Mood Disorders. Overview and Treatments By: Aiza Espanol July 13, 2009. Key Terms. Antidepressants: Pharmacologic class of drugs used to treat depression; can be subdivided into the MAOIs, TCAs ( tricyclic antidepressants), SSRIs, and miscellaneous group of agents
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Overview and Treatments
July 13, 2009
Antidepressants: Pharmacologic class of drugs used to treat depression; can be subdivided into the MAOIs, TCAs (tricyclic antidepressants), SSRIs, and miscellaneous group of agents
Bipolar Disorder: A category of mood disorders characterized by one or more manic or hypomanic episodes and, usually, by one or more depressive episodes
Cognitive Symptoms: Inability to concentrate, slowed thinking, confusion, and poor memory of recent events; common in older patients with depression
Cyclothymic Disorder: A chronic and relatively continual mood disorder characterized by hypomanic episodes and depressed moods that do not meet the criteria for major depressive episode
Depression: An emotional state characterized by intense sadness, feelings of futility and worthlessness, and withdrawal from others
Depressive Disorders: DSM-IV-TR category including major depressive disorders, dysthymic disorder, and depressive disorders not otherwise specified; also known as unipolar disorders because no mania is exhibited
Dysthymic Disorder: A disorder characterized by chronic and relatively continual depressed mood that does not meet the criteria for major depression
Euphoria: heightened mood
Grandiose Delusions: Persistent irrational beliefs that somehow exaggerate the person’s importance, such as believing oneself to be a famous person, or having an enviable position such as being the President or God
Labile Mood: Mood swings that often shift rapidly towards anger and irritability
Learned Helplessness: Acquiring the belief that one is helpless and unable to affect the outcomes in one’s life
Lethality: The probability that a person will choose to end his or her life
Major Depression: A disorder in which a group of symptoms, such as depressed mood, loss of interest, sleep disturbances, feelings of worthlessness, and an inability to concentrate, are present for at least 2 weeks
Mania: An emotional state characterized by elevated mood, expansiveness, or irritability, often resulting in hyperactivity
Mood: Sustained, emotional feeling perceived along a normal continuum of sad to happy
Mood Disorder: Disturbances in emotions that cause subjective discomfort, hinder a person’s ability to function, or both; depression and mania are central to these disorders
Neurotransmitters: Chemical substances that are released by axons of sending neurons and that are involved in the transmission of neural impulses to the dendrites of receiving neurons
Psychological Autopsy: The systematic examination of existing information for the purpose of understanding and explaining a person’s behavior before his or her death
Psychomotor Symptoms: Slowed or retarded movements, thought processes, and speech, or conversely, agitation manifesting as purposeless, restless motion
Suicide: The intentional, direct, and conscious taking of one’s own life
What are the symptoms of mood disorders?
How are mood disorders classified in the APA diagnostic scheme?
Why do people develop depression and mania?
What kinds of treatment are available for people with mood disorders, and how effective are the therapies?
What do we know about suicide?
Why do people decide to end their lives?
How can we intervene or prevent suicides?
We have all felt depressed or elated at some time during our lives. The loss of a job or the death of a loved one may result in depression; good news may make us manic (for example, ecstatic, hyperactive, and brazen). Although the vast majority of people with mood disorders do not commit suicide and although many suicides are not attributable to depression, we include the topic of suicide with mood disorders because depression is implicated in many suicides.
Mood Disorders are disturbances in emotions that cause subjective discomfort, hinder a person’s ability to function, or both. Depression and mania are central to these disorders. Depression is characterized by intense sadness, feelings of futility and worthlessness, and withdrawal from others. Mania is characterized by elevated mood, expansiveness, or irritability, often resulting in hyperactivity.
Prevalence of depression has been found to be more than 10 times higher than that of mania
Depression is quite prevalent in the general population and is much higher among women than men
Some 10 million Americans, and more than 100 million people worldwide, will experience clinical depression
Lifetime prevalence (the proportion of people who develop severe depression at some point in their lives) ranges from 10 to 25 percent for women and from 5 to 12 percent for men
Large-scale study has found even higher overall lifetime prevalence rates for all mood disorders- reaching almost 15% for adult males and almost 24% for adult females
Among college students, one survey found that over half indicated that they had experienced depression, 9% had thought of suicide, and 1% had attempted suicide since the beginning of college
Depression shortens life expectancy and increases the risk of dying from heart disease by as much as threefold
Severe depression may afflict the rich or the poor, the successful or the unsuccessful and the highly educated or uneducated
Certain core characteristics are often seen among people with depression. These characteristics may be organized within the four psychological domains used to describe anxiety: affective domain, cognitive domain, behavioral domain, and physiological domain.
