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Part I. Clinical Aspects of Depression
1. The Definition of Depression
PREVALENCE AND SEVERITY BY TYPES AND AGE AT ONSET
Descriptive Concepts of Depression
2. Symptomatology of Depression
Avoidance, Escapist, and Withdrawal Wishes
VEGETATIVE AND PHYSICAL MANIFESTATIONS
Depression as a Clinical Entity
Importance of Course and Outcome
Remission from Dysthymic Disorder
Remission from Functional Impairments
Brief Attacks of Manic-Depressive Psychosis (Bipolar Disorder)
OUTCOME FOR “ENDOGENOUS” VERSUS “NEUROTIC” DEPRESSION
Suicide Risk in Bipolar Disorder
PREDICTORS OF CHRONIC DEPRESSION
Derivation of System of Classification
Reliability and Validity of Classification
Dichotomies and Dualisms: Past and Present
Endogenous and Exogenous Depressions
ORIGIN OF ENDOGENOUS-EXOGENOUS MODEL
DISTINCTION BETWEEN ENDOGENOUS AND REACTIVE DEPRESSIONS
Physiological Responses and Tests
Depressions Secondary to Somatic Disorders
5. Psychotic Versus Nonpsychotic Depression
“Psychoneurotic” Depressive Reaction
Severe Depression with Psychotic Features (Psychotic Depressive Reaction)
CASE 2
CASE 3
Contemporary Diagnosis
History and Definition
Current Criteria for Bipolar Disorder
Relationship of Manic to Depressive Episodes
Symptomatology of Manic Phase
EMOTIONAL MANIFESTATIONS
Elation
Increased Gratification
Self-Love
Increased Attachment to People and Activities
Increased Mirth Response
COGNITIVE MANIFESTATIONS
Positive Self-Image
Positive Expectations
Assignment of Blame
Denial
Arbitrariness
Delusions
MOTIVATIONAL MANIFESTATIONS
Impulse-Driven
Action-Oriented
Drive for Independence
Drive for Self-Enhancement
PHYSICAL AND VEGETATIVE MANIFESTATIONS
Hyperactivity
High Tolerance for Fatigue
Appetite
Increased Libido
Insomnia
Behavioral Observations of Manic Phase
Periodicity of Manic-Depressive Behavior
Premorbid Personality of Manic-Depressive Patients
Issues for Further Study
CLASSIFICATION PROBLEMS
GOAL ACHIEVEMENT AND MANIC SYMPTOMS
History of the Concept
Etiology
Age
Symptomatology
Premorbid Personality
Conclusion
Definition
Evolution of the Concept
CATATONIA AND MANIC-DEPRESSIVE PSYCHOSIS
BENIGN STUPOR
Inactivity
Negativism
Affect
Catalepsy
Intellectual Processes
Ideational Content
Follow-up Studies
ACUTE SCHIZOAFFECTIVE PSYCHOSIS
ACUTE REMITTING SCHIZOPHRENIA
STUDIES OF REVISED DIAGNOSES
Differentiation of Depression and Schizophrenia
Prognosis
AFFECTIVE FACTORS AND PROGNOSIS IN SCHIZOPHRENIA
Manifest Affect
Content of Delusions
Hallucinations
Manic-Depressive Heredity and Outcome in Schizophrenia
Presence of Depression
Patterns of Aggression in Overt Behavior
Present Classification of Schizoaffective Disorder
Unresolved Issues for Continuing Research
Course of Illness
Symptom and Cognitive Profiles
Family and Genetic Studies
Bertelsen and Gottesman’s Review
Conclusion
Part II. Experimental Aspects of Depression
9. Biological Studies of Depression
Early studies
Manic-Depressive Disorder and Constitution
Heredity in Manic-Depressive Disorder
IDENTICAL TWIN STUDIES
IDENTICAL TWINS REARED SEPARATELY
