Psychology Depressive Disorders
by
Lawrence P. Riso, Matthew Vaughn
  • LAST MODIFIED: 28 July 2015
  • DOI: 10.1093/obo/9780199828340-0171

Introduction

Depression is a highly prevalent condition, often with an early onset. Nearly a quarter of all individuals will experience a diagnosable depression at some point in their lifetimes. The early onset and recurrent nature of depression contribute to making depression the most burdensome illness in the entire world, according to the World Health Organization. Over the last thirty years, the diagnosis of depression has changed little. Since 1980, every edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) has included a category for severe acute depression (i.e., “major depression” or “major depressive disorder”) and a category for chronic forms of depression (i.e., “dysthymia,” “dysthymic disorder,” or “persistent depressive disorder”). The current edition of the DSM (DSM-5) includes two main categories, “major depressive disorder” and “persistent depressive disorder.” There is a very large literature on the etiology and treatment of depression.

General Overviews

The German psychiatrist and descriptive psychopathologist Emil Kraepelin (Kraepelin 1921) provided an early comprehensive work describing depressive disorders. His ideas continue to influence modern conceptions of depressive disorders. A more recent compendium on depressive disorders, Gotlib and Hammen 2009, is one of the most comprehensive single works devoted to depression. The chapters review an array of topics, including epidemiology, classification, personality function, cognitive-behavioral theories, biological theories, treatment, cultural factors, and suicidality. The chapter on epidemiology by Kessler and Wang reviews the prevalence of depression and notes the consistent finding that depression is twice as common in women as in men. The most influential theoretical model for the development of depression in the literature is the cognitive perspective (i.e., a focus on thoughts, assumptions, and underlying beliefs). Ingram, et al. 2011 is exclusively devoted to the explication and evaluation of the cognitive model for depression. This volume, in its authoritative overview, pays close attention to the empirical support for the model. Over the last two to three decades, there has been increasing attention to depression in its chronic form. Two edited volumes, Alpert and Fava 2004 and Kocsis and Klein 1995, focus entirely on chronic depression. Both volumes cover etiology and treatment. Alpert and Fava 2004 is somewhat more comprehensive. For those looking for a concise general overview of depressive disorders, there is a recent book chapter in Ritschel, et al. 2013 addressing major depressive disorder, and another, Klein and Black 2013, that reviews chronic depression.

  • Alpert, J. E., and M. Fava, eds. 2004. Handbook of chronic depression. New York: Marcel Dekker.

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    An edited volume with a comprehensive overview of chronic depression. It covers a range of topics, including diagnosis, epidemiology, biological factors, etiology, and treatment.

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    • Gotlib, I. H., and C. L. Hammen, eds. 2009. Handbook of depression. 2d ed. New York: Guilford.

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      This is the most extensive volume on depression available. The chapters offer brief but rigorous literature reviews. It reviews the empirical and theoretical literature with relatively less applied information.

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      • Ingram, R. E., R. A. Atchley, and Z. V. Segal. 2011. Vulnerability to depression: From cognitive neuroscience to prevention and treatment. New York: Guilford.

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        This is a follow-up to an earlier volume by Ingram and colleagues that focused on cognitive vulnerability to depression. This updated book merges what we know about cognitive vulnerability with the latest findings in cognitive neuroscience.

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        • Klein, D. N., and S. R. Black. 2013. Persistent depressive disorder: Dysthymia and chronic depression. In Psychopathology: History, diagnosis, and empirical foundations. 2d ed. Edited by W. E. Craighead, D. J. Miklowitz, and L. W. Craighead, 334–355. Hoboken, NJ: Wiley.

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          This chapter presents an up-to-date examination of chronic depression. It covers assessment, course, etiology, and treatment. It also reviews the literature that contributed to the formation of the new DSM-5 category “persistent depressive disorder.”

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          • Kocsis, J. H., and D. N. Klein, eds. 1995. Diagnosis and treatment of chronic depression. New York: Guilford.

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            The editors of this volume have published numerous articles on chronic depression. The volume focuses mostly on diagnosis, assessment, course, and clinical correlates of chronic depression, although there are two chapters on treatment. At the time the book was published, the terms “dysthymic disorder” and “chronic major depressive disorder” were in widespread use. Virtually all of the contributors to the volume are prolific scholars on this topic.

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            • Kraepelin, E. 1921. Manic depressive insanity and paranoia. Translated by R. M. Barclay. Edinburgh: E. and S. Livingstone.

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              This is a translation of a classic text (from the eighth edition of Psychiatrie: Ein Lehrbuch für Studierende und Aerzte, Leipzig: J. A. Barth, 1913–1922) by Emil Kraepelin, one of psychiatry’s most influential descriptive psychopathologists (often described as the “father of modern psychiatry”). The diagnostic distinctions he described in this volume continue to influence modern-day classification of depressive disorders.

