An Overview of Mood Disorders • Gross Deviations in Mood • 2 Fundamental states: Depression & Mania Chapter 7 • Depression: “The Low” – Major Depressive Episode •The most commonly diagnosed & most severe Mood Disorders depression •Depressed (or in children, irritable) mood state that lasts at least 2 weeks –Cognitive symptoms •Feelings of worthlessness or inappropriate guilt •Diminished ability to concentrate or indecisiveness – Dysthymic Disorder –Disturbed physical functions (vegetative •Similar symptoms to Major Depressive Episode, symptoms) (central to the disorder) but milder •Insomnia or hypersomnia nearly every day –Also fewer symptoms: need only 2 of the •Significant weight loss or gain or change in symptoms, as opposed to 5 in Major Depressive appetite Episode •Fatigue or loss of energy nearly every day •A persistently depressed (or, in children & •Psychomotor agitation or retardation adolescents, irritable) mood that continues for at –Nearly always accompanied by markedly least 2 years diminished interest or ability to experience pleasure –During those 2 years, the individual has never been (anhedonia) from life without the symptoms for more than 2 months at a • Average duration if untreated: 9 months time •Most people with Dysthymia eventually experience a major depressive episode • Mania: “The High” –Abnormally exaggerated elation, joy, or euphoria OR irritability (common toward the –Behavioral symptoms end of the episode) lasting at least 1 week •More talkative / pressured speech –Cognitive symptoms •Psychomotor agitation or increase in goal–directed activity •Inflated self–esteem or grandiosity •Excessive involvement in pleasurable •Flight of ideas (too many ideas at once)/ activities with a high potential for racing thoughts painful consequences •Distractibility –Average duration if untreated: 3 to 6 –Physical symptoms months •Decreased need for sleep 1 • Hypomanic episode –Less severe version of a manic Mania episode –Does not cause marked impairment in social or occupation functioning Depression The Structure of Mood Disorders • Unipolar Mood Disorder • Important to Determine the Course – Either Depression or Mania – Temporal Patterning of the Episodes • Bipolar Mood Disorder – Important to prevent future episodes, not – Alternates Between Depression and Mania just relieve current symptoms – Somewhat misleading term • An individual can experience manic symptoms but feel depressed or anxious at the same time –Dysphoric Manic or Mixed Episode Major Depressive Disorder The Nature of Mood Disorders Clinical Description • Depressive Disorders • Major Depressive Episode – Major Depressive Disorder • No Manic or Hypomanic Episodes – Dysthymic Disorder • Single episode or Recurrent – Double Depression • Bipolar Disorders – Bipolar I and Bipolar II Disorders 2 Weeks or More – Cyclothymic Disorder Facts and Statistics 2 Dysthymia Double Depression Clinical Description Clinical Description Dysthymia Dysthymia 