PEDIGREE STUDIES
SUMMARY
Bipolar Disorder
Unipolar Depression
Biochemical Studies of Depression
EARLY STUDIES
Blood Glucose
Glucose Tolerance
Acidity and Alkaline Reserve
Serum Calcium and Phosphorus
Nitrogenous Substances
Lipoidal Substances
Chlorides
Critique of Studies
MORE RECENT STUDIES
Differences Between Manic and Depressive Phases
Studies of Continued Cycles
Studies During Depressive Episodes
An Experimental Test of Biological Markers
Responses of Normal Subjects to Stress
Endocrine Studies
STEROID METABOLISM
THYROID FUNCTION
Autonomic Function
BLOOD PRESSURE RESPONSES TO MECHOLYL
SALIVATION STUDIES
Critique of Salivation Studies
Neurophysiological Studies
SEDATION THRESHOLD
Anatomical Studies
Frodl’s Study
Neurotropic and Neurogenesis Theories
ELECTROMYOGRAPH (EMG) STUDIES
ELECTROENCEPHALOGRAM (EEG) SLEEP STUDIES
EEG AROUSAL RESPONSE
Recent Studies of Children and Adolescents
Neuropsychological Studies
Conclusions
10. Psychological Studies: Tests of Psychoanalytic Theory
Early Tests of Psychological Functioning
PSYCHOMOTOR PERFORMANCE
CONCEPTUAL PERFORMANCE
PERCEPTUAL THRESHOLD
DISTORTION OF TIME JUDGMENT
DISTORTION OF SPATIAL JUDGMENT
Early Experimental Studies
Family Background and Personality
Self-Concept
Beck’s Systematic Investigation of Depression
PSYCHODYNAMIC FACTORS
HISTORY OF THE INVESTIGATION
TESTING THE HYPOTHESIS
Definition of Negative
Dream Study
Early Memories
Focused Fantasy Test
Negative Inventory
Self-Concept Test
Experimental Studies
Collateral Studies
COGNITIVE PATTERNS IN VERBAL MATERIAL
LONGITUDINAL STUDIES
PATTERNS IN DREAMS OF DEPRESSED PATIENTS
Preliminary Study
Principal Study
CHILDHOOD BEREAVEMENT AND ADULT DEPRESSION
Childhood Bereavement Study
COGNITIVE DISTORTIONS IN DEPRESSION
Thematic Content of Cognitions
Typology of Cognitive Distortions
Formal Characteristics of Depressive Cognitions
Relationship of Depressive Thoughts to Affect
Discussion
Afterword
Part III. Theoretical Aspects of Depression
Behavioral Theories
Cognitive and Evolutionary Theories
Psychoanalytic Theories
AGGRESSION IN DEPRESSION
ORALITY IN DEPRESSION
Psychodynamic and Psychological Theories
Existential Theories
Neurological Theory
Neuropsychological Theories
Biochemical Theory
Animal Models
Expressed Emotion
12. Cognition and Psychopathology
The Primary Triad in Depression
NEGATIVE INTERPRETATION OF EXPERIENCE
Thwarting or Defeat
Deprivation
Deprecation
NEGATIVE VIEW OF SELF
NEGATIVE EXPECTATIONS
The Affective Response
Cognitive Primacy
Changes in Motivation
Physical Symptoms
Cognition in Mania and Other Disorders
A Cognitive Classification of Psychiatric Disorders
NEUROSES
Depressive
Hypomanic
Anxious
Phobic
Somatization
Paranoid
Obsessive and Compulsive
PSYCHOSES
Conclusions
Predisposition to Depression
FORMATION OF PERMANENT CONCEPTS
VALUE JUDGMENTS AND AFFECT
SPECIFIC VULNERABILITY
Precipitation of Depression
SPECIFIC STRESS
GENETIC MODERATION OF THE STRESS-DEPRESSION LINK
NONSPECIFIC STRESS
OTHER CONTRIBUTING FACTORS
Developmental Studies on Effects of Chronic Stress
GENETIC RISK, PREVIOUS EPISODES, AND CHRONIC STRESS