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              • Ritschel, L. A., C. F. Gillespie, E. Ö. Arnarson, and W. E. Craighead. 2013. Major depressive disorder. In Psychopathology: History, diagnosis, and empirical foundations. 2d ed. Edited by W. E. Craighead, D. J. Miklowitz, and L. W. Craighead, 285–333. Hoboken, NJ: Wiley.

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                The chapter focuses specifically on major depressive disorder. It provides excellent coverage of biological and cognitive (with a focus on Aaron T. Beck) theories.

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                Classification

                Some of the major issues in the classification of depressive disorders include diagnostic criteria, subtypes of depression, the classification of chronic depression, and whether or not to exclude individuals experiencing a bereavement. Kendler and Gardner 1998 examines the diagnostic criteria, specifically the duration requirement of two weeks for major depressive disorder. Parker 2000 reviews ways of subtyping depressive disorders. McCullough, et al. 2003 provides data on the distinction among different forms of chronic depression, and Klein 2008 proposes a dimensional system for classifying depression (based on course and severity). Both authors have written extensively on the topic. Another issue is whether or not individuals suffering the recent loss of a loved one (i.e., bereavement) should be diagnosed with a depressive disorder. Two important studies, Corruble, et al. 2011 and Kendler, et al. 2008, present data on this topic. The Kendler, et al. paper in particular offers a highly sophisticated empirical investigation and a large sample size. The authors concluded that bereavement-related depression is not appreciably distinct from depression related to other stressful events. Horwitz and Wakefield 2007 argues that psychiatric nosology overemphasizes symptoms (e.g., sleep, appetite, fatigue) in the diagnosis of depression. Consequently, “normal” sad reactions to external events get classified as “disordered” reactions.

                • Corruble, E., B. Falissard, and P. Gorwood. 2011. Is DSM-V bereavement exclusion for major depression relevant to treatment response? A case-control, prospective study. Journal of Clinical Psychiatry 72.7: 898–902.

                  DOI: 10.4088/JCP.09m05681bluSave Citation »Export Citation »E-mail Citation »

                  This study compared a large sample of individuals meeting criteria for major depression to those who were excluded from the diagnosis because of a recent bereavement. No differences in treatment response were found between the two groups.

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                  • Horwitz, A. V, and J. C. Wakefield. 2007. The loss of sadness: How psychiatry transformed normal sorrow into depressive disorder. New York: Oxford Univ. Press.

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                    This book takes a critical view of the way modern psychiatry, at least since 1980, has diagnosed depression. The authors believe that the emphasize placed on symptoms (e.g., sleep problems, fatigue, loss of interest) tends to pathologize “normal” reactions to stressful events (e.g., loss of job or a relationship). As a result, we arrive at the mistaken conclusion of an epidemic of depression. These ideas are quite relevant to recent controversies surrounding the expansion of many categories in the DSM-5.

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                    • Kendler, K. S., and C. O. Gardner Jr. 1998. Boundaries of major depression: An evaluation of DSM-IV criteria. American Journal of Psychiatry 155.2: 172–177.

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                      Using twin study data, these authors found little support for the two-week duration requirement for a diagnosis of major depressive disorder. The authors concluded that the requirement appeared to be an arbitrary cutoff imposed on a continuum of duration.

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                      • Kendler, K. S., J. Myers, and S. Zisook. 2008. Does bereavement-related major depression differ from major depression associated with other stressful life events? American Journal of Psychiatry 165:1449–1455.

                        DOI: 10.1176/appi.ajp.2008.07111757Save Citation »Export Citation »E-mail Citation »

                        This study examined clinical and demographic characteristics of those with bereavement-related depression compared to those with depression from other types of life events. Few differences were found. The authors concluded that these results bring into question the validity of the bereavement exclusion for a diagnosis of major depressive disorder.

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                        • Klein, D. N. 2008. Classification of depressive disorders in the DSM-V: Proposal for a two-dimension system. Journal of Abnormal Psychology 117:552–560.

                          DOI: 10.1037/0021-843X.117.3.552Save Citation »Export Citation »E-mail Citation »

                          In this review, the author proposes to simplify the classification of depression by classifying it along two dimensions, chronicity and severity.

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                          • McCullough, J. P., D. N. Klein, M. S. Munsaka, et al. 2003. Group comparisons of DSM-IV subtypes of chronic depression: Validity of the distinctions, part 2. Journal of Abnormal Psychology 112:614–622.

