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Mood Disorders

Mood Disorders. Major Depressive Disorder. Five or more symptoms present for two weeks or more: Disturbed Mood depressed mood anhedonia (reduced interest or pleasure) Disturbed Cognitive Functions trouble concentrating feelings of worthlessness thoughts of death / suicide.

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Mood Disorders

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  1. Mood Disorders

  2. Major Depressive Disorder • Five or more symptoms present for two weeks or more: • Disturbed Mood • depressed mood • anhedonia (reduced interest or pleasure) • Disturbed Cognitive Functions • trouble concentrating • feelings of worthlessness • thoughts of death / suicide

  3. Major Depressive Disorder • Disturbed Physical (vegetative) Functions • weight loss / gain • sleep problems • psychomotor disturbance • lack of energy

  4. Major Depressive Disorder • How long does depression last if untreated? • 6 to 9 months • 90% chance gone in 5 years • Are men or women more likely to be depressed? • women are twice as likely as men to have major depression

  5. Gender differences in depression • Cultural effects: gender roles encourage mastery in males, dependence in females • the way in which a person responds to the onset of a depressed mood • rumination vs. distraction

  6. Depression across the lifespan: • rate of depression rises dramatically in adolescence • average age of onset 25 - 29 • depression closely related to anxiety - almost all depressed patients are also anxious

  7. Persistent Depressive Disorder (Dysthymia) • Dysthymic Disorder: • symptoms of major depression are milder but remain unchanged for at least two years • can last 20 – 30 years – median duration of 5 years • 79% with dysthymia have had a major depressive episode • Double Depression: • both major depressive disorder and dysthymia

  8. Seasonal Affective Disorder(SAD) • depressive episode begins in the fall and ends with beginning of spring • more common in northern climates • Phototherapy– exposure to bright light

  9. Grief • Acute • Integrated • Complicated

  10. Suicide • 11th leading cause of death in the US • more common among Caucasians than African Americans and Hispanics • higher rates among the elderly than other groups. • women are 3 times more likely to attempt suicide • males are 4 to 5 times more likely to commit suicide

  11. Importance of Assessment • Suicidal desire – Ideation • Suicidal capability – Past attempts • Suicidal intent - Plan

  12. Risk & Protective Factors

  13. Integrative Theory of Mood Disorders • Shared biological vulnerability with anxiety • Psychological vulnerability • Exposure to Stress • Social and interpersonal relationships

  14. Biological Theories • low levels of serotonin and norepinephrine • permissive hypothesis: when serotonin levels are low, other neurotransmitters can range more widely

  15. Anti-depressants • tricyclic - prevents reuptake of norepinephrine and serotonin (e.g., Imipramine, Amitriptyline) • SSRI - (selective serotonin reuptake inhibitor) blocks the reuptake of serotonin (e.g., Prozac) • MAO inhibitors - elevate level of norepinephrine and serotonin by blocking deactivating enzyme (e.g., Nardil)

  16. Electroconvulsive Therapy (ECT): • shock is delivered to the brain • transcranial magnetic stimulation: • magnetic coil delivers electromagnetic pulse to the brain.

  17. Cognitive Treatment • Depressive Attributional Style: 1) internal – attributes negative events to personal failings 2) stable – things will always be this way. 3) global – this is true for almost all events

  18. Cognitive Theories and Treatment • Depressive Cognitive Triad (Beck, 1967): 1) self 2) world 3) future

  19. Interpersonal Psychotherapy (IPT) • Depression stems fromproblems in relationships. • Wedevelopcyclicalmaladaptive patterns (CMPs) of relating to othersfromour interaction withothers. • These patterns getplayed out in adultrelationshipsincludingwith the therapist. • Therapyseeks to identify and treattheseCMPs.

  20. Efficacy of Psychological Treatment of Mood Disorders • CBT and IPT Outcomes • Comparison with medications

  21. Bipolar and Related Disorders http://www.youtube.com/watch?v=R87GfrbXQmU

  22. Bipolar and Related Disorders • Manic Episode: period of abnormally elevated mood (at least one week) • inflated self-esteem • decreased need for sleep • extremely talkative • racing thoughts • distractible • increase in goal-directed activity and/or pleasurable activities

  23. Types • Bipolar I: At least one manic episode. Often alternate manic episodes with major depressive episodes. • Bipolar II: alternate hypomanic episodes with major depressive episodes • Cyclothymia: at least two years – periods of hypomania and depressive symptoms

  24. Specifiers • Rapid cycling : at least four manic or depressive episodes within a year • Mixed episode : criteria met for both a manic episode and major depressive episode for at least a week

  25. Medications for Bipolar Disorder • lithium bicarbonate • anticonvulsants (e.g.,depakote, lamictal)

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