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Mood Disorders. Mood Disorders. Depressive Disorders Major Depressive Disorder Dysthymic Disorder Bipolar Disorders Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder. Major Depressive Disorder. aka unipolar depression lifetime prevalence: up to 21\% in women 13\% in men

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mood disorders1
Mood Disorders
  • Depressive Disorders
    • Major Depressive Disorder
    • Dysthymic Disorder
  • Bipolar Disorders
    • Bipolar I Disorder
    • Bipolar II Disorder
    • Cyclothymic Disorder
major depressive disorder
Major Depressive Disorder
  • aka unipolar depression
  • lifetime prevalence:
    • up to 21% in women
    • 13% in men
  • typical age of onset:
    • 20s, but can occur at any time
major depressive episode
Major Depressive Episode
  • DSM-IV-TR criteria include
    • 1 of 2 mood symptoms
    • at least 5 symptoms total
    • duration of at least 2 weeks
mood symptoms of depression
Mood Symptoms of Depression
  • persistent sad, depressed mood
  • loss of interest or pleasure in previously enjoyable activities
  • DSM-IV criteria specify that person must have 1 of above plus 4 additional sx for at least 2 weeks
physical symptoms of depression
Physical Symptoms of Depression
  • Sleep disturbance
    • too much or too little
  • loss of energy, fatigue
  • appetite disturbance/weight change
    • loss of appetite or increase in appetite
  • changes in activity level
    • psychomotor retardation or agitation
cognitive symptoms of depression
Cognitive Symptoms of Depression
  • difficulty concentrating, thinking, and making decisions
  • feelings of worthlessness, guilt, or hopelessness
  • recurrent thoughts of death or suicide
course of depression
Course of Depression
  • if untreated, average duration of first episode is 6-9 months
  • often recur
dysthymic disorder
Dysthymic Disorder
  • Less severe, but more chronic
  • Chronic “low grade” depression
  • Depressed mood, plus 2 additional sx
    • poor appetite or overeating
    • insomnia or hypersomnia
    • low energy or fatigue
    • low self-esteem
    • poor concentration or difficulty making decisions
    • feelings of hopelessness
dysthymic disorder continued
Dysthymic Disorder (continued)
  • Sx must have lasted for at least 2 yrs
  • Never without symptoms for longer than 2 mos.
double depression
Double-Depression
  • dysthymic disorder with episodes of major depression
  • prognosis more negative
bipolar i disorder
Bipolar I Disorder
  • often called manic depression
  • typically involves episodes of major depression and mania
  • lifetime prevalence is 1% for both men and women
  • typical age of onset is late teens-early 20s
symptoms of manic episodes
Symptoms of Manic Episodes
  • elevated, expansive, or irritable mood for at least 1 week, plus 3 additional symptoms
symptoms of manic episodes1
Symptoms of Manic Episodes
  • inflated self-esteem/grandiosity
  • decreased need for sleep (3 hrs.)
  • unusual talkativeness or pressured speech
  • flight of ideas/racing thoughts
  • marked distractibility
  • increased activity at work, school, or in social situations
  • excessive involvement in pleasurable activities with potential for painful consequences
course of bipolar i disorder
Course of Bipolar I Disorder
  • there is great variability in cycle time
  • 35% of individuals go through only 1 cycle in 5 years
  • 1% of individuals go through 1 cycle every 3 months
  • rapid cycling: 4 or more cycles per year
other bipolar disorders
Other Bipolar Disorders
  • Bipolar II
    • Alternate between hypomanic and major depressive episodes
  • Cyclothymic Disorder
    • Alternate between depressive (not MDE) and hypomanic episodes for at least 2 yrs.