                            DOI: 10.1037/0021-843X.112.4.614Save Citation »Export Citation »E-mail Citation »

                            Several forms of chronic major depressive disorder were compared in over 600 patients. Few differences were found. The authors argue for “lumping” these different manifestations of chronic depression into one broad category. This paper was an important contribution to the new DSM-5 category of persistent depressive disorder.

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                            • Parker, G. 2000. Classifying depression: Should paradigms lost be regained? American Journal of Psychiatry 157:1195–1203.

                              DOI: 10.1176/appi.ajp.157.8.1195Save Citation »Export Citation »E-mail Citation »

                              The current nomenclature distinguishes among different types of depression largely on the basis of clinical severity. This article reviews the support for an alternative model that distinguishes depressive disorders on the basis of clinical manifestations such as psychotic and psychomotor symptoms.

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                              Cognitive and Personality Factors

                              Psychosocial theories of depression have been dominated by the cognitive theory. Ingram, et al. 1998 is an extremely comprehensive and authoritative volume on this topic. A subsequent volume, Ingram, et al. 2011, considers cognitive factors in the context of cognitive neuroscience and neural circuitry. There is a large literature examining the role of personality factors in depression. Klein, et al. 2009 presents a concise overview of this literature, including the role of neuroticism and temperament in depression. See also Alloy, et al. 2000 and Scher, et al. 2005.

                              • Alloy, L. B., L. Y. Abramson, M. E. Hogan, et al. 2000. The Temple-Wisconsin Cognitive Vulnerability to Depression (CVD) Project: Lifetime history of Axis I psychopathology in individuals at high and low cognitive risk for depression. Journal of Abnormal Psychology 109:403–418.

                                DOI: 10.1037/0021-843X.109.3.403Save Citation »Export Citation »E-mail Citation »

                                In this landmark project, elevated levels of cognitive vulnerability (e.g., problematic attributional style and dysfunctional attitudes) were associated with a history of depression.

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                                • Ingram, R. E., R. A. Atchley, and Z. V. Segal. 2011. Vulnerability to depression: From cognitive neuroscience to prevention and treatment. New York: Guilford.

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                                  This is a follow-up to an earlier volume by Ingram and colleagues that focused on cognitive vulnerability to depression. This updated book merges what we know about cognitive vulnerability with the latest findings in cognitive neuroscience.

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                                  • Ingram, R. E., J. Miranda, and Z. V. Segal. 1998. Cognitive vulnerability to depression. New York: Guilford.

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                                    This volume begins with a discussion on the meaning of vulnerability and offers general methodological strategies for studying vulnerability to psychopathology. This discussion is followed by a focus on what is known about cognitive vulnerability to depression specifically. Overall, this book provides a uniquely focused and comprehensive discussion of cognitive approaches to understanding depression and offers an integrative cognitive perspective in the final chapter.

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                                    • Klein, D. N., C. E. Durbin, and S. A. Shankman. 2009. Personality and mood disorders. In Handbook of depression. 2d ed. Edited by I. H. Gotlib and C. L. Hammen, 93–112. New York: Guilford.

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                                      This chapter examines the role of personality factors, personality disorders, and temperament in depressive disorders. The authors place particular emphasis on the role of temperament in depression.

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                                      • Scher, C. D, R. E. Ingram, and Z. V. Segal. 2005. Cognitive reactivity and vulnerability: Empirical evaluation of construct activation and cognitive diatheses in unipolar depression. Clinical Psychology Review 25.4: 487–510.

                                        DOI: 10.1016/j.cpr.2005.01.005Save Citation »Export Citation »E-mail Citation »

                                        Over the decades, there has been controversy over whether or not cognitive variables (e.g., negative thoughts, attitudes, and beliefs) contribute to vulnerability to depression. This paper reviews this enormous literature and concludes that the existing data support the cognitive vulnerability hypothesis.

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                                        Interpersonal Factors and Depression

                                        A number of works emphasize the interpersonal context of depression. Joiner and Coyne 1999 focuses exclusively on interpersonal factors in depression. A briefer and more current chapter, Joiner and Timmons 2009, discusses several models of interpersonal factors in depression, including social skills deficits, excessive reassurance seeking, negative feedback seeking, and insecure attachment. Eberhart and Hammen 2009 empirically evaluates the ways in which depressed individuals may generate interpersonal stress (the “stress generation” hypothesis). The edited volume Beach 2001 more specifically examines the relationship between depression and marital and family functioning; it contains applied material as well as empirical and theoretical information.

                                        • Beach, S. R. H., ed. 2001. Marital and family processes in depression: A scientific foundation for clinical practice. Washington, DC: American Psychological Association.

                                          DOI: 10.1037/10350-000Save Citation »Export Citation »E-mail Citation »

                                          The chapters examine the association between depression and marital discord from empirical, theoretical, and applied perspectives. The concluding chapters examine ways to treat depression through couples therapy.

