Mood Disorders

Major Depressive Disorder

Five or more of the following: Depressed mood most of the day, nearly every day Markedly diminished interest or pleasure in all, or almost all, activities most of the day Significant weight loss when not dieting or gaining weight or decrease in appetite Insomnia or hypersomnia nearly every day Psychomotor agitation or retardation nearly every day Fatigue or loss of energy nearly every day Feelings of worthlessness or excessive or inappropriate guilt nearly every day

Major Depressive Episode

Diminished ability to think or concentrate, or indecisiveness, nearly every day Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide Either depressed mood or loss of interest and pleasure must be one of the five symptoms Symptoms cannot be due to the direct physiological effects of a substance (e.g., drug of abuse, medication) or a general medical condition (e.g., hypothyroidism).

Bipolar I Disorder
Episodes of mania or mixed episodes that include

symptoms of both mania and depression. Three of the following (four if mood is irritability)
Increase in activity level - at work, socially, or sexually Unusual talkativeness, rapid speech Flight of ideas or subjective impression that thoughts are racing Less than the usual amount of sleep needed Inflated self-esteem, belief that one has special powers, talents, abilities Distractibility; attention easily diverted Excessive involvement in risky activities

Unipolar-Bipolar Distinction
Variable Motor Activity Sleep Age of onset Unipolar Typically agitated Difficulty sleeping Late 30s to early 40s Bipolar Typically retarded when depressed Sleeps more than usual when depressed Thirty First-degree relatives at high risk for unipolar and bipolar About equal in gender Best response to lithium

Family History First-degree relatives at high risk for unipolar depression Gender Much more common among women Biological Some response to Treatment lithium but better to tricyclics

Cyclothymic Disorder
For at least 2 years (1 year for children), the

presence of numerous periods with hypomanic symptoms and numerous periods with depressive symptoms that do not meet criteria for a Major Depressive Disorder During the above 2-year period, the person has not been without symptoms for more than 2 months at a time No Major Depressive Disorder, Manic Episode, or Mixed Episode has been present during the first 2 years of the disturbance

Dysthymic Disorder
Depressed mood for most of the day, for more days than

not, for at least 2 years (1 year in children) Presence, while depressed, of two or more of the following:
poor appetite or overeating insomnia or hypersomnia low energy or fatigue low self-esteem poor concentration or difficulty making decisions feelings of hopelessness

During the 2 years of the disturbance, the person has never

been without the symptoms for more than 2 months at a time

Cognitive Theory of Depression

People are depressed because their thinking is

biased toward negative interpretations People acquire negative schema due to experiences in childhood (loss of a parent, rejection by peers) Negative schema are activated whenever they encounter new situations which resemble (even vaguely), the conditions in which the schemata were learned The negative schemata fuel and are fueled by cognitive biases, which lead depressed people to misperceive reality

Becks Negative Triad

Self
I am inadequate

World
I cannot cope

Future
Things will always turn out poorly

Examples of Cognitive Biases

After failing a math exam: Im a big

failure. Following a disagreement with the boss She thinks everything I say is stupid. During an argument with her husband He thinks I never get anything right. After a complement from a friend He just said that because he feels sorry for me.

Evaluation of Cognitive Theory

Depressed people judge themselves in biases ways
Depressed people demonstrate the cognitive biases

which Beck outlines Negative thinking decreases after treatment Although pessimistic, depressed people sometimes are actually more accurate than normal (e.g., judging probability of success) Whether depression is the result of cognitive biases or vice versa is not clear

Learned Helplessness

Uncontrollable Aversive Event

Sense of Helplessness

Depression

Attributional Theory

Aversive events

Attributed to global and stable factors

Sense of helplessness; no response available to alter the situation

Depression

Why I Failed My Math Test

Internal (Personal) Degree Global Stable I lack intelligence Unstable I am exhausted External (Environmental) Stable These tests are all unfair Unstable Its an unlucky day, Friday the 13th Specific I lack math ability I am fed up with The math tests math are unfair My math test was numbered 13

Hopelessness Theory
Sense of hopelessness; no response available to alter the situation and expectation that desirable outcomes will not occur

