodes are
substance-induced or are attributable to the physiological effects of another medical
condition.
Persistent Depressive Disorder (Dysthymia)
Diagnostic Criteria 300.4 (F34.1)
This disorder represents a consolidation of DSM-IV-defined chronic major depressive
disorder and dysthymic disorder.
, 4
• Depressed mood for most of the day, for more days than not, as indicated by either
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.
• Presence, while depressed, of two (or more) of the following:
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.
• During the 2-year period (1 year for children or adolescents) of the disturbance, the
individual has never been without the symptoms in Criteria A and B for more than 2
months at a time.
• Criteria for a major depressive disorder may be continuously present for 2 years.
• There has never been a manic episode or a hypomanic episode, and criteria have
never been met for cyclothymic disorder.
• The disturbance is not better explained by a persistent schizoaffective disorder,
schizophrenia, delusional disorder, or other specified or unspecified schizophrenia
spectrum and other psychotic disorder.
• The symptoms are not attributable to the physiological effects of a substance (e.g., a
drug of abuse, a medication) or another medical condition (e.g. hypothyroidism).
• The symptoms cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
Note: Because the criteria for a major depressive episode include four symptoms that are
absent from the symptom list for persistent depressive disorder (dysthymia), a very limited
number of individuals will have depressive symptoms that have persisted longer than 2 years
but will not meet criteria for persistent depressive disorder. If full criteria for a major
depressive episode have been met at some point during the current episode of illness, they
should be given a diagnosis of major depressive disorder. Otherwise, a diagnosis of other
specified depressive disorder or unspecified depressive disorder is warranted.
Specify if:
With anxious distress (p. 184)With mixed features (pp. 184–185)With melancholic
features (p. 185)With atypical features (pp. 185–186)With mood-congruent psychotic
features (p. 186) With mood-incongruent psychotic features (p. 186) With peripartum
onset (pp. 186–187)
Specify if:In partial remission (p. 188) In full remission (p. 188)
Specify if:Early onset: If onset is before age 21 years. Late onset: If onset is at age 21 years
or older.
Specify if (for most recent 2 years of persistent depressive disorder):With pure dysthymic
syndrome: Full criteria for a major depressive episode have not been met in at least the
preceding 2 years.With persistent major depressive episode: Full criteria for a major
depressive episode have been met throughout the preceding 2-year period.With intermittent
major depressive episodes, with current episode: Full criteria for a major depressive
episode are currently met, but there have been periods of at least 8 weeks in at least the
preceding 2 years with symptoms below the threshold for a full major depressive episode.
With intermittent major depressive episodes, without current episode: Full criteria for a
major depressive episode are not currently met, but there has been one or more major
depressive episodes in at least the preceding 2 years.
Specify current severity: Mild (p. 188) Moderate (p. 188) Severe (p. 188)
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