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                                          • Eberhart, N., and C. Hammen. 2009. Interpersonal predictors of stress generation. Personality and Social Psychology Bulletin 35:544–556.

                                            DOI: 10.1177/0146167208329857Save Citation »Export Citation »E-mail Citation »

                                            Provides data examining the mechanism by which depressed individual generate interpersonal stressors. Anxious attachment and reassurance seeking in depressed undergraduates predicted later romantic conflict stress.

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                                            • Joiner, T., and J. C. Coyne. 1999. The interactional nature of depression. Washington, DC: APA Books.

                                              DOI: 10.1037/10311-000Save Citation »Export Citation »E-mail Citation »

                                              These authors argue that the interpersonal context of depression (e.g., interpersonal behavior and the quality of one’s relationships) is among the major etiological factors. Interpersonal factors are said to contribute to both the onset and maintenance of depressive episodes. The authors also present theoretical models of how interpersonal variables may interact with other vulnerability factors.

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                                              • Joiner, T., and K. A. Timmons. 2009. Depression in its interpersonal context. In Handbook of depression. 2d ed. Edited by I. H. Gotlib and C. L. Hammen, 322–339. New York: Guilford.

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                                                Examines interpersonal characteristics of depression individuals and the interpersonal consequences of their “depressotypic” behavior. The ways in which these behaviors contribute to and maintain depression are modeled and discussed.

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                                                Depression in Children and Adolescents

                                                The literature on depression in children and adolescents is much smaller than that for depression in adulthood, but it is growing. Two comprehensive volumes, Abela and Hankin 2008 and Shaffer and Waslick 2002, cover the major topics pertaining to depression in youth, such as epidemiology, etiology, suicidality, and treatment. The Shaffer and Waslick book provides a more “psychiatric” and biological perspective, while the Abela and Hankin volume presents a more psychosocial perspective. For more concise works, there is a chapter Garber, et al. 2009 reviewing depression in young adulthood and a chapter Rudolph 2009 that reviews adolescent depression. Kessler, et al. 2001 reviews the epidemiology of depression in children and adolescents, with some comparisons to depression in adulthood. See also Kistner 2006 and Luby 2009.

                                                • Abela, R. Z., and B. L. Hankin, eds. 2008. Handbook of depression in children and adolescents. New York: Guilford.

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                                                  Covers etiology and treatment of depression in younger populations. There are chapters on suicidality in youth and prevention of depression. The book primarily presents a psychosocial perspective, but biological vulnerability and pharmacotherapy are also discussed.

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                                                  • Garber, J., C. M. Gallerani, and S. A. Frankel. 2009. Depression in children. In Handbook of depression. 2d ed. Edited by I. H. Gotlib and C. L. Hammen, 405–443. New York: Guilford.

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                                                    Provides a brief and concise overview of depression in children. Prevalence, correlates, etiological theories, and treatment are all covered.

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                                                    • Kessler, R. C., S. Avenevoli, and K. Merikangas. 2001. Mood disorders in children and adolescents: An epidemiological perspective. Biological Psychiatry 49.12: 1002–1014.

                                                      DOI: 10.1016/S0006-3223(01)01129-5Save Citation »Export Citation »E-mail Citation »

                                                      This widely cited article examines the epidemiology of all mood disorders (including bipolar disorder) in children and adolescents. Some data on the continuity of depression from childhood to adulthood are presented.

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                                                      • Kistner, J. 2006. Children’s peer acceptance, perceived acceptance, and risk for depression. In The interpersonal, cognitive, and social nature of depression. Edited by T. E. Joiner, J. S. Brown, and J. Kistner, 1–12. Mahwah, NJ: Lawrence Erlbaum.

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                                                        This chapter examines the possible role of problematic peer relationships and later development of depression. It provides a careful analysis of the methodology and assessment measures used in prior research.

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                                                        • Luby, J. 2009. Early childhood depression. American Journal of Psychiatry 166.9: 974–979.

                                                          DOI: 10.1176/appi.ajp.2009.08111709Save Citation »Export Citation »E-mail Citation »

                                                          Reviews the existence of depression in preschool-aged children, including children as young as three. It presents a psychotherapeutic model that may be effective for this population. A case example is presented, and treatment considerations are discussed.

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                                                          • Rudolph, K. D. 2009. Adolescent depression. In Handbook of depression. 2d ed. Edited by I. H. Gotlib and C. L. Hammen, 444–466. New York: Guilford.

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                                                            Presents an overview of adolescent depression, including clinical presentation and epidemiology. Several etiological factors are reviewed, including biological, interpersonal, family, and cognitive.