The following physiological and somatic and related symptoms frequently accompany depression:
Loss of appetite and weight. The loss of appetite often stems from the person’s disinterest in eating; food seems tasteless. In severe depression, weight loss can become life threatening. Some people, however, have increased appetite and gain weight.
Constipation. The person may not have bowel movements for days at a time.
Sleep disturbance. Difficulty in falling asleep, waking up early, waking up erratically during the night, insomnia, and nightmares that leave the person exhausted and tired during the day. Some depressed people, however, show hypersomnia, or excessive sleep.
Disruption of the normal menstrual cycle in women. The disruption is usually a lengthening of the cycle, and the woman may skip one or several periods. The volume of menstrual flow may decrease.
Aversion to sexual activity. Many people report that their sexual arousal dramatically declines.
Culture influences the experience and expression of symptoms of depression. In some cultures, depression may be experienced largely in somatic or bodily complaints, rather than in sadness or guilt. Complaints of “nerves” and headaches (latino and Mediterranean), of weakness, tiredness, or “imbalance” (Chinese and Asians), of problems of the “heart” (Middle Eastern), or of being “heartbroken” (among Hopi) may reveal the depressive experience.
In mania, affective symptoms include elevated, expansive, or irritable mood. Social and occupational functioning is impaired. People with mania show boundless energy, enthusiasm, and self assertion. If frustrated, they may become profane and quite belligerent. People who suffer from serious forms of mania display more disruptive behaviors, including pronounced overactivity, grandiosity, and irritability. Their speech may be incoherent and they do not tolerate criticisms or restraints imposed by others.
In the more severe cases of mania, the person is wildly excited, rants and raves (“maniac”), and is constantly agitated and on the move. Hallucinations and delusions may appear. The most prominent somatic characteristic is a decreased need for sleep, accompanied by high levels of arousal.
Mood disorders are largely divided into 2 major categories: depressive disorders (often referred to as unipolar disorder) and bipolar disorder. Once a depressive or manic episode occurs, the disorder is classified into both a category and a subcategory.
Depressive disorders include major depressive disorders, dysthymic disorder, and depressive disorders not otherwise specified. All of these disorder classifications include no history of a manic episode. People who experience a major depressive episode are given the diagnosis of MAJOR DEPRESSION. Symptoms should have been present for at least 2 weeks and should represent a change from the individual’s previous functioning. The symptoms of major depression include a depressed mood or a loss if interest or pleasure, weight loss/gain, sleep difficulties, fatigue, feelings of worthlessness, inability to concentrate, and recurrent thoughts of death. About ½ of those who experience a depressive episode eventually have another episode. In general, the earlier the age of onset, the more likely is a recurrence. If a disorder is characterized but does not meet the criteria of major depression then it is usually diagnosed as a dysthymic disorder.
The essential feature of bipolar disorders is the occurrence of one or more manic or hypomanic episodes; the term bipolar is used because the disorders are usually accompanied by one or more depressive episodes. Symptoms of manic episodes include abnormally and persistently elevated, expansive, or irritable moods lasting at least 1 week in the case of mania and 4 days in the case of hypomania. Grandiosity, decreased need for sleep, flight of ideas, distractibility, and impairment in occupational or social functioning are often observed in persons with this disorder.
Little is known about what causes the extreme mood changes in the bipolar disorders. Some research findings raise the possibility that manic symptoms in bipolar disorder are manifestations of dysregulation in the brain activation system, which corresponds to neural pathways in the brain. In any case, much more is known about what causes unipolar depression than about what causes the bipolar disorders, and psychological-sociocultural perspectives focus primarily on depression rather than on mania.
Treatment consists primarily of controlling the level of neurotransmitters at brain synapses
Treatment usually requires both nonpharmacologic and pharmacologic therapy
Risk for self-directed violence (indication)
Dysfunctional grieving (indication)
Ineffective coping (indication)
Social isolation (indication)
Disturbed sensory perception, visual or auditory (indication)
Part II: Suicide
The WHO (2002) found that suicide worldwide causes more deaths every year than homicide or war
Suicide is now recognized as a serious threat to public health
Suicide has many causes and people kill themselves for many different reasons
Depression is involved in more than half of attempted suicides and is often related to unhappiness over a broken or unhappy love affair, marital discord, disputes with parents, and recent bereavements
Suicide is not classified as a mental disorder
Every 20 min, someone in the US takes his or her life
Approximately 31,000 persons kill themselves each year
Persons under the age of 25 account for 15% of all suicides in 1997. These statistics has gradually increased over the years
The completed suicide rate for men is about three to four times that for women
Lowest incidence of suicide is found among people who are married and the highest among those who are divorced
Over 60% of suicides are committed by firearms and 70% are accounted for by drug overdose
More than 2/3 of the people who commit suicide communicate their intent to do so within 3 months of the fatal act