Depression Explained (Major Depressive Disorder)

00:08:02
https://www.youtube.com/watch?v=tJQRsIbD110

摘要

TLDRThe video outlines major depressive disorder (MDD), the projected leading cause of disease burden by 2030. It explains the DSM-5 diagnostic criteria, which require core symptoms like low mood and anhedonia, alongside other criteria. The video discusses contributing factors, including genetic predisposition and environmental stressors, and presents the diathesis-stress model. Various treatment methods are covered, emphasizing lifestyle changes, psychotherapy, and pharmacotherapy. It also mentions the higher prevalence of MDD in females and the significance of relapses in treatment-resistant cases.

心得

  • 🧠 Major depressive disorder is a leading cause of disease burden by 2030.
  • 📋 DSM-5 outlines 9 criteria for diagnosis, core being low mood and anhedonia.
  • 🔬 Genetic and environmental factors contribute to MDD risk.
  • 📉 Lifetime risk of developing MDD is about 12%.
  • 👩‍⚕️ Effective treatment includes lifestyle changes, therapy, and medications.
  • 💊 SSRIs are common first-line antidepressants.
  • ⚡️ Electroconvulsive therapy is effective for treatment-resistant cases.
  • 🚫 Around 50% of treated individuals may relapse within 12 months.

时间轴

  • 00:00:00 - 00:08:02

    The video begins by defining depression as a low mood state, specifically highlighting major depressive disorder (MDD) which is anticipated to be the leading cause of disease burden globally by 2030. MDD was formally recognized in the 1970s and incorporated into the DSM in the 1980s. The DSM-5 outlines nine diagnostic criteria for MDD, with core symptoms including a prevailing low mood and anhedonia, which necessitate at least five symptoms present for two weeks resulting in significant distress or functional impairment.

思维导图

视频问答

  • What are the core symptoms of major depressive disorder?

    The core symptoms include low mood most of the day and anhedonia, which is a loss of pleasure in previously enjoyable activities.

  • How is major depressive disorder diagnosed?

    Diagnosis is based on having five or more symptoms over at least two weeks, including low mood, anhedonia, weight changes, sleep disturbances, and fatigue.

  • What factors contribute to major depressive disorder?

    MDD is thought to be caused by a combination of genetic and environmental factors, including stressful life events and a family history of depression.

  • What are common treatments for major depressive disorder?

    Common treatments include lifestyle modifications, psychotherapy, and pharmacological therapy with antidepressants.

  • What is the lifetime risk of developing major depressive disorder?

    The lifetime risk is around 12%, or about one in eight people.

  • Which demographic is more affected by major depressive disorder?

    Major depressive disorder is nearly twice as common in females compared to males.

  • What therapy is most effective for treatment-resistant major depressive disorder?

    Electroconvulsive therapy is considered the most effective treatment for major depressive disorder.

  • What role does exercise play in the treatment of depression?

    Exercise is part of lifestyle modifications that can help alleviate symptoms of depression.

  • What are some first-line antidepressants?

    First-line medications often include selective serotonin reuptake inhibitors like sertraline and citalopram.

  • How common is relapse after treatment for major depressive disorder?

    Around 50% of patients who respond to treatment may relapse within 12 months.