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                                                            • Shaffer, D., and B. Waslick, eds. 2002. The many faces of depression in children and adolescents. Washington, DC: American Psychiatric.

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                                                              This edited volume has chapters reviewing epidemiology, psychotherapy, pharmacotherapy, and suicidality. Several of the contributors are international experts.

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                                                              Biological Etiology

                                                              The search for biological explanations for depression dates back to antiquity. Contemporary efforts focus on genetics and neurobiology. Levinson 2009 provides a brief overview of the role of genetics in depression and speculates on candidate genes. The monoamine hypothesis has long been influential in the treatment and understanding of depression. Hirschfeld 2000 provides a very concise overview of the history of this theory along with some of its basic shortcomings. Thase 2009 provides a brief review of what is known about neuroendocrinology and sleep physiology in depression. Krishnan and Nestler 2010 covers similar information to Thase, but is much more lengthy, comprehensive, and theoretical. Nemeroff 2004 discusses a possible link between early childhood trauma and neurobiological responsivity to stress. Davidson, et al. 2002 provides an expert review of what is known about the neuroscience of mood and depression. Mayberg 2006 reviews the literature examining brain changes following pharmacotherapy, cognitive-behavioral therapy, and deep brain stimulation, attempting to model the different neuromechanisms involved for each of these therapeutic modalities. The classic article Akiskal and McKinney 1979 demonstrates how to integrate diverse biological and psychosocial theories.

                                                              • Akiskal, H. S., and W. T. McKinney. 1979. Overview of recent research in depression: Integration of ten conceptual models into a comprehensive clinical frame. Archives of General Psychiatry 32:285–305.

                                                                DOI: 10.1001/archpsyc.1975.01760210019001Save Citation »Export Citation »E-mail Citation »

                                                                To help integrate ten diverse models, depression is viewed as a final common pathway of interacting biological, experiential, and behavioral levels of functioning. While the data are not current, the method of theoretical integration used is still relevant.

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                                                                • Davidson, R. J., D. A. Pizzagalli, J. B. Nitschke, and K. Putnam. 2002. Depression: Perspectives from affective neuroscience. Annual Review of Psychology 53:545–574.

                                                                  DOI: 10.1146/annurev.psych.53.100901.135148Save Citation »Export Citation »E-mail Citation »

                                                                  This review comes from the leading neuroscience laboratory on the affective neuroscience of mood and depression. The authors focus on neural circuitry and discuss the role of the prefrontal cortex, anterior cingulated, hippocampus, and amygdala in the etiology of depression.

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                                                                  • Hirschfeld, R. M. 2000. History and evolution of the monoamine hypothesis of depression. Journal of Clinical Psychiatry 61, suppl., 6: 4–6.

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                                                                    Gives a concise review of the origin of the monoamine hypothesis of depression, the most influential biological theory of depressive disorders. It also describes shortcomings of the theory. For instance, the monoamine hypothesis does not address why antidepressants work for anxiety disorders or why some other serotonin-enhancing medications are not effective for depression.

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                                                                    • Krishnan, V., and E. J. Nestler. 2010. Linking molecules to mood: New insight into the biology of depression. American Journal of Psychiatry 167:1305–1320.

                                                                      DOI: 10.1176/appi.ajp.2009.10030434Save Citation »Export Citation »E-mail Citation »

                                                                      Provides a review of immunologic and neuroendocrine aspects of depression. Reviews the role of heterogeneity in biological explanations of depression and discusses both human and animal studies. Implications for diagnosis and treatment are provided.

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                                                                      • Levinson, E. F. 2009. Genetics of major depression. In Handbook of depression. 2d ed. Edited by I. H. Gotlib and C. L. Hammen, 93–112. New York: Guilford.

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                                                                        This is a relatively brief chapter with a broad overview of the genetics of major depression. It covers the importance of clinical characteristics in determining genetic influence (e.g., age of onset, severity), candidate genes for depression, and genetic linkage studies.

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                                                                        • Mayberg, H. S. 2006. Defining neurocircuits in depression: Strategies toward treatment selection based on neuroimaging phenotypes. Psychiatric Annals 36.4: 259–268.

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                                                                          This author attempts to model the different neurocircuits involved in different treatments for depression (e.g., psychopharmacology, cognitive-behavioral therapy, and deep brain stimulation). Depression is said to be related to changes in cortical, subcortical, and limbic regions of the brain. The ultimate goal is to identify biological and clinical markers of different biological subtypes of depression to help select among the various available treatments.

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                                                                          • Nemeroff, C. B. 2004. Neurobiological consequences of childhood trauma. Journal of Clinical Psychiatry 65, suppl., 18–28.

