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Chapter 7 Mood Disorders and Suicide. An Overview of Depression and Mania. Mood Disorders “Depressive disorders” “Affective disorders” “Depressive neuroses” Gross deviations in mood Depression Mania. An Overview of Depression. Major depressive episode Extreme depression 2 weeks

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Chapter 7 Mood Disorders and Suicide


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  1. Chapter 7Mood Disorders and Suicide

  2. An Overview of Depression and Mania • Mood Disorders • “Depressive disorders” • “Affective disorders” • “Depressive neuroses” • Gross deviations in mood • Depression • Mania

  3. An Overview of Depression • Major depressive episode • Extreme depression • 2 weeks • Cognitive symptoms • Physical dysfunction • Anhedonia • Duration - 4 to 9 months, untreated

  4. An Overview of Mania • Manic episode • Exaggerated elation, joy, euphoria • 1 week, or less • Cognitive symptoms • Physical dysfunction • Duration – 3 to 6 months, untreated • Hypomanic episode

  5. Structure of Mood Disorders • Unipolar disorders • Depression or mania alone • Typically depression • Bipolar disorders • Depression and mania • Mixed episodes

  6. Structure of Mood Disorders • Diagnostic considerations • Accompanying symptoms • Overlap between disorders • Severity • Course • Recurrent • Alternating • Seasonal

  7. Depressive Disorders: An Overview • Major Depressive Disorder • No mania/hypomania • Single episode • Rare • Recurrent • 4 episodes (lifetime) • Duration – 4 to 5 months

  8. Major Depressive Disorder • Onset • Low until early teens • Mean age = 30

  9. Depressive Disorders: An Overview • Dysthymic Disorder • Milder symptoms • 2+ years • Chronic • Persistent

  10. Dysthymic Disorder • Onset = early 20’s • Early onset = before 21 • Greater chronicity • Poor prognosis • Stronger familial component • Median duration = 5 years • Depends on comorbidity

  11. Dysthymic Disorder

  12. Depressive Disorders: An Overview • Double Depression • Major depressive episodes and dysthymic disorder • Dysthymia first • Severe psychopathology • Poor course • High recurrence rates

  13. Grief and Depression • Depression frequently follows loss • 62% after death • Pathological or Complicated Grief • Severity of symptoms • Dysfunction • Persistence of symptoms

  14. Bipolar I Disorder: An Overview • Alternating major depressive and manic episodes • Single manic episode • Recurrent • Symptom free for 2 months

  15. Bipolar I Disorder: An Overview • Statistics • Onset = age 18 • Childhood • Chronic • Suicide

  16. Bipolar II Disorder • Alternating major depressive and hypomanic episodes • Statistics • Onset = age 19 to 22 • Childhood • Chronic

  17. Cyclothymic Disorder • Alternating manic and depressive episodes • Less severe • Persists longer • Chronic symptoms • Adults = 2+ years • children and adolescents= 1+ year

  18. Cyclothymic Disorder • Statistics • Onset = age 12 or 14 • Chronic • Lifelong • Female>Male • Risks for Bipolar I/II

  19. Additional Defining Criteria • Symptom Specifiers • Atypical • Melancholic • Chronic • Catatonic • Psychotic • Mood congruent/ incongruent • Postpartum

  20. Additional Defining Criteria

  21. Additional Defining Criteria • Course Specifiers • Longitudinal course • Rapid cycling pattern • Seasonal pattern • Depression vs. mania • Melatonin • Phototherapy • CBT

  22. Prevalence of Mood Disorders

  23. Prevalence of Mood Disorders • Children and Adolescents • Similar to adults • Symptom presentations • Prevalence • Early childhood • Adolescence • Misdiagnosis • ADHD • Conduct disorder

  24. Prevalence of Mood Disorders • Elderly • Prevalence may depend on setting • Symptom profile • Female : Male = 1:1 • Diagnostic difficulty • Comorbidities

  25. Prevalence of Mood Disorders • Across Cultures • Similar prevalence among US subcultures • Exceptions • Physical or somatic symptoms • Comparability