    • Never without symptoms for longer than 2 mos.
hypomanic episode
Hypomanic Episode
  • Elevated, expansive, or irritable mood for at least 4 days
  • Symptoms similar to manic episode, except no marked impairment/hospitalization
causes of mood disorders genetics
Causes of Mood Disorders: Genetics
  • twin studies and adoption studies show genetic link for mood disorders
  • link is stronger for bipolar disorder than unipolar depression
concordance rates
Concordance Rates
  • likelihood that if one member of pair has disease, other member will also have disease
  • unipolar depression
    • MZ twins = 36%
    • DZ twins = 17%
    • rates are higher for severe depression
concordance rates continued
Concordance Rates (continued)
  • bipolar disorder
    • MZ twins = 80%
    • DZ twins = 16%
causes neurotransmitters
Causes: Neurotransmitters
  • depression is associated with low levels of serotonin in relation to norepinephrine and dopamine
    • primary function of serotonin is to regulate our emotional reactions
    • when levels of serotonin are low, we are more impulsive and our moods swing more wildly
causes neurotransmitters continued
Causes: Neurotransmitters (continued)
  • medications that treat depression increase the availability of serotonin and/or norepinephrine in the synapse
  • within a few weeks, this changes postsynaptic receptor sensitivity
  • change in postsynaptic receptor sensitivity (down-regulation) correlates with symptom improvement
causes the endocrine system
Causes: The Endocrine System
  • depression can be a symptom of some endocrine disorders
    • hypothyroidism
    • Cushing’s syndrome
  • HPA axis
    • hypothalamus
    • pituitary gland
    • adrenal gland
  • hypothalamus sends signals to pituitary gland, which sends signals to adrenal gland to secrete hormones related to stress response
    • 50% of depressed individuals show elevated levels of cortisol
causes circadian rhythms
Causes: Circadian Rhythms
  • overview
    • circadian rhythms (sleep-wake, temperature, hunger) are regulated by hypothalamus
    • exposure to light affects circadian rhythms (suppresses melatonin)
causes circadian rhythms continued
Causes: Circadian Rhythms (continued)
  • interesting findings:
    • prevalence of seasonal affective disorder is higher in extreme northern and southern lattitudes
    • depriving depressed patients of sleep can temporarily reduce their depression
    • extended bouts of insomnia can trigger manic episodes
causes circadian rhythms continued1
Causes: Circadian Rhythms (continued)
  • theory
    • mood disorders are caused by disturbance in circadian rhythms
causes stress
Causes: Stress
  • general finding: stressful life events are strongly related to the onset of mood disorders
    • 20-50% of individuals who experience stressful life events become depressed
causes stress continued
Causes: Stress (continued)
  • a few caveats:
    • same stressors that are associated with depression are associated with other disorders
    • new data indicate that approximately 1/3 of the association between stressful life events and depression is due to the tendency of people who are vulnerable to depression to place themselves in high-risk stressful environments
    • social support seems to reduce risk for developing depression when exposed to stress
causes learned helplessness
Causes: Learned Helplessness
  • animal research
    • animals who have been exposed to inescapable aversive events do not make adequate attempts to escape in the future
  • learned helplessness theory of depression
    • people become anxious and depressed when they make an attribution that they have no control over the stress in their lives
depressive attributional style
Depressive Attributional Style
  • attribution
    • the way in which people assign causes to events in their lives
  • people who are depressed tend to make attributions that are
    • Internal
    • Stable
    • Global
  • sense of hopelessness is important
causes negative cognitive style
Causes: Negative Cognitive Style
  • tendency to interpret everyday events in a negative way
  • reflects cognitive errors
    • all or nothing
      • seeing things in “black or white”
      • one order of french fries means I’ve blown my whole diet
    • overgeneralization
      • one critical remark on paper means I will fail class
    • arbitrary inference
      • selective attention to negative aspects
      • I assume I’m a terrible teacher because 2 students fell asleep
causes negative cognitive style continued
Causes: Negative Cognitive Style (continued)
  • make negative interpretations about
    • self
    • world
    • future
  • depressive cognitions emerge from distorted and probably automatic methods of processing information
causes cognitive vulnerability for depression
Causes: Cognitive Vulnerability for Depression
  • 5-year longitudinal study of college students
  • method
    • at first assessment: subjects who were not depressed filled out questionnaires to assess cognitive vulnerability to depression