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                                                                            Discusses biological mediators of the relationship between early trauma (sexual abuse, physical abuse, or death of a parent) and vulnerability to both depression and anxiety later in life. According to the author, repeated stress and trauma create changes in central neurobiological systems which lead to increased responsivity to stress.

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                                                                            • Thase, M. E. 2009. Neurobiological aspects of depression. In Handbook of depression. 2d ed. Edited by I. H. Gotlib and C. L. Hammen, 187–217. New York: Guilford.

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                                                                              A brief and technically detailed review of the role of monoamines, the hypothalamic-pituitary-adrenocortical (HPA) axis, and sleep neurophysiology in depression.

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                                                                              Psychosocial Treatment

                                                                              There is a large literature on psychosocial treatments for depression. Hollon and Dimidjian 2009 provides a brief but comprehensive overview of cognitive and behavioral treatments that emphasizes the cognitive and behavioral approaches with the greatest empirical support, as well as comparisons between psychosocial treatments and medication. DeRubeis, et al. 2005 compares cognitive therapy to medication for moderate to severe depression. This is an important study in that it evaluates the notion that cognitive therapy is only appropriate for depression in the mild to moderate range of severity and finds that cognitive therapy can treat depression in the moderate to severe range as well. Behavioral activation is a newer approach designed to help patients re-engage with their environment. Dimidjian, et al. 2006 compares behavioral activation to both cognitive therapy and medication. Dimidjian, et al. 2008 describes the theory and techniques of, and empirical support for, behavioral activation. Driessen, et al. 2013 addresses the comparative efficacy of psychodynamic therapy versus cognitive-behavioral therapy for depression. The literature on the treatment of depression in young children and adolescents is still small, particularly in comparison to the voluminous literature on the treatment of depression in adults. The TADS team 2007 describes one of the largest studies of adolescent depression from a multisite randomized clinical trial. While there are few trials of psychotherapy with young children, Fristad, et al. 2009 examines the use of multifamily psychoeducational groups with children aged eight to twelve. Acceptance and commitment therapy is a relatively new approach, but rapidly growing in its evidence base for a variety of conditions. It is not well studied for depression, although Forman, et al. 2007 studies this therapy in patients with both depression and anxiety.

                                                                              • DeRubeis, R. J., S. D. Hollon, J. D. Amsterdam, et al. 2005. Cognitive therapy vs. medications in the treatment of moderate to severe depression. Archives of General Psychiatry 62:409–416.

                                                                                DOI: 10.1001/archpsyc.62.4.409Save Citation »Export Citation »E-mail Citation »

                                                                                No differences were found for medication versus cognitive therapy. The authors concluded that cognitive therapy can be as effective as medication as a first-line treatment for moderate to severe major depression. A high level of therapist expertise may be required for cognitive therapy to be efficacious.

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                                                                                • Dimidjian, S., S. D. Hollon, K. S. Dobson, et al. 2006. Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of major depression. Journal of Consulting and Clinical Psychology 74:658–670.

                                                                                  DOI: 10.1037/0022-006X.74.4.658Save Citation »Export Citation »E-mail Citation »

                                                                                  The efficacy of behavioral activation was comparable to medication and outperformed cognitive therapy for more severely depressed patients.

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                                                                                  • Dimidjian, S., C. R. Martell, M. E. Addis, and R. Herman-Dunn. 2008. Behavioral activation for depression. In Clinical handbook of psychological disorders: A step-by-step treatment manual. 4th ed. Edited by D. H. Barlow, 353–393. New York: Guilford.

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                                                                                    Behavioral activation is a freestanding therapy for depression. This chapter gives the theoretical background of the treatment and detailed information on how to implement the treatment. A clinical case is provided to illustrate its application.

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                                                                                    • Driessen, E., H. L. Van, F. J. Don, et al. 2013. The efficacy of cognitive-behavioral therapy and psychodynamic therapy in the outpatient treatment of major depression: A randomized clinical trial. American Journal of Psychiatry 170:1041–1050.

                                                                                      DOI: 10.1176/appi.ajp.2013.12070899Save Citation »Export Citation »E-mail Citation »

                                                                                      There are few methodologically sound direct comparisons between cognitive-behavioral therapy and psychodynamic therapy for depression. This study found no differences in efficacy between the two treatments.

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                                                                                      • Forman, E. M., J. D. Herbert, E. Moitra, P. D. Yeomans, and P. A. Geller. 2007. A randomized controlled effectiveness trial of acceptance and commitment therapy and cognitive therapy for anxiety and depression. Behavior Modification 31.60: 772–799.

