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Course: Mental Health Nursing�Topic: Mood Disorder: Depression Part I

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Module Goals

Learners will be able to

Define Mood Disorder.
Identify the types of Mood disorders.
Define Depression.
Explain genetic, biological, psychological, & cultural factors contributing to depressive disorders.
Examine the connection of the genetic clusters on functional behaviors related to depressive disorders.
Explain the influence of the prefrontal lobe, hippocampus, anterior cingulate, & amygdala on the functional and dysfunctional behaviors of individuals experiencing depression.

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Mood Disorder

A mental health problem that primarily affects a person’s emotional state in which a person experiences long periods of extreme happiness, extreme sadness, or both

Common mood disorders

Depression and
Bipolar disorders

Cleveland Clinic. Org, 2018

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Different Types of Mood Disorders

Major Depression
Dysthymia (a chronic, low-grade, depressed, or irritable mood lasts at least for two years)
Bipolar Disorder
Substance-induced mood disorder
Mood disorder related to another health condition

Johns Hopkins Medicine, 2021

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Definition of Depression

A mood disorder that causes a persistent feeling of sadness and loss of interest.

The (DSM-5) classifies depressive disorders into:

Disruptive mood dysregulation disorder
Major depressive disorder
Persistent depressive disorder (dysthymia)
Premenstrual dysphoric disorder
Depressive disorder due to another medical condition

Chand, Arif, & Kutlenios, 2021

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Etiology of Depression

Multifactorial with both genetic and environmental factors

First-degree relatives of depressed individuals are three times as likely to develop depression.

However, depression may occur in people without family histories of depression.

Biological risk factors in the elderly

Chand, Arif, & Kutlenios, 2021

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Etiology of Depression

Neurodegenerative diseases

Specifically Alzheimer disease and Parkinson disease.
Stroke, multiple sclerosis, seizure disorders, cancer, macular degeneration.
Chronic pain is associated with higher rates of depression.

Life events operate as triggers
Traumatic events

Death or loss of a loved one.
Lack or reduced social support, caregiver burden.
Financial problems, interpersonal difficulties, and conflicts are examples of stressors that may trigger depression.

Chand, Arif, & Kutlenios, 2021

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Critical Thinking Question

Which of the following might be a trigger for depression?

Two grown siblings have been estranged for two years
A victim of a car accident has a permanent limp after recovering from severe injuries
A wife needed to leave her work as a teacher to care for her aging husband
An elderly man has Parkinson’s disease
A salesman received a promotion to sales manager

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Risk Factors for Depression

The prevalence in 18- to 29-year-old individuals is threefold higher than in individuals aged 60 years or older.

Females experience 1.5- to 3-fold higher rates than males beginning in early adolescence.

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Biological Factors

May all play a role in the development of major depression:

Genetic
Neurological
Hormonal
Immunological, and
Neuroendocrinological mechanisms

National Research Council et al., 2009

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Genetic Factors

The serotonin (5-HT) exerts effects on a broad range of physiological functions (Emotions, sleep, circadian rhythm, thermoregulation, appetite, aggression, sexual behavior)

Deficits in the central 5-HT system:

Reduced 5-HT concentrations
Impaired uptake function of the 5-HT transporter
Altered 5-HT receptor binding, and tryptophan depletion, have been linked to a depression.

National Research Council et al., 2009

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Neuroendocrine Factors

Depression is associated with elevated cortisol and related neurohormones.

There is a higher cortisol level and abnormalities in cortisol regulation among depressed individuals compared with nondepressed individuals.

Depressed clients show slower recovery of cortisol levels in response to psychological stress.

National Research Council et al., 2009

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Environmental and Personal Vulnerabilities

Environmental stressors associated with depression.

Acute life events
Chronic stress
Childhood exposure to adversity

Personal vulnerabilities associated with depression

Cognitive
Interpersonal
Personality factors

National Research Council et al., 2009

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A major risk factor for depression is the experience of undesirable, negative life events
There is ample evidence that most major depressive episodes are triggered by stressful life events
A specific example of a chronically stressful condition amplified by co-occurring adverse conditions is single-mother status. Single mothers have been found to have higher rates of major depression than married mothers
In addition to recent negative events and chronically stressful conditions, increasing evidence focuses on the link between childhood exposure to adversity and the development of depression in adolescence or adulthood. One research strategy studies associations between a single specific experience, such as sexual abuse or physical or emotional maltreatment, and depression.
Interpersonal: considerable impairment in interpersonal functioning—marital discord, intimate partner violence, parenting difficulties, insecure attachment, and low social support, to mention several specific areas)

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Cognitive Vulnerability to Depression

Three variants of cognitive models of depression:

The classical cognitive triad model (negative views of the self, world, and future) of Aaron Beck 1967.

The versions of the helplessness/hopelessness cognitive style (Abramson, Seligman, and Teasdale, 1978).

Information-processing perspectives.