    • questionnaires: measured dysfunctional attitudes and hopelessness attributions
    • subjects were assessed every several months for next 5 years for symptoms of depression
causes cognitive vulnerability for depression continued
Causes: Cognitive Vulnerability for Depression (continued)
  • Results
    • negative cognitive styles do indicate a vulnerability to later depression
    • subjects who scored high on measures of cognitive vulnerability were far more likely to experience later depression (17% vs. 1%)
treatment of depression
Treatment of Depression
  • Medical
    • antidepressants
    • electroconvulsive therapy (ECT)
  • Psychosocial
    • cognitive-behavioral therapy
    • interpersonal therapy
antidepressant medication
Antidepressant Medication
  • most meds increase levels of serotonin and/or norepinephrine
    • result in down-regulation of these systems
  • take 2-8 weeks to work
  • effective
    • 65-70% of those on meds improve, vs. 25-30% of those taking placebos
    • however, 40% will stop taking drugs due to side effects
  • relapse rate after going off medications is high (50%)
types of antidepressants
Types of Antidepressants
  • tricyclics
  • MAO inhibitors
  • SSRIs
  • others
tricyclics
Tricyclics
  • block reuptake of norepinephrine and (to a lesser extent) serotonin
  • examples:
    • amitriptyline (Elavil)
    • imipramine (Tofranil)
  • side effects:
    • dry mouth, constipation, blurred vision, weight gain, orthostatic hypotension
  • are likely to be lethal if taken in overdose
mao inhibitors
MAO Inhibitors
  • block enzyme (monoamine oxidase) which breaks down norepinephrine and serotonin (monoamines)
  • examples:
    • phenelzine (Nardil)
    • tranylcypromine (Parnate)
  • problem:
    • dangerously interact with many other drugs (nasal decongestants, SSRIs) and with foods containing tyramine (smoked meats, ages cheeses, beer)
    • can produce hypertensive crisis
ssris
SSRIs
  • selectively inhibit reuptake of serotonin
  • side effects:
    • physical agitation, insomnia, gastrointestinal upset, and sexual dysfunction (low desire)
  • examples
    • fluoxetine (Prozac)
    • paroxetine (Paxil)
    • sertraline (Zoloft)
  • are less likely to be lethal if taken in overdose
other antidepressants
Other Antidepressants
  • buproprion (Wellbutrin)
    • blocks reuptake of dopamine
  • venlaxafine (Effexor) and nefazodone (Serzone)
    • inhibit reuptake of serotonin and norepinephrine
electroconvulsive therapy
Electroconvulsive Therapy
  • used for depression that doesn’t respond to other treatments
  • effective
  • exact mechanism of action is unknown
  • receive treatments every other day for total of 6-10 treatments
  • side effects: short-term memory loss
cognitive behavioral therapy
Cognitive-Behavioral Therapy
  • focuses on changing dysfunctional beliefs associated with depression
  • clients do homework
    • monitor and log thought processes
    • engage in hypothesis testing
  • important to reactivate client
  • 10-20 weekly sessions
  • effective
interpersonal psychotherapy
Interpersonal Psychotherapy
  • focuses on resolving problems in client’s existing interpersonal relationships and forming new ones
  • 4 major areas
    • dealing with interpersonal role disputes (marital conflict, conflict with friends)
    • adjusting to the loss of a relationship (death, divorce)
    • acquiring new relationships (getting married or establishing professional relationships)
    • identifying and correcting deficits in social skills
interpersonal psychotherapy continued
Interpersonal Psychotherapy (continued)
  • 15-20 weekly sessions
  • effective
comparing treatments
Comparing Treatments
  • studies compare CBT and IPT to antidepressant meds and other control conditions
  • results
    • CBT, IPT, and meds are equally effective
    • CBT, IPT, and meds are more effective than
      • placebo conditions
      • brief psychodynamic treatments
      • other control conditions
  • 50-70% of people benefit from treatment to a significant extent, compared to 30% in placebo or control conditions
combined treatments
Combined Treatments
  • Meds work more quickly
  • Psychosocial treatments
    • Increase long-range social functioning
    • Prevent relapse
treatment of bipolar disorder
Treatment of Bipolar Disorder
  • lithium is best known treatment
  • not sure how it works
  • side effects
    • excessive thirst and urination, eventual damage to kidneys and thyroid
  • blood levels must be carefully monitored
  • effective
    • 30-60% respond well initially
treatment of bipolar disorder continued
Treatment of Bipolar Disorder (continued)
  • other approaches include anticonvulsant medications
    • example: valproate (Depakote)
  • psychosocial treatment
    • family therapy: increase medication compliance, educate family about symptoms, help family develop new coping skills and communication styles
    • decreases relapse
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