Mood Disorders & Suicide

• Depression


  Low, sad state with symptoms of sadness, low energy, low self-worth, guilt
• Mania


  State of euphoria or frenzied activity with exaggerated sense of well-being and abilities
• Depressive Disorders


  Group of disorders marked by unipolar depression (depression without mania)
• Bipolar Disorder


  Alternating or intermixed periods of mania and depression
• Unipolar Depression


  • Prevalence: 20% lifetime, 8% 12-month
  • Onset: Average age 19 years
  • Remission: 85% recover within 6 months
  • Persistence: >50% experience multiple episodes
• Symptoms of Unipolar Depression

  • Emotional: Negative mood, anhedonia (lack of pleasure)
  • Motivational: Loss of energy, initiative, spontaneity, suicidal thoughts
  • Behavioral: Decreased activity, productivity, slowed or agitated speech/movement
  • Cognitive: Negative self-views, impaired concentration, pessimism, hopelessness
  • Physical: Sleep disturbance, appetite changes, headaches, dizziness, pain
• Depressive Disorders in DSM-5

  • Major Depressive Disorder: One or more Major Depressive Episodes, no history of mania or hypomania
  • Persistent Depressive Disorder: Symptoms of major or mild depression for at least 2 years, no history of mania or hypomania
  • Premenstrual Dysphoric Disorder (PMDD): Severe mood changes related to the menstrual cycle (not discussed in this lecture)
• Criteria for Major Depressive Episode (DSM-5)

  • Five or more symptoms for at least two weeks, including:
  • Depressed mood for most of the day
  • Loss of interest/pleasure in most activities
  • Significant weight change or appetite changes
  • Sleep disturbance
  • Agitation or slowed movement
  • Fatigue
  • Feelings of worthlessness or excessive guilt
  • Concentration/decision-making difficulties
  • Thoughts of death or suicide
• Explanatory Models for Depression

  • Biological Perspective:
  • Genetic Factors
  • Biochemical Factors
  • Brain Circuits
  • Immune System
  • Psychological Perspective:
  • Psychodynamic View
  • Cognitive-Behavioral Model
  • Sociocultural Perspective:
  • Family-Social
  • Multicultural
  • Developmental Psychopathology Perspective
• Biological Treatments for Unipolar Depression

  • Antidepressant Drugs:
  • MAO Inhibitors
  • Tricyclics
  • Second-Generation Antidepressants (SSRIs)
  • Brain Stimulation:
  • ECT
  • Vagus Nerve Stimulation
  • TMS
  • DBS
• CBT for Unipolar Depression

  • Behavioral Activation: Increase pleasurable activities and events
  • Beck's Cognitive Therapy: Recognize and change negative cognitive processes
  • New-Wave CBT: Mindfulness training, accepting negative cognitions
• Mania


  Elevated mood, increased energy, grandiosity, reduced sleep need, racing thoughts, distractibility, risky behavior
• Bipolar Disorders


  • Bipolar I Disorder: One or more manic episodes, may include hypomanic or depressive episodes
  • Bipolar II Disorder: History of major depressive episodes and hypomanic episodes, no manic episodes
  • Cyclothymic Disorder: Numerous periods of hypomanic and mild depressive symptoms for at least two years
• Causes of Bipolar Disorders


  • Biological Factors:
  • Neurotransmitter Activity
  • Ion Activity
  • Brain Structure
  • Genetics
• Treatment of Bipolar Disorders

  • Mood Stabilizers:
  • Lithium
  • Other Mood Stabilizers
  • Adjunctive Psychotherapy: Individual, group, or family therapy to improve coping skills and support medication treatment
• Suicide


  Intentional, direct, and conscious effort to end one's life
• Types of Suicide


  • Death Seeker: Intentional desire to die
  • Death Initiator: Desire to end pain and suffering
  • Death Ignorer: Not concerned with death, acts impulsively
  • Death Darer: Tests fate, taking risks
• Non-Suicidal Self-Injury (NSSI)


  Deliberate self-harm without suicidal intent
• Suicide Patterns and Statistics

  • Variation: Rates vary across countries, genders, marital status, race/ethnicity, social environments, and religious devoutness
• Triggers for Suicide


  • Stressful Events: Immediate (loss of loved one, job loss) or long-term (social isolation, illness)
  • Mood and Thought Changes: Hopelessness, sadness, anxiety, psychache (psychological pain), dichotomous thinking
  • Alcohol and Drug Use: Increased risk, especially in teens and young adults
  • Mental Disorders: Unipolar depression, bipolar disorder, schizophrenia, PTSD, anxiety, substance use disorder
  • Modeling: Contagion of suicide, especially among teens
• Underlying Causes of Suicide

  • Interpersonal View:
  • Interpersonal-Psychological Theory: Perceived burdensomeness, thwarted belongingness, psychological ability to carry out suicide
  • Biological View:
  • Genetics
  • Brain Development: Low serotonin activity, abnormalities in depression-related brain circuits
• Suicide and Age


  • Children: Infrequent, but often preceded by behavioral struggles
  • Adolescents: More common after age 13, Risk Factors: Developmental stress, long-term stressors, depression, low self-esteem, impulsivity
  • Elderly: Highest rates and most successful attempts, Risk Factors: Illness, loss of loved ones, loss of control, loss of social status
• Treatment After Suicide Attempts

  • Medical Care: Immediate attention is critical
  • Follow-Up: Psychotherapy, drug therapy
  • Therapy Goals: Keep the patient alive, reduce psychological pain, achieve a nonsuicidal state of mind, develop better coping skills
  • Therapies: Psychodynamic, drug therapy, group/family therapy, CBT, mindfulness-based therapy, dialectical behavior therapy
• Suicide Prevention


  • Prevention Programs and Crisis Hotlines: Offer support and resources
  • Goals: Establish a positive relationship, understand the problem, assess suicide potential, mobilize resources, formulate a plan
  • Longer-Term Prevention: Referral to therapy, reducing access to common suicide means
• Suicide Prevention Program Effectiveness: Difficult to assess due to program diversity, variables, and confounds. Mixed results. Accurate suicide risk assessment is complex. Newer Assessment Approaches: Nonverbal behaviors, psychophysiological measures, brain scans, Self-Injury Implicit Association Test.