Mood Disorders

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Mood Disorders

• Sinking into the pit
• of despair

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What is depression?

• A state of great sadness characterized by
  feelings of despair, worthlessness, hopelessness,
  withdrawal from others.
• Is the common cold of psychopathologyweve all
  had symptoms at some point.

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I. The two major mood disorders listed in the
DSM are

• 1. Major depression (Unipolar depression)
• 2. Bipolar disorder (Manic depression)

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A. Major depression DSM diagnosis made if

• Person has 5 of the following symptoms (next
  slide) for at least 2 weeks.
• Depressed mood or loss of interest pleasure in
  enjoyable activities (anhedonia) must be included
  in symptoms.

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Symptoms of major depression

• 1. Depressed mood.
• 2. Loss of interest and pleasure.
• 3. Significant weight loss or weight gain.
• 4. Difficulty in sleeping-Insomnia or
• hypersomnia.
• 5. Shift in activity level, psychomotor
  retardation, or agitated.
• 6. Fatigue or loss of energy.
• 7. Negative self-concept.
• 8. Difficulty concentrating.
• 9. Recurrent thoughts of death or suicide.

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Major depression Facts

• Lifetime prevalence ranges from 5 to
• 17.
• Average age of onset- mid-late 20s.
• Gender 2-3 times more likely in women then men
• SES- occurs more in lower SES classes.

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Recurrence rate Major Depression

• 80 of those with this disorder, experience
  another episode.
• Average episode- lasts for 3 to 5 months
• Average of episodes- 4

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B. Bipolar Disorder I

• Involves episodes of mania
• OR
• mixed episodes that include symptoms of both
  mania depression.
• Most bipolar patients-experience depression along
  with the mania.

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Formal diagnosis of a manic episode

• Requires presence of elevated or irritable mood
• -plus 3 additional symptoms.
• 1. Increase in activity level-at work,
  socially, or sexually.
• 2. Unusual talkativeness, rapid speech.
• 3. Flight of ideas or subjective impression that
  thoughts are racing.
• 4. Less than the usual amount of sleep needed.
• 5. Inflated self-esteem belief that one has
• special talents, powers, and abilities.
• 6. Distractibility, attention easily diverted.
• 7. Excessive involvement in pleasurable
  activities likely to have undesirable
  consequences, such as reckless spending.

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Bipolar facts

• Lifetime prevalence- 1 of the general
  population.
• -Average Age of onset 20s
• Gender occurs equally in men women.

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Recurrence rate Bipolar disorder

• More than 50 of cases have 4 or more episodes.
• Women experience more depression than mania. Men
  experience more mania.

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Heterogeneity in classification

• People with same diagnosis can vary from one
  another.
• A.) Some BP patients experience both mania
  depression every day called a mixed episode.
• B.) Some BP patients, have symptoms of only mania
  or only depression during a clinical episode.
• C.) Some patients with major depression may also
  experience hypomania (less extreme than
  full-blown mania) this is called Bipolar Disorder
  II.

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Heterogeneity in classification contd.

• Major Depression with psychotic features
• Depressed patients are diagnosed as psychotic
  when they experience delusions hallucinations.
• Depression is more severe for this group, than
  for unipolar depression without psychotic
  features.
• Patients generally dont respond to the usual
  drug therapies, but can improve with if
  antipsychotics are also given.

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II. Chronic Mood disorders

• Must occur for at least 2 years.
• Must not be severe enough to be diagnosed as
  major depression or bipolar disorder.

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A. Cyclothymia periods of depressed mood
hypomania (less than full-blown mania)

• Periods may be mixed with, may alternate with,
  or may be separated by periods of normal mood
  lasting as long as 2 months.
•  
• Can be thought of as a minor version of Bipolar I
  disorder.

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B. Dysthymic disorder patient is chronically
depressed.

• Person experiences anhedonia
• Plus several other signs of depression
• insomnia, sleeping too much, feeling inadequate,
  no energy, etc.

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III. Theories of depression

• A. Cognitive theories
• 1. Becks theory-negative thoughts cause
  depression (depressed people are biased toward
  negative thoughts).
• Depressed people have illogical or irrational
  thoughts, that are negative self-defeating,
  leaving them to feel worthless.

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How we become depressed (Beck)?