Personality Organization in Depression
LITERATURE ON COGNITIVE ORGANIZATIONS
DEFINITION OF SCHEMAS
IDENTIFICATION OF SCHEMAS
SCHEMAS IN DEPRESSION
Modes and Psychopathology
DISTORTION AND MISINTERPRETATION
PERSEVERATION (RUMINATION)
LOSS OF OBJECTIVITY
Affects and Cognition
A Feedback Model
Part IV: Treatment of Depression
Pharmacotherapy
THE TRICYCLIC DRUGS
Early Studies
MAO INHIBITORS
SELECTIVE SEROTONIN-REUPTAKE INHIBITORS (SSRIS)
ANTIDEPRESSANT PRESCRIBING PATTERNS
SIDE EFFECTS
STIMULANTS
LITHIUM
CURRENT USE OF TRICYCLICS AND MAOIS
TREATMENT RESISTANCE
Augmenting Versus Switching Antidepressants
Placebo-Controlled Studies of Drug Combinations
Medication, Psychotherapy, and Prescriptive Indices
Clinical Considerations
TREATMENT AFTER AGE 60
RESEARCH PROBLEMS AND CONTROVERSIES
Rater Bias
Placebo Response
Nonrandom Distribution of Variables
Variability of Measures
Other Problems
ISSUES OF RISK VERSUS BENEFIT
CONTROVERSY ABOUT PLACEBO EFFECT
ADVERSE EFFECTS OF ANTIDEPRESSANT DRUGS
SSRIs
Tricyclic Drugs
MAO Inhibitors
Electroconvulsive Therapy
Physiological Effects
Biochemical Effects
Psychological Effects
Complications
Mechanism of Action
Efficacy
Future Directions
Transcranial Magnetic Stimulation
Pharmacogenomics
Early Approaches
Supportive Psychotherapy
REASSURANCE
VENTILATION AND CATHARSIS
GUIDANCE AND ENVIRONMENTAL CHANGE
Psychoanalysis and Psychoanalytic Psychotherapy
Depression-Focused Psychotherapies
Interpersonal Therapy (IPT)
IPT FOR CHRONIC DEPRESSION
IPT FOR ELDERLY POPULATIONS
Cognitive Therapy
FORMULATION AND CONCEPTUALIZATION
STRUCTURE AND STRATEGY
Basic Elements
Structure of Sessions
Behavioral Aspects
INTERPERSONAL ASPECTS OF CHANGE
Maintaining a Therapeutic Relationship
A Collaborative Context
Teaching Independent Problem-solving
Modification of Interpersonal Dysfunctions
Behavioral Activation
COGNITIVE TECHNIQUES
Delineating the Major Maladaptive Patterns
Neutralizing Automatic Thoughts
Pinpointing Depressive Cognitions
Identifying Idiosyncratic Content
Recognizing Formal Characteristics of Cognitions
Distinguishing “Ideas” from “Facts”
Checking Observations
Responding to Depressive Cognitions
Weighing Alternative Explanations
Validating Basic Premises
Modifying Mood by Induced Fantasies
Case Illustration
Case Illustration: Relapse Prevention
TREATING BIPOLAR DISORDER: DRUGS AND PSYCHOTHERAPY
PREVENTION OF SUICIDE
PREVENTION OF RELAPSE
PSYCHOTHERAPY CHANGE PROCESSES
16. Evaluating Depression Treatments: Randomized Controlled Trials
Outcome and Follow-Up Data
RANDOMIZED CLINICAL TRIALS
ECOLOGICAL VALIDITY AND RANDOMIZED CLINICAL TRIALS
RELAPSE PREVENTION
Overall Conclusions
Issues for Further Study
Afterword
The New Developmental Cognitive Model
Cognitive Vulnerability
Genetic Links to Cognitive Vulnerability
Physiological Hyperreactivity
Cognitive Neurobiology
Appendix: Scoring Instructions for Negative Dreams
Definition
Scoring
NEGATIVE REPRESENTATION OF THE SELF
PHYSICAL DISCOMFORT AND INJURY
THWARTING
DEPRIVATION
PHYSICAL ATTACK
NONPHYSICAL ATTACK
EXCLUDED, SUPERSEDED, OR ABANDONED
LOST
PUNISHMENT
FAILURE
Exclusions
THREAT DREAMS