  26. Prevalence of Mood Disorders • Among the creative • Higher prevalence • Melancholia • Mania • Gender differences

  27. Overlap of Anxiety and Depression • More alike than different • Almost all depressed persons are anxious • Not all anxious persons are depressed • Negative affect • Core symptoms of depression • Anhedonia • Slowing • Negative cognitions

  28. Causes of Mood Disorders : Biological • Familial and Genetic Influences • Family Studies • Adoption Studies • Twin Studies • Bipolar • Unipolar • Higher concordance with higher severity • Higher heritability for females

  29. Causes of Mood Disorders : Biological

  30. Depression and Anxiety: The Same Genes? • Shared genetic vulnerability • High familial heritability • Same genetic factors • General predisposition • Except mania?

  31. Causes of Mood Disorders : Biological • Neurotransmitter Systems • Serotonin - depression • The “permissive” hypothesis • Dopamine • Norepinephrine • Dopamine - mania

  32. Causes of Mood Disorders : Biological • Endocrine System • “Stress hypothesis” • Overactive HPA axis • Neurohormones • Elevated cortisol • Suppressed hippocampal neurogenesis • Dexamethasone suppression test (DST)

  33. Causes of Mood Disorders : Biological • Sleep and Circadian Rhythms • REM sleep • Reduced latency • Increased intensity • Decreased slow wave sleep • Sleep deprivation effects

  34. Causes of Mood Disorders : Biological • Brain Wave Activity • Indicator of vulnerability? • Greater right side anterior activation • Less alpha wave activity

  35. Causes of Mood Disorders : Psychological • Stressful life events • Context • Meaning • Timing • Effects of stress • Poorer treatment response • Delayed remission • Trigger for episode or relapse

  36. Causes of Mood Disorders : Stress • Reciprocal-gene environment model • Stress triggers depression • Depressed individuals create or seek out stressful situations • Interaction with vulnerability • Genetic • Psychological

  37. Causes of Mood Disorders : Psychological • Learned Helplessness (Seligman) • Lack of perceived control • Depressive Attributional Style • Internal • Stable • Global • Also characterizes anxiety

  38. Causes of Mood Disorders : Psychological • Sense of hopelessness • Lack of perceived control • Will not regain control • Pessimism • Before or after?

  39. Causes of Mood Disorders : Psychological • Negative Cognitive Styles • Cognitive Theory of Depression (Beck) • Cognitive errors in depression • Negative interpretations • Types of Cognitive Errors • Arbitrary inference • Overgeneralization

  40. Causes of Mood Disorders : Psychological • Beck’s Depressive Cognitive Triad

  41. Causes of Mood Disorders : Psychological • Cognitive Theory of Depression (Beck) • Negative schemas • Automatic thoughts • Treatment implications • Correcting the errors

  42. Causes of Mood Disorders : Psychological • Cognitive Vulnerability for Depression • Pessimistic explanatory style • Negative cognitions • Hopelessness attributions • Interactions with: • Biological vulnerabilities • Stressful life events

  43. Mood Disorders: Social and Cultural Dimensions • Marriage and Interpersonal Relationships • Relationship disruption precedes depression • Strongest effects for males • Martial conflict vs. marital support • Gender differences in causal direction

  44. Mood Disorders: Social and Cultural Dimensions • Mood Disorders in Women • Prevalence: Females > males • True for all mood disorders • Except bipolar

  45. Mood Disorders: Social and Cultural Dimensions • Mood Disorders in Women • Gender roles • Perceptions of uncontrollability • Socialization • Access to resources

  46. Mood Disorders: Social and Cultural Dimensions • Social Support • Related to depression • Lack of support • predicts late onset depression • Substantial support • predicts recovery for depression (not mania)

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

  48. Integrative Theory of Mood Disorders

  49. Treatment of Mood Disorders • Changing the chemistry of the brain • Medications • ECT • Psychological treatment

  50. Treatment : Antidepressant Medications • Tricyclics (Tofranil, Elavil) • Frequently used for severe depression • Block reuptake/down regulate • Norepinephrine • Serotonin • 2 to 8 weeks to work • Many negative side effects • Lethality