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  • 00:00:00
    [Music]
  • 00:00:05
    depression is a mental state of low mood
  • 00:00:08
    there are several subtypes of depression
  • 00:00:11
    but major depressive disorder is the one
  • 00:00:14
    that's usually intended it is expected
  • 00:00:17
    to be the number one cause of disease
  • 00:00:19
    burden worldwide by 2030.
  • 00:00:23
    the term major depressive disorder was
  • 00:00:26
    first used in the 1970s and the disorder
  • 00:00:29
    was added to the diagnostic and
  • 00:00:31
    statistic manual of mental disorders
  • 00:00:34
    known as the dsm in the 1980s today we
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    have the dsm 5 which lays out 9 criteria
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    on which the diagnosis is based
  • 00:00:45
    they include a low mood most of the day
  • 00:00:48
    on most days and anedonia which means a
  • 00:00:52
    loss of pleasure or interest in
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    previously enjoyable activities
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    these two are considered core symptoms
  • 00:01:00
    and one of them must be present for a
  • 00:01:02
    diagnosis of major depressive disorder
  • 00:01:06
    the other criteria include significant
  • 00:01:09
    weight loss or weight gain
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    insomnia or hypersomnia meaning not
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    sleeping enough or sleeping too much
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    fatigue or a loss of energy nearly every
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    day
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    psychomotor retardation which means a
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    slowing down of thoughts and physical
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    movements that is noticed by others then
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    there is inappropriate guilt or feeling
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    worthless
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    a reduction in the ability to
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    concentrate and the recurrent thoughts
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    of death a total of five or more over a
  • 00:01:42
    period of at least two weeks leading to
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    significant clinical distress or
  • 00:01:47
    impaired functioning need to be present
  • 00:01:50
    for the diagnosis
  • 00:01:51
    and the symptoms cannot be the result of
  • 00:01:54
    substance abuse or another condition
  • 00:01:58
    major depressive disorder is thought to
  • 00:02:00
    be caused by multiple factors including
  • 00:02:03
    genetic and environmental factors
  • 00:02:07
    some studies have suggested that 40 of
  • 00:02:10
    difference in risk between individuals
  • 00:02:13
    can be accounted for by genetics
  • 00:02:16
    there is a high concordance rate of
  • 00:02:18
    depression in monozygotic twins and
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    overall this means a family history is
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    considered a risk factor
  • 00:02:26
    environmental factors can include
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    stressful life events childhood abuse
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    which also correlates with the severity
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    of the depression
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    and a diagnosis of another medical
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    condition or substance abuse but as we
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    mentioned they cannot be the direct
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    cause
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    based on these factors there's the
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    diathesis stress model represented by
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    these two cups
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    it states that the stressful event on a
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    pre-existing vulnerability means an
  • 00:02:56
    increased likelihood of developing
  • 00:02:58
    depression
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    so from two people experiencing the same
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    stress
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    one may develop depression while the
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    other may not
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    visualized as the contents of the cup
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    spilling over
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    taking this a step further the exact
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    mechanisms underlying major depressive
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    disorder are not entirely known but
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    theories include the monoamine theory
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    which suggests that a lack of monoamine
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    neurotransmitters like serotonin
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    dopamine and norepinephrine is the cause
  • 00:03:31
    there is evidence to support this
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    however lower serotonin levels in
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    healthy individuals do not cause
  • 00:03:38
    depression
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    and antidepressants instantly replenish
  • 00:03:41
    neurotransmitter levels but the effects
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    are not felt for several weeks
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    other theories include abnormalities in
  • 00:03:49
    the hypothalamic pituitary axis as
  • 00:03:52
    people with depression have demonstrated
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    elevated cortisol levels and less
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    dexamethasone suppression
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    there is also thought to be a link
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    between thyroid hormone and growth
  • 00:04:03
    hormone levels with depression
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    immune system abnormalities may also be
  • 00:04:09
    involved including excessive cytokine
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    release
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    this is suggested by the improvement of
  • 00:04:15
    symptoms on non-steroidal
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    anti-inflammatory drugs and
  • 00:04:19
    normalization of cytokine levels after
  • 00:04:22
    treatment this may also explain closer
  • 00:04:25
    links with immune related diseases like
  • 00:04:28
    asthma
  • 00:04:29
    the lifetime risk of developing major
  • 00:04:31
    depressive disorder is around 12 percent
  • 00:04:34
    or approximately one in eight
  • 00:04:37
    it is nearly twice as common in females
  • 00:04:40
    as it is in males which may be explained
  • 00:04:43
    by different psychosocial stressors and
  • 00:04:46
    hormonal differences
  • 00:04:48
    but the exact cause is not clear
  • 00:04:50
    the mean age of onset is 40 however
  • 00:04:54
    depression is becoming increasingly
  • 00:04:56
    prevalent in younger people
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    we have already mentioned the clinical
  • 00:05:00
    criteria for the diagnosis via the dsm-5
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    and there is also a set of criteria
  • 00:05:07
    known as the
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    icd-11 primarily used in europe
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    the severity of depression can be gauged
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    using scoring systems like the patient
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    health questionnaire 9.
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    it's also important to note that the
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    presence of other disorders are more
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    likely in patients with depression this
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    includes anxiety and substance misuse
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    especially alcohol others can include an
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    association with adhd
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    ptsd and the presence of chronic pain
  • 00:05:39
    the treatment for major depressive
  • 00:05:40
    disorder can vary with combinations
  • 00:05:43
    being thought to be the most effective
  • 00:05:46
    this usually involves lifestyle
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    modification including exercise
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    healthier diets
  • 00:05:52
    limiting alcohol use and smoking
  • 00:05:55
    stopping drug use and developing a
  • 00:05:57
    regular schedule
  • 00:05:59
    then there is psychotherapy also called
  • 00:06:02
    talking therapy examples of which
  • 00:06:04
    include cognitive behavioral therapy or
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    interpersonal therapy
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    they are often the first line and have
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    been shown to be effective
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    it is the treatment of choice for
  • 00:06:15
    patients under the age of 18 according
  • 00:06:18
    to the nice guidelines pharmacological
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    therapy is used in patients with
  • 00:06:23
    moderate or severe depression or in
  • 00:06:25
    patients who have mild depression that
  • 00:06:28
    is not responding to other interventions
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    the medications include selective
  • 00:06:32
    serotonin reuptake inhibitors like
  • 00:06:35
    sertraline citalopram or fluoxetine
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    which are usually first line
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    serotonin norepinephrine reuptake
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    inhibitors like duloxetine and
  • 00:06:45
    venlafaxine can also be used especially
  • 00:06:48
    in patients with associated pain
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    disorders
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    and atypical antidepressants with
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    metazepine in particular aiding in
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    increasing appetite and regulating sleep
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    then we have tricyclic antidepressants
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    like amitriptyline and monoamine oxidase
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    inhibitors like celleduline these are
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    used less commonly due to the high
  • 00:07:10
    incidence of side effects
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    there's also some evidence to suggest
  • 00:07:14
    that vitamin d supplementation can help
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    depressive symptoms in those who are
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    vitamin d deficient
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    and cox-2 inhibitors like celecoxib have
  • 00:07:25
    also been found to be effective
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    according to some studies
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    electroconvulsive therapy is the most
  • 00:07:31
    effective therapy for major depressive
  • 00:07:34
    disorder it involves electrically
  • 00:07:36
    inducing seizures to relieve the
  • 00:07:38
    disorder it's been estimated to be
  • 00:07:40
    effective in around 50 percent of
  • 00:07:42
    patients with treatment resistant major
  • 00:07:45
    depressive disorder and is normally
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    administered with a muscle relaxant
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    under general anesthesia however around
  • 00:07:52
    50 of patients who do respond will
  • 00:07:55
    relapse within 12 months
标签
  • Depression
  • Mental Health
  • Major Depressive Disorder
  • DSM-5
  • Treatment
  • Symptoms
  • Risk Factors
  • Therapies
  • Prevalence
  • Psychotherapy