mood disorders

• Bipolar Disorder


  the patient exhibits extremely low moods and acts as if there is no chance for life during a depressive episode
• Bipolar I Disorder


  people with bipolar I frequently engage in risky activities that could have detrimental effects on themselves or others while they are experiencing manic episodes
• Bipolar II Disorder


  people with bipolar II would experience at least one episode of significant depression and at least one episode of hypomania (less severe form of mania), but no previous manic episodes
• Cyclothymic Disorder 


  this disorders diagnosis requires at least a 2 year history of several episodes that have features of profound depression and hypomania
• Major Depressive Disorder (MDD)


  intense sadness, anger, or a sense of impending doom are the hallmarks of MDD, severe depression can make it difficult for a person to appreciate things that are often quite enjoyable
• Substance/Medication Induced Depressive Disorder


  a depressive state caused by drugs, alcohol, or prescription medication
• Premenstrual Dysphoric Disorder


  anger, irritation, anxiety, depression, and insomnia are some of the symptoms, this kind of mood disorder starts 7 to 10 days before menstruation and disappears a few days after the menstrual period begins
• Disruptive Mood Dysregulation Disorder


  children and teenagers affected by DDMD show a lot of anger outbursts and irritability that is excessive for the circumstance
• Seasonal Affective Disorder (SAD)


  this sort of depression happens during particular seasons of the year, usually lasting until spring or summer if it begins in late autumn or early winter
• Unipolar Depression


  suffer from only depression

  • individual has no history of mania
  • mood returns to normal when depression lifts

  in contrast, those who display bipolar disorder experience periods of mania that alternate with periods of depression
• Unipolar Depression


  15% of people worldwide will experience a severe episode at some point in their lives

  twice as many women (but milder)

  prevalence the same in girls and boys

  dramatic increase in younger years

  between the ages of 30-65 white americans have higher rates than afro-americans

  85% recover without treatment, but 40% will have at least one further episode
• Unipolar Depression Symptoms


  • perform as well as non-depressed people but believe they have done worse
  • feeling miserable, empty, humiliated
  • poor memory
  • headaches, indigestion, constipation, dizziness, pain
  • appetite & sleep disturbances are common
  • 7-15% commit suicide (1% of non-depressed)
• Emotional Symptoms of Depression


  • feeling miserable, empty, humiliated
  • experiencing little pleasure
• Motivational Symptoms of Depression


  • lacking drive, initiative, and spontaneity
  • between 6-15% of those with severe depression die by suicide
• Behavioural Symptoms of Depression

  • less active
  • less productive
• Cognitive Symptoms of Depression


  • hold negative views of themselves
  • blame themselves for unfortunate events
  • pessimistic
• Physical Symptoms of Depression


  • Headaches
  • Dizzy Spells
  • General Pain
• Diagnosing Unipolar Depression


  a major depressive episode is a period of two or more weeks marked by 5 or more symptoms of depression

  in extreme cases symptoms can be psychotic, including hallucinations and delusions
• Dysthymic Disorder


  individuals who experience a longer-lasting, at least 2 years, but less disabling pattern of depression
• Stress and Unipolar Depression


  people with depression experience a bigger number of stressful life events during the month before the onset of their symptoms

  can become cyclical as the depression makes them less likely to engage in stress reduction activities, and are more likely to strain their relationships, creating more stress

  some clinicians distinguish reactive (exogenous) depression from endogenous (internal) depression
• Biological Model of Unipolar Depression: Genetic Factors


  family lineage, twins, adoption, and molecular gene studies suggest that some people inherit a biological predisposition

  • researchers have found that as many as 20% of relatives of those with depression are also depressed, compared with fewer than 10% of the general population

  twin studies demonstrate a strong genetic component

  • concordance rate for MZ twins -> 46%
  • concordance rate for DZ twins -> 20%

  using techniques from molecular biology, researchers have found that unipolar depression may be tied to specific genes
• Biological Model of Unipolar Depression: Biochemical Factors


  neurotransmitters (NT): serotonin & norepinephrine

  • 1950s -> medication for high blood pressure found to cause depression, because some lowered either serotonin or norepinephrine

  discovery of effective antidepressants, confirmed the role of NT

  depression likely doesn't involve just serotonin and norepinephrine, but other NT as well
• Biological Model of Unipolar Depression: Endocrine System/Hormone Release


  people with depression have been found to have abnormally high levels of cortisol, which is released by the adrenal glands in times of stress

  people with depression have been found to have abnormal melatonin secretion, which regulates sleep patterns
• Biological Treatments for Unipolar Depression: Antidepressants


  Monoamine Oxidase Inhibitors (MAO inhibitors)

  • originally used to treat tuberculosis, but doctors noticed that it made patients happier
  • the drug slows down the body's production of MAO
  • MAO breaks down norepinephrine, and MAO inhibitors prevent that, which leads to a rise in norepinephrine activity and a reduction in depressive symptoms
  • approximately half of the patients taking them are helped
• Biological Treatments for Unipolar Depression: Antidepressants


  Tricyclics

  • during the search for medication against schizophrenia, researchers found that imipramine relieved symptoms of depression
  • most patients who immediately stop taking tricyclics upon relief of symptoms relapse within the year, they need to take them for approximately an additional 5 months (maintenance therapy)
  • are believed to reduce depression by affecting NT reuptake mechanisms
• NT reuptake mechanisms


