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
typical age of onset:
20s, but can occur at any time
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
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
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
difficulty concentrating, thinking, and
making decisions
feelings of worthlessness, guilt, or
hopelessness
recurrent thoughts of death or suicide
Course of Depression
if untreated, average duration of first
episode is 6-9 months
often recur
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)
Sx must have lasted for at least 2 yrs
Never without symptoms for longer than
2 mos.

Double-Depression
dysthymic disorder with episodes of
major depression
prognosis more negative
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
elevated, expansive, or irritable mood
for at least 1 week, plus 3 additional
symptoms
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
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
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
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
twin studies and adoption studies show
genetic link for mood disorders
link is stronger for bipolar disorder than
unipolar depression
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)
bipolar disorder
MZ twins = 80%
DZ twins = 16%
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)
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
depression can be a symptom of some endocrine
disorders
hypothyroidism
Cushings 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
overview
circadian rhythms (sleep-wake,
temperature, hunger) are regulated by
hypothalamus
exposure to light affects circadian rhythms
(suppresses melatonin)
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
(continued)
theory
mood disorders are caused by disturbance
in circadian rhythms
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)
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
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
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
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 Ive blown my whole diet
overgeneralization
one critical remark on paper means I will fail class
arbitrary inference
selective attention to negative aspects
I assume Im a terrible teacher because 2 students fell
asleep
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
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)
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
Medical
antidepressants
electroconvulsive therapy (ECT)
Psychosocial
cognitive-behavioral therapy
interpersonal therapy
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
tricyclics
MAO inhibitors
SSRIs
others
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
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
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
buproprion (Wellbutrin)
blocks reuptake of dopamine
venlaxafine (Effexor) and nefazodone
(Serzone)
inhibit reuptake of serotonin and
norepinephrine
Electroconvulsive Therapy
used for depression that doesnt
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
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
focuses on resolving problems in clients
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)
15-20 weekly sessions
effective
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
Meds work more quickly
Psychosocial treatments
Increase long-range social functioning
Prevent relapse
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)
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