                                                                                        DOI: 10.1177/0145445507302202Save Citation »Export Citation »E-mail Citation »

                                                                                        This clinical trial did not find any difference between the efficacy of acceptance and commitment therapy and cognitive therapy for the treatment of depression. The two treatments, however, appeared to work through different mechanisms. Outcomes for the acceptance and commitment therapy condition were mediated by experiential avoidance and acceptance relative to the cognitive therapy condition.

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                                                                                        • Fristad, M. A., J. S. Verducci, K. Walters, and M. E. Young. 2009. Impact of multifamily psychoeducational psychotherapy in treating children aged 8 to 12 with mood disorders. Archives of General Psychiatry 66.9: 1013–1021.

                                                                                          DOI: 10.1001/archgenpsychiatry.2009.112Save Citation »Export Citation »E-mail Citation »

                                                                                          Treatment as usual plus a brief multifamily psychoeducational group was superior to treatment as usual without the multifamily psychoeducational group intervention (control condition was also waitlisted for the group intervention). The sample included children with both unipolar depression and bipolar disorder.

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                                                                                          • Hollon, S. D., and S. Dimidjian. 2009. Cognitive and behavioral treatment of depression. In Handbook of depression. 2d ed. Edited by I. H. Gotlib and C. L. Hammen, 586–603. New York: Guilford.

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                                                                                            Provides a concise but comprehensive review of cognitive and behavioral treatments for depression. It reviews treatments with both a cognitive and a behavioral emphasis.

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                                                                                            • The TADS team. 2007. The Treatment of Adolescent Depression Study (TADS): Long-term effectiveness and safety outcomes. Archives of General Psychiatry 64.10: 1132–1143.

                                                                                              DOI: 10.1001/archpsyc.64.10.1132Save Citation »Export Citation »E-mail Citation »

                                                                                              This multisite study examined the comparative efficacy of medication, cognitive behavior therapy, and their combination in the treatment of adolescents with major depression. The major finding of this study was that combining medication with cognitive behavior therapy was superior to either treatment alone.

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                                                                                              Pharmacological and Other Somatic Treatments

                                                                                              Pharmacological treatments are the most extensively studied interventions for depression. The chapter Nemeroff and Schatzberg 2007 reviews all the major classes of antidepressant medications and provides some treatment guidelines. Gitlan 2009 reviews antidepressant medications along with other (e.g., electroconvulsive therapy) somatic treatments for depression; it is concise and quite accessible to those without any training in psychopharmacology. Gelenberg, et al. 2010, from the American Psychiatric Association workgroup on major depressive disorder, contains practice guidelines for the treatment of depression; this extensive document describes both psychotherapy and pharmacologic treatments for depression. The meta-analysis Imel, et al. 2008 concludes that medication and psychotherapy are both effective for depression; moreover, certain forms of psychotherapy may confer protection against relapse after being discontinued. By contrast, the same protection against relapse is not provided by medication after it is discontinued. After combining both published and unpublished clinical trials, Kirsch, et al. 2002 concludes that medication has little if any therapeutic effect beyond placebo in the treatment of depression. However, this controversial conclusion was criticized by Hollon, et al. 2002. The large and important meta-analysis Fournier, et al. 2010 pools data from six clinical trials and concludes that the benefit of antidepressant medication increases with increasing severity and that it may offer little or no benefit over placebo, on average, for patients with mild to moderate symptoms. Dell’Osso, et al. 2011 concludes that the noninvasive treatment transcranial magnetic stimulation has had mixed support in the literature. Finally, the efficacy of the herbal extract St. John’s wort was examined in the meta-analysis Linde, et al. 2005. A more recent analysis, Sarris 2013, suggests that St. John’s wort is efficacious for mild to moderate depression.

                                                                                              • Dell’Osso, B., G. Camuri, F. Castellano, et al. 2011. Meta-review of metanalytic studies with repetitive transcranial magnetic stimulation (rTMS) for the treatment of major depression. Clinical Practice and Epidemiology in Mental Health 7:167–177.

                                                                                                DOI: 10.2174/1745017901107010167Save Citation »Export Citation »E-mail Citation »

                                                                                                Transcranial magnetic stimulation became of interest to the field because of its safety and virtually nonexistent side effect profile. However, this review suggests that support for its efficacy in the literature has been mixed.

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                                                                                                • Fournier, J. C., R. J. DeRubeis, S. D. Hollon, et al. 2010. Antidepressant drug effects and depression severity. Journal of the American Medical Association 303.1: 47–53.

                                                                                                  DOI: 10.1001/jama.2009.1943Save Citation »Export Citation »E-mail Citation »

                                                                                                  A significant aspect of the study is the use of a large pooled dataset of clinical trials approved by the Food and Drug Administration. When medication was compared to placebo, medication offered minimal or no benefit for depression in the mild to moderate range, although it had substantial benefit for patients with very severe depression. This was a controversial study that generated considerable attention.

