Mood Disorders

1. Mood Disorders Depressive Disorders Bipolar Disorders Suicide Cato Grønnerød PSY2600

2. Defining Mood Disorders • Mood is different from ‘affect’ or ‘emotion’ • Pervasive and sustained • Depression is different from ‘sadness’ or ‘grief’ • More serious cognitive, behavioural and somatic indicators • More severe and invariable in the face of objective events and situations • Longer duration • Often occurs without external trigger

3. Defining Mood Disorders • Mania is different from ‘good mood’ • Extremeness and insensitivity to external persons or situations • Defintions • Single episode versus stable/recurrent • Serious versus moderate • Unipolar versus bipolar • Unipolar: single or double

4. Defining Mood Disorders • Major depressive disorder • Single episode • Recurrent • With melancholic features • With psychotic features • With postpartum onset • With seasonal pattern • Dysthymic disorder

5. Depressive (Unipolar) Disorders • Currently the most prevalent psychological disorder • Children also suffer from depression • Women tend to be diagnosed with depression more often than men • No strong evidence of socio-economic differences without other risk factors • The similarities in people’s experiences outweigh the differences

6. Major Depressive Disorder • Emotional symptoms • Sadness, guilt, helplessness, hopelessness • Anxiety • Cognitive symptoms • Feeling of having failed, cause of own misery, pessimism about the future • Physiological symptoms • Loss of appetite, sleep disturbances, weight loss, somatic complaints • Motivational symptoms • Trouble doing daily routines, nothing seems worthwile, ambivalence

7. Major Depressive Disorder • Person must not have experienced any episodes of mania • Must have experienced at least one major depressive episode. • Five or more symptoms out of 9 for at least 2 weeks • Change from normal functioning • Either depressed mood or decreased interest/pleasure • Must be one of the five symptoms

8. Dysthymic Disorder • Chronic depression that becomes ‘personality like’ • Similar symptoms to those for Major Depression • Must not have had a manic episode • Person is typically able to maintain normal functioning outwardly • Often goes undiagnosed • Symptoms are less severe and less changeable • People don’t report their difficulties

9. Dysthymic Disorder • Typically diagnosed when a person presents with other issues, including a Major Depressive Episode • Reasonably good responses to treatment • Indicate that it is a mood disorder and not a personality disorder • Long term negative impact on sense of self and life satisfaction

10. Depressive Disorders • Depression can be difficult to recognise or diagnose • Cultural differences • Variety of presentation • Lack of self referral • Don’t feel depressed but behaviour suggests otherwise • Unwillingness to report symptoms • Requirement that there be a change from normal functioning

11. Vulnerability to depression • Younger persons more at risk than older persons • Women more at risk than men • Ethnic differences • Life events • Prior depression • Bad childhood experiences • Stressful losses

12. Course of depression • Depression usually dissipates in time • 75-90% recovery rate • Three courses after an episode • Recovery witout relapse • Recovery with recurrence • Greatest risk the first six months • Chronic depression (dysthymia)

13. Biological Causes • Heritability: relatives have higher risk • Reduced amounts or poor circulation of norepinephrine and/or serotonin in the brain • Hormonal imbalance (e.g. low oestrogen/testosterone, long-term high exposure to cortisol) • Poor metabolic activity in certain areas of the brain (e.g. frontal lobes)

14. BiologicalCauses • Synaptic regulation • Discharge • Reception • Reuptake • Degration

15. Biological Causes • First hypothesis: Reduced avaiability of norepinephrine and dopamine • Serotonine levels were also reduced • Medication takes 2-3 weeks to have effect, yet serotonine levels change immediately • Downregulation • Kindling • Mononamine deficits only evident when the person is depressed

16. Biological Treatment: Medication • Tricyclic antidepressants • Block the reuptake of norepinephrine • Can have strong side effects and vulnerable to overdose • MAOIs (monoamine oxidase inhibitors) • Prevent the breakdown of norepinephrine • Dangerous side effects especially when combined with substances found in common foods and drinks

17. Biological Treatment: Medication • SSRIs (selective serotonin reuptake inhibitors) • Blocks specifically the reuptake of serotonin • Currently the preferred drug group • Some evidence of danger emerging e.g. physical dependency • Links to suicide (e.g. Prozac and Paxil)

18. Biological Treatment • Electro Convulsive Therapy (ECT) • Bad reputation due to past overenthusiasm and poorly understood techniques • Still used in severe cases that do not respond to other treatments • Improved technology • More targeted and appropriate treatment • Still high relapse rates, due to treatment or disorder?

