on major depressive disorder (dr cheng)

 source: notes taken during the webinar by dr cherryrich m cheng, part-time psychiatrist at the DJNRMHS

>depression vs sadness

>mood = pervasive & sustained F (feeling) that leads to A (actions) & T (thoughts)

>diagnostic criteria: (a) 1 core symptom (depression &/or anhedonia), (b) 4 associated features (sleep, weight, negative thoughts, suicidality) & (c) poor functioning

>3 types of sleep problem: (a) initial = difficulty falling asleep, (b) intermittent, (c) terminal = wakes up early & can't sleep anymore (the most common type)

>normal range of sleep for ages 25-60: 6-10 HRs 

>non-purposeful activity = agitated, unfocused

>weight problem = weight loss of ~2 lbs/wk without purposeful effort

>2 types of suicidality: (a) active, (b) passive (e.g. "i wish i would not wake up anymore")

>untreated: can last from 6 to 13 months vs treated: up to 3 months

>treatment by medications can last from 6 months to a year

>average number of episodes = 5-6 over a 20-year period for unipolar depressives

>hospitalization: 50% recover; 50% relapse

>etiology: bio-psycho-social

--bio: (a) low serotonin, norepinephrine, dopamine; (b) 1 parent with depression = 10-25% chance in children; if both parents with depression = 20-50% chance for children; NB: however, it's nature vs nurture

--psycho: beck's CBT model: (a) self: "I AM WORTHLESS." (b) future: "NOTHING WILL EVER CHANGE." & (C) others: "EVERYONE IS AGAINST ME."

--social: actual &/or symbolic LOSS; NB: esp actual loss of a parent before age 11; symbolic = e.g. missed opportunity

>treatment: (a) meds, (b) psychotherapy: 1-2x/wk for 12 or more sessions