Depressive and Bipolar Disorders

• Two key emotions on a continuum:

  Depression and Mania
• Unipolar Depression

  • No history of mania
  • Mood returns to normal when depression lifts
• Periods of mania that alternate with periods of depression

  Bipolar Disorder
• Is unipolar mania common?

  No
• Five areas of functioning impacted by depressiom

  • Emotional symptoms
  • "miserable" "empty"
  • Little pleasure
  • Motivational Symptoms
  • Lacking drive, initiative, spontaneity
  • Between 6% to 15% of those with severe depression commit suicide
  • Behavioral symptoms
  • Less active, less productive
  • Cognitive symptoms
  • Negative self-view
  • Self-blaming for unfortunate events
  • Pessimism
  • Physical symptoms
  • Headaches, dizzy spells, pain
• Diagnostic Criteria for Unipolar Depression

  Criteria 1: Major Depressive Episode

  • 5 or more symptoms lasting two or more weeks

  Criteria 2: No history of mania
• Major Depressive Disorder vs Dysthymic disorder

  Criteria 1 and 2 are met in both but in Dysthymic disorder, symptoms are "mild but chronic"

  In Dysthymic disorder symptoms are consistent for at least 2 years
• Double-depression


  When dysthymic disorder leads to major depressive disorder
• Biological model for the cause of unipolar depression

  • Stress (trigger) (# of stressful events)
  • Genetic factors
  • Biochemical factors
  • Neurotransmitters: Serotonin and norepinephrine
  • 1950s Blood pressure med causing depression
  • Endocrine system/hormone release
  • Abnormal levels of cortisol
  • Released by adrenal glands during times of stress
  • Abnormal melatonin secretion
  • Brain anatomy/circuitry
• Unipolar Depression: Cognitive Views

  • Negative thinking
  • Beck theory: 4 interralted cognitive components combine to produce unipolar depression
• Beck Theory


  Maladaptive attitudes

  • Self-defeating attitudes are developed during childhood
  • Beck suggests upsetting situations later in life can trigger an extended round of negative thinking
• Negative thinking takes 3 forms called the

  Cognitive Triad
• Cognitive triad


  Individuals repeatedly interpret

  1. Their experiences
  2. Themselves
  3. Their futures in negative ways

  Leading to depression
• Cognitive views of negative thinking

  Depressed people make errors in their thinking including:

  • Arbitrary interferences
  • Minimization of the positive and magnification of the negative.
  • Depressed people experience automatic thoughts
  • Steady train of unpleasant thoughts that suggest inadequacy and hopelessness
• Analysis of Beck's Model


  Significant research support but fails to show such cognitive patterns are the cause and core of unipolar depression
• Learned Helplessness (Cognitive Views)

  Theory asserts that people become depressed when they think that they no longer have control over the reinforcements (rewards and punishments) in their lives. They themself are responsible for this helpless state.
• Seligman's work with laboratory dogs

  Dogs subject to uncontrollable shock were later placed in a shuttle box. Even when presented with an opportunity to escape, dogs who experienced the uncontrollable shock made no attempt to do so.
• Internal attribution theory


  Internal attributions that are global and stable lead to greater feelings of helplessness and possibly depression ("It's all my fault"[internal], "I ruin everything"[global] "I always will" [stable]
• Five symptom areas of mania

  • Emotional
  • active, powerful
  • Motivational
  • need for constant excitement, involvement, companionship
  • Behavioral
  • Very active- move quick, talk loud or rapid
  • Cognitive
  • Poor judgment or planning
  • Physical symptoms
  • High energy level with little to no rest
• Diagnosing Bipolar Disorders


  Criteria 1: Manic Episode

  Three or more symptoms of mania lasting one week or more

  Criteria 2: History of mania

  If experiencing hypomania or depression
• Bipolar I Disorder


  Full manic and major depressive episodes. Some mixed.
• Bipolar II Disorder


  Hypomanic episodes and major depressive episodes
• What is rapid cycling?

  When people experience 4 or more episodes within a one-year period
• Is depression or mania more common for people with bipolar disorder?

  Depression (3x more likely and last longer)
• Cyclothymic disorder


  Numerous episodes of hypomania and mild depressive symptoms
• What is the activity of norepinephrine in unipolar depression and mania?

  Low levels of norepinephrine= unipolar depression

  High levels= mania
• Serotonin activity in unipolar depression and mania

  Parallel to norepinephrine in unipolar depression

  BUT no relationship with high serotonin has been found. Bipolar Disorder may be linked to low serotonin.
• Low serotonin + Low norepinephrine

  Depression
• Low Serotonin + High Norepinephrine

  Mania
• Treatments for Unipolar Depression

  Psychodynamic: Widely used despite no strong research evidence of its effectiveness

  Behavioral: Primarily used for mild or moderate depression but practiced less than in past decades

  Cognitive: Has performed so well in research that it has a large and growing clinical following
• How does psychofynamic therapy for unipolar depression work?

  Bringing unconcious grief over real or imagined losses into consciousness and working on them
• Procedures for psychodynamic therapy for unipolar depression

  • Free Association
  • Therapist interpretation
  • Review of past events and feelings
• Limitations of Psychodynamic therapy of Unipolar Depression

  • Depressed clients may be too passive or weary to fully particioate in clinical discussions
  • Depressed clients may become discouraged and end treatment too early when treatment is unable to provide quick relief
• Name of man who has a theory on behavioral therapy

  Lewinsohn
• What was Lewinsohn's approach?

  • Reintroduce clients to pleasurable activities and events, often using a weekly schedule
  • Appropriately reinforce their depressive and nondepressive behaviors
  • Help improve social skills
  • Works best when used in combination with techniques
• Who had a cognitive therapy approach on Unipolar Depression?

  Beck
• Beck's Cognitive Approach on Unipolar Depression

  Resulted from a pattern of negative thinking that may be triggered by current upsetting situations

  • Maladaptive attitudes lead people to the "cognitive triad"
  • Negatively viewing oneself, the world, and the future

  These biased views combine with illogical thinking to produce automatic thoughts
• 4 phases of cognitive therapy for unipolar depression

  1. Increasing activities and elevating mood
  2. Challenging automatic thoughts
  3. Identifying negative thinking and biases
  4. Changing primary attitudes
• Sociocultural Treatment Approaches to Unipolar Depression

  Family-Social Treatment

  Interpersonal Therapy

  Couple Therapy
• What is Interpersonal Therapy? (IPT)

  4 interpersonal problems may lead to depression and must be addressed:

  • Interpersonal loss
  • Interpersonal role dispute
  • Interpersonal role transition
  • Interpersonal deficits

  Studies show IPT is as effective as cognitive therapy for treating depression