  • to prevent an NT from remaining in the synapse for too long, a pump like mechanism is used to recapture the NT and draw it back into the presynaptic neuron
  • reuptake processes appear efficient in some people, but in some people too much NT is drawn in from the synapse, which is thought to result in clinical depression
  • tricyclics block the reuptake process, and therefore NT activity is increased in the synapse
• Second Generation Antidepressants


  the third group of effective antidepressant drugs is structurally different from MAO inhibitors and tricyclics

  • most drugs in this group are labelled selective serotonin reuptake inhibitors (SSRIs)
  • these drugs increase serotonin activity specifically (no other NT are affected), this includes fluoxetine (Prozac), sertraline (Zoloft), and escitalopram (Lexapro)
  • selective norepinephrine and serotonin-norepinephrine reuptake inhibitors are also now available
• Biological Treatments for Unipolar Depression: Vagus Nerve Stimulation


  • stimulate the brain by electrically stimulating the vagus nerve through the use of a pulse generator implanted under the skin of the chest
  • found that the procedure brings significant relief to as many as 40% of those with treatment resistant depression
• Biological Treatments for Unipolar Depression: Transcranial Magnetic Stimulation (TMS)


  • stimulate the brain without the undesired effects of ECT
  • TMS has been found to reduce depression when administered daily for 2-4 weeks
• Biological Treatments for Unipolar Depression: Deep Brain Stimulation


  • theorising a 'depression switch' located deep within the brain
  • researchers have successfully experimented with electrode implantation in the brains Brodman Area 25
• Biological Treatments for Unipolar Depression: Electroconvulsive Therapy (ECT)


  • one of the most controversial forms of treatment
  • the procedure consists of targeted electrical stimulation to cause a brain seizure
  • usual course of treatment is 6-12 sessions spaced out over 2-4 weeks
• Psychological Models of Unipolar Depression: Psychodynamic Model


  link between depression and grief, when a loved one dies, the mourner unconsciously merges their identity with the deceased, symbolically getting them back

  • usually temporary, if grief is severe & long lasting depression ensues

  studies show general support for a correlation between depression and a major loss

  • research supports the theory that early losses set the stage for later depression, however no indication that loss is always at the core & not all studies find a correlation between childhood loss and later depression
• Psychodynamic Model: Treatments


  long term psychodynamic therapy only occasionally helpful in some cases of unipolar depression

  two features may be particularly limiting:

  • depressed clients may be too passive or weary to fully participate in subtle therapy discussions
  • depressed clients may become discouraged and end treatment too early when it is unable to provide a quick relief
• Psychological Models of Unipolar Depression: Behavioural Model


  depression results from changes in rewards and punishments people receive in their lives

  • suggest that the positive rewards in life dwindle for some, leading them to perform fewer constructive behaviours and they spiral towards depression

  research supports the relationship between the number of rewards received and the presence or absence of depression

  • social rewards are especially important
• Behavioural Model: Treatment


  use a variety of strategies to help increase the number of rewards increased by clients

  • reintroduce to pleasurable activities and events, often using a weekly schedule
  • appropriately reinforce their depressive and non-depressive behaviours
  • help them improve their social skills

  techniques seem to be of limited help when just one is applied

  • when two or more are combined, behavioural treatment does seem to reduce depressive symptoms
  • note: researchers have combined behavioural techniques with cognitive strategies
• Psychological Models of Unipolar Depression: Cognitive Model


  Learned Helplessness Model

  • significant research to support it
  • human subjects who undergo helplessness training score higher on depression surveys
  • animal subjects lose interest in sex and social activities
  • theory based on Seligman's work with lab dogs
• Seligman - Learned Helplessness with dogs


  • dogs subjected to uncontrollable shock were placed in a shuttle box
  • even when presented with an opportunity to escape, dogs that experienced the uncontrollable shocks made no attempts to escape
  • Seligman theorised that the dogs 'learned' to be helpless to do anything to change negative situations, and drew parallels to human depression
• Psychological Models of Unipolar Depression: Cognitive Models


  Negative Thinking (Beck & Alford, 2009)

  • maladaptive attitudes or dysfunctional beliefs are a vulnerability factor -> self defeating factors develop during childhood, suggest that upsetting situations later in life can trigger an extended round of negative thinking
  • dysfunctional beliefs lead to the negative cognitive triad -> negative view of oneself, the world, and the future
  • depressed people make errors in thinking -> arbitrary inferences, minimisation of the positive, magnification of the negative
• Psychological Models of Unipolar Depression: Cognitive Models



  • depressed people also experience automatic thoughts -> steady train of unpleasant thoughts that suggest inadequacy and hopelessness
  • high correlation between level of depression and number of maladaptive attitudes held
• Cognitive Models: Treatments


  Beck's Cognitive Therapy (includes various behavioural techniques) is designed to help clients recognise and change their negative cognitive processes

  approach follows 4 phases and usually last fewer than 20 sessions

  • increasing activities and elevating mood
  • challenging automatic thoughts
  • identifying negative thinking and biases
  • changing primary attitudes

  hundreds of studies have shown that cognitive therapy helps unipolar depression

  • around 50-60% of clients show a near total elimination of symptoms