National Research Council et al., 2009

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Interpersonal Vulnerability to Depression

Depressive disorders are known to be associated with considerable impairment in interpersonal functioning:

Marital discord
Intimate partner violence
Parenting difficulties
Insecure attachment and low social support

The symptoms of depression may contribute to problems in a close relationship.
(Irritability, loss of energy and enjoyment, sensitivity to criticism, and pessimistic)

National Research Council et al., 2009

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Critical Thinking Question

What are the biological genetic changes present in depressive disorder?

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Personality and Vulnerability to Depression

Factors that have received considerable recent attention:

Neuroticism

Defined by negative emotionality and high reactivity to real and perceived stress.
It may be one of the genetically transmitted traits that predispose an individual to both stressful life events and depression (Kendler et al., 1995).

Ruminative response style

A cognitive and behavioral coping strategy, employed mainly by women, for responding to negative emotions, particularly dysphoria.

National Research Council et al., 2009

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Cultural Factors

Depressive disorders can be influenced by cultural context:

For example, black women have lower rates of depression than white women.

People from collectivistic cultures are not encouraged to prioritize personal gratification.

Are less frustrated about their failure to achieve personal success, leading to decreased development of depressive disorders.

Rigid gender role culture (loses husband or wife) is at risk of developing depression.

Nimade, 2021

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Influence of Prefrontal Lobes on Depression

A decreased metabolism in the prefrontal cortex, especially dorsolateral and dorsoventral brain regions, is a frequently replicated finding in Major Depressive Disorders (MDD)

Deficient prefrontal perfusion, coupled with a reduction in problem-solving abilities and a higher propensity to act on negative emotions, has been implicated in suicidal behavior.

Structural brain magnetic resonance imaging imaging (MRI) research suggests:

A decreased frontal lobe volume
A reduced volume of the orbitofrontal cortex

Pandya, Altinay, Malone, & Anand, 2012

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Influence of Subcortical Limbic Region on Depression

The central subcortical limbic brain regions implicated in depression:

The amygdala,
The hippocampus
The dorsomedial thalamus

The Hippocampus:

Decreased hippocampal volumes found in depression.
Smaller hippocampal volumes were reported to be more prone to relapse.

Pandya, Altinay, Malone, & Anand, 2012

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Influence of Subcortical Limbic Region on Depression

The Amygdala:

Decreased amygdala core volume
The Increased volume reported in some studies may be related to medication effects.
Increased activation in the resting state as well as in response to stimuli has been reported in many of positron emission tomography (PET) and MRI studies.
However, in another study hypometabolism of the amygdala and paralimbic regions was reported in more severe treatment resistant depression.

Pandya, Altinay,Malone, & Anand, 2012

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Influence of Subcortical Limbic Region on Depression

The Thalamus

Significant volume reductions and changes in shape have been observed in the left thalamus with Major Depressive Disorders (MDD).
The gray matter volume of the right thalamus was also found to be reduced in MDD.

Pandya, Altinay, Malone, & Anand, 2012

Zhang, Peng, Sweeney, Jia, & Gong, 2018

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Critical Thinking Question

What changes are noted in the Hippocampus related to depression?

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Red Flag

Depressive behavior may lead to suicide if an individual in psychic distress sees this as their only option for escape.

Most anti depressant medication may take up to 3 weeks to reach therapeutic effect.

There is potential increase in suicide when severely depressed individuals are initially placed on anti depressant medications as once their severe depression lifts they may feel energized to carry out their suicide plan.

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References

Chand SP, Arif H, Kutlenios RM. Depression (Nursing) [Updated 2021 Jul 26]. In: StatPearls [Internet]. StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK568733/

Cleveland Clinic. (2018). Mood Disorders. https://my.clevelandclinic.org/health/diseases/17843-mood-disorders

Johns Hopkins Medicine. (2021). Mood Disorders. https://www.hopkinsmedicine.org/health/conditions-and-diseases/mood-disorders#:~:text=Mood%20disorders%20can%20often%20be,behavioral%20and%2For%20interpersonal%20therapy

National Research Council (US) and Institute of Medicine (US) Committee on Depression, Parenting Practices, and the Healthy Development of Children; England MJ, Sim LJ, editors(2009). Depression in Parents, Parenting, and Children: Opportunities to Improve Identification, Treatment, and Prevention. Washington (DC): National Academies Press (US); 2009. 3, The Etiology of Depression. Available from: https://www.ncbi.nlm.nih.gov/books/NBK215119/

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References

Nimade, R. (2021). Sociology of Depression- Effects of Culture. Gracepoint. https://www.gracepointwellness.org/5-depression-depression-related-conditions/article/13009-sociology-of-depression-effects-of-culture

Pandya, M., Altinay, M., Malone, D. A., Jr, & Anand, A. (2012). Where in the brain is depression?. Current psychiatry reports, 14(6), 634–642. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3619732/

Zhang, F. F., Peng, W., Sweeney, J. A., Jia, Z. Y., & Gong, Q. Y. (2018). Brain structure alterations in depression: Psychoradiological evidence. CNS neuroscience & therapeutics, 24(11), 994–1003. https://doi.org/10.1111/cns.12835

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