19. Cognitive Causes • Explanatory Style (Martin Seligman) • Learned helplessness • People given inescapable events will become passive later on when they are given escapable events • Depressive patterns of negative thought • Internal causes for negative events, external for positive events • Causes are global and stable

20. Cognitive Causes • The Cognitive Triad (Aaron T. Beck) • Negative beliefs about 1) self, 2) world (experience) and 3) future • Arbitrary inference • Drawing conclusions when there is little support • Selective abstraction • Focusing on one insignificant detail while ignoring more important features

21. Cognitive Causes • The Cognitive Triad • Overgeneralization • Drawing global conclusions about worth, ability or performance on the basis of a single fact • Magnification or minimization • Small bad events are magnified and large good events are minimized • Personalization • Incorrectly taking responsibility for bad events

22. Cognitive Causes

23. Treatment of Depression • Cognitive Therapy • Helping the person first to become aware of and then counter their negative beliefs and expectations • Detecting and testing automatic thoughts • Usually paired with behavioural exercises • Interpersonal Therapy (IPT) • Psychodynamic therapy focused on present social and interpersonal relationships • Short-term (e.g. 10-12 sessions) • Helps person to examine the meaning of current interpersonal experiences

24. Bipolar Disorder • ‘Manic depression’ • Less common than unipolar depression, but arguably greater impact, on others especially • Can resemble unipolar depression whilst in the depressed phase • But more severe, more rapidly severe, does not respond in the same way to anti-depressants • Presence of mania or manic episodes is the major distinguishing feature.

25. Types and Features of Bipolar Disorder • Mania • Characterised by euphoric or highly irritable mood; grandiose, rapid, irrational and even delusional thoughts and ideas; hyperactive, insistent and persistent behaviour; greatly reduced need for or desire for sleep • Cyclic pattern • A person’s cycle may stretch over many months or even years, or they may have a ‘rapid cycling’ pattern where swings between mania and depression occur more frequently e.g. every few weeks

26. Types and Features of Bipolar Disorder • Bipolar I • At least one Manic Episode and one Major Depressive Episode • Bipolar II • At least one Hypomanic (less severe) Episode and one Major Depressive Episode • Cyclothymic • Repeated severe mood swings but not severe enough to be either Manic or Major Depressive Episodes

27. Causes and Treatment of Bipolar Disorder • Genetic vulnerability – greater even than for unipolar depression • Dysfunction with self-correcting mechanisms in the brain that normally balance mood • Dysfunction with the inhibition-disinhibition system in the brain (protection vs. pleasure-seeking) • No adequate explanation for the co-occurrence of depression and mania • E.g. is one a defence against the presence of the other? • Treatment is largely drug-based • Lithium carbonate • Recently some anti-convulsants

28. Seasonal Affective Disorder • Depression that starts in October or November • Full remission by March or April • Sometimes toward mania • Remits shortly on travels southwards • Light therapy • Phosphor fluorescent lamps

29. Suicide • In the 45 years from 1950 to 1995, suicide rates increased 60% worldwide • Particular increases observed in the 15-34 age group • Among the top three causes of death for this age group • For every completed suicide there are 10-20 more attempted suicides • Suicide rates are particularly high among Eastern European countries according to 2003 data • Women attempt more suicides • Sleeping pills, wrist cutting • Men succeed more suicides • Weapons, jumping off buildings

30. Suicidal Risk Factors • Demographic and sociocultural factors • Male, low SES, social isolation, atheism, unemployment • Psychopathological factors • Depression, bipolar disorder, schizophrenia • Impulsivity, substance abuse • Previous attempts • Biological and medical factors • Genetic predisposition • Neurochemical factors • Severe, painful and disabling physical illness

31. Suicidal Risk Factors • Life events • Separation/divorce or death of partner • Knowing other suicide attempts/victims • Physical and mental trauma, issues of sexual orientation • Environmental factors • Access to and availability of lethal means • Rural residence • Media portrayals of suicide

32. Suicide Prevention • Apart from altruism, two main reasons for suicidal attempts • Surcease: to end suffering of self and others • Manipulation: to invoke responses from society or others • Prevention is difficult and inexact • Aftercare of suicide attempters is also important as is intervention for families and friends of victims • Risk assessment is crucial