Aversive events

Attributed to global and stable factors, or other cognitive factors

Depression

Interpersonal Theory
Depressed people may elicit negative reactions

from others The interactions of depressed people and their spouses are characterized by hostility on both sides Depressed people are often low in social skills and their own behavior contributes to the high levels of stress they experience The constant seeking of reassurance is a critical interpersonal variable in depression

Genetics of Mood Disorders

About 10 to 25 percent of the first-degree

relatives of bipolar patients also have experienced an episode of mood disorder For bipolar disorder, the concordance rate for identical twins is 72% and in fraternal twins about 14% The information indicated that for unipolar depression, genetic factors, although influential, are not as decisive as with bipolar disorder

Neurochemistry of Mood Disorders

For bipolar disorder: low levels of norepinephrine

leads to depression and a high level to mania. Depression due to low levels of Serotonin. Tricyclic drugs - prevent the reuptake of both norepinephrine and serotonin by the presynaptic neuron after it has fired. Monoamine oxidase inhibitors - keep the enzyme monoamine oxidase from deactivating neurotransmitters, thus increasing the levels of norepinephrine and serotonin Selective serotonin reuptake inhibitors - specifically inhibit the reuptake of serotonin

Pharmacotherapy for Mood Disorders

Category Generic Trade Some Side Effects Tricyclic Imipramine Antidepressants Amitriptyline Tofranil Heart attack, stroke, Elavil hypotension, dry mouth, gastric disorders, erectile failure MAO Inhibitors Tranylcypromine Parnate Possible fatal hypertension Dry mouth, dizziness, nausea, headaches SSRIs Fluoxetine Prozac Nervousness, fatigue, GI complaints, headaches, insomnia Lithium Lithium Lithium Tremors, GI distress, lack of coordination, dizziness. Cardiac arrhythmia, blurred vision, fatigue

Problems with Neurochemical Theories of Mood Disorders

These drugs do increase levels of

norepinephrine and serotonin when they are first taken, but after several days the neurotransmitters return to their earlier levels. The drugs take 7-14 days to work Drugs which involve other mechanisms also relieve depression Future research will center on serotonin receptors

The Neuroendocrine System

The limbic area of the brain is closely linked to emotion and

also has effects on the hypothalamus (hormonal secretion) Hormones secreted by the hypothalamus also affect the pituitary gland and the hormones it produces Because of its relevance to the vegetative symptoms of depression (e.g., disturbances in appetite and sleep), the hypothalamic-pituitary-adrenocortical axis is thought to be overactive in depression. Levels of cortisol (an adrenocortical hormone) are high in depressed patients. High levels of cortisol may lower the density of serotonin receptors and impair the function of noradrenergic receptors.

Treatments for Depression

Cognitive Behavioral Therapy Becks Cognitive Therapy Elliss REBT Interpersonal Therapy Drug Therapies Tricyclics MAO Inhibitors SSRIs Electroconvulsive Therapy

Childhood Depression
As with adults, depression in childhood is

recurrent and has high rates of comorbidity (e.g., anxiety disorders, conduct disorder) Theories of etiology point to genetic factors and interpersonal relationships. Research on the treatment of childhood depression does not support the use of antidepressants. Both CBT and Interpersonal therapies have been used and combined with family and school interventions

Suicide
Characteristic Gender Age Method Attempters Majority Female Predominantly Young Low lethality (e.g., pills) Completers Majority Male Risk increases with age More violent (e.g., guns) Depression with hopelessness Death

Dominant Affect Depression with anger Motivation Attitude Toward Attempt Change in situation Cry for help Relief to have survived Promises not to repeat

Shneidmans Approach to Suicide

The common purpose of suicide is to seek a solution

The common goal of suicide is the cessation of

consciousness The common stimulus in suicide is intolerable psychological pain The common stressor in suicide is frustrated psychological needs The common emotion in suicide is hopelessnesshelplessness The common cognitive state in suicide is ambivalence The common perceptual state in suicide is constriction

Shneidmans Approach to Suicide

The common action in suicide is egression
The common interpersonal act in suicide is

communication of intention The common consistency in suicide is with lifelong coping patterns