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                                                                                                  • Gelenberg, A. J., M. P. Freeman, J. C. Markowitz, et al. 2010. Practice guideline for the treatment of patients with major depressive disorder. 3d ed. American Journal of Psychiatry 167.10, suppl., 1–3, 9–11, 13–118.

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                                                                                                    This large document attempts to provide basic guidelines for all aspects of treatment for depression. Each phase of treatment is discussed (acute, continuation, and maintenance), along with both pharmacotherapy and psychotherapy. Side effects of medications, complicating medical conditions, and “alternative” treatments are all discussed.

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                                                                                                    • Gitlan, M. J. 2009. Pharmacotherapy and other somatic treatments for depression. In Handbook of depression. 2d ed. Edited by I. H. Gotlib and C. L. Hammen, 554–585. New York: Guilford.

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                                                                                                      This chapter provides a relatively brief review of pharmacologic and other somatic treatments. It was not intended as a “guideline” for how to administer treatment, but rather introduces the reader to the major treatments that are currently available.

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                                                                                                      • Hollon, S. D., R. J. DeRubeis, R. C. Shelton, and B. Weiss. 2002. The emperor’s new drugs: Effect size and moderation effects. Prevention and Treatment 5.1.

                                                                                                        DOI: 10.1037/1522-3736.5.1.528Save Citation »Export Citation »E-mail Citation »

                                                                                                        These authors respond to Kirsch, et al. 2002, which suggested that the effects of antidepressant medications are minimal beyond that of a placebo effect. The authors argue, on methodological grounds, that the analysis of Kirsch, et al. underestimates the potential benefit of antidepressant medications for many patients.

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                                                                                                        • Imel, Z. E., M. B. Malterer, K. M. McKay, and B. E. Wampold. 2008. A meta-analysis of psychotherapy and medication in unipolar depression and dysthymia. Journal of Affective Disorders 110.3: 197–206.

                                                                                                          DOI: 10.1016/j.jad.2008.03.018Save Citation »Export Citation »E-mail Citation »

                                                                                                          This meta-analysis (an analysis of pooled data from published studies) suggests that psychotherapy may have an enduring or prophylactic effect, while medication does not. Medication may be more efficacious than psychotherapy for dysthymia.

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                                                                                                          • Kirsch, I., T. J. Moore, A. Scoboria, and S. S. Nicholls. 2002. The emperor’s new drugs: An analysis of antidepressant medication data submitted to the U.S. Food and Drug Administration. Prevention and Treatment 5.1.

                                                                                                            DOI: 10.1037/1522-3736.5.1.523Save Citation »Export Citation »E-mail Citation »

                                                                                                            Based upon their analysis of data submitted to the U.S. Food and Drug Administration, these authors found that antidepressant medication offers little benefit beyond placebo. They argue that either the effects of antidepressants are clinically negligible or new study designs are needed to demonstrate their effect.

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                                                                                                            • Linde, K., M. Berner, M. Egger, and C. Mulrow. 2005. St John’s wort for depression: Meta-analysis of randomized controlled trials. British Journal of Psychiatry 18:99–107.

                                                                                                              DOI: 10.1192/bjp.186.2.99Save Citation »Export Citation »E-mail Citation »

                                                                                                              This meta-analysis attempted to examine the efficacy of St. John’s wort (an herbal extract) for depression. The authors found some evidence of efficacy beyond placebo, but also concluded that the evidence was “inconsistent and confusing.”

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                                                                                                              • Nemeroff, C. B., and A. F. Schatzberg. 2007. Pharmacological treatments for unipolar depression. In A guide to treatments that work. 3d ed. Edited by P. E. Nathan and J. M. Gorman, 271–288. New York: Oxford Univ. Press.

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                                                                                                                This is a very brief chapter reviewing the major pharmacological strategies for depressive disorders.

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                                                                                                                • Sarris, J. S. 2013. St. John’s wort for the treatment of psychiatric disorders. Psychiatric Clinics of North America 36.1: 65–72.

                                                                                                                  DOI: 10.1016/j.psc.2013.01.004Save Citation »Export Citation »E-mail Citation »

                                                                                                                  Reviews the evidence for the efficacy of St. John’s wort for a variety of disorders. The author concludes that the herb is efficacious for the treatment of mild to moderate depression and somatization disorder, but not for a number of other psychiatric conditions (e.g., anxiety disorders, attention-deficit hyperactivity disorder). According to the author, there are important difference in the quality and safety of the plant’s extracts which need to be considered when using this treatment. The full text may take 40–60 seconds to translate; larger documents may take longer.

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