• In childhood adolescencedepressed people
  acquire a negative schema (tendency to view world
  negatively).
• May have been trigged by some external event
  (death of loved one rejection by peers).
• These schemata are fueled by cognitive biases,
  which lead them to misperceive events.
• --this spirals further, as depressed people fail
  to achieve goals they set for themselves.

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Becks theory

• Negative triad
• 1. Pessimistic view of self world.
• 2. Negative schemata or beliefs- fuel cognitive
  biases.
• 3. Cognitive biases (depressed people misperceive
  reality seek information to confirm their
  negative view).

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Types of cognitive biases

• 1. Arbitrary inference conclusions drawn in
  absence of sufficient information.
• (E.g. A man concludes he is worthless because
  it is raining the day he hosts a party.)
• 2. Selective abstraction conclusion based on one
  of many elements.
• (a worker feels worthless when a product fails
  to function, even though she is only one of many
  people who contributed to its production.)
•  

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Cognitive Biases contd.

• 3. Over generalization - overall conclusions
  based on a single event.
• (A student regards his or her performance on a
  particular day as final proof of his or her
  worthlessness stupidity).
•  
• 4. Magnification/minimization Gross errors in
  evaluation performance.
• (A woman believes herself worthless in spite of
  praise from her colleagues).
•  

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2. Interpersonal theory of depression  

• How do depressed people interact with
  non-depressed folks?
• Depressed individualshave few social support
  networks which make them vulnerable to
  depression.
• Depressed people elicit negative reactions from
  others (they are perceived as annoying).

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Joiner, Alfano, Metalsky (1992)

• Found that depressed people produce behavior that
  elicits rejection.
• Roommates of depressed college students rated
  their social contacts with these folks as low in
  enjoyment.
• Roommates expressed high levels of aggression
  towards depressed students.

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What is it about the depressed person that
elicits the negative reactions?

• Depressed may be low in social skills
  (complaining whining, slow delayed speech,
  poor eye contact).
• Depressed people constantly seek reassurances
  that they are okay. Eventually, they seek out
  negative info to confirm their negative bias.

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2. Biological theories Behavioral genetics

• 10- 25 of 1st degree-relatives of bipolar
  patients have experienced an episode of a mood
  disorder
• 6 -bipolar depression 13 -unipolar
  depression.
• Concordance rate-identical twins 72
• Concordance rate-dizygotic twins 14

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Unipolar depression Behavioral genetics

• Relatives of proband only slightly at risk.
• Concordance rates for monozygotic twins higher
  than dizygotic twins.

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Biochemistry Neurotransmitters

• Bipolar disorder--low levels of norepinephrine
  may lead to depression high level of mania.
• Unipolar depression--low levels of serotonin
  leads to depression

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IV. Biological therapies

• 1. ECT
• Used for severe depression when all else fails.
• Drug therapies
• Antidepressant drugs-very successful with
  unipolar depression.

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Drugs

• 1. Tricyclics - imipramine (Tofranil) and
  amitriptyline (Elavil).
• These prevent reuptake of both norepinephrine
  serotonin by the presynaptic neuron.
• 2. Monoamine oxidase (MAO) inhibitors -
  tranylcypromine (Parnate)
• Keeps enzyme monoamine oxidase from
  deactivating neurotransmitters, thereby
  increasing the levels of both serotonin and
  norepinephrine.

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3. Selective serotonin reuptake inhibitors
(SSRIs) fluoxetine (Prozac) sertraline
(Zoloft). 

• Selectively blocks reuptake of serotonin.
• Efficacy of all three classes of drugs about the
  same (50-70 effective).
• Side effects fewer in SSRIs. Tricyclics can be
  dangerous.

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V. Cognitive-Behavioral therapies

• Maladaptive thoughts behaviors are changed to
  positive ones.
• Therapists provide examples of patients
  successes to counter-act their negative views.
• Patients-asked to monitor private monologues
  identify illogical thoughts that promote
  depression.
• Patients taught to distract themselves when
  experiencing depressing thoughts.

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Becks therapy Does it work?

• Yes!!! Follow-up studies support Becks therapy
  for treating unipolar depression.
• May be effective in reducing or eliminating
  future bouts of depression.
• May help patients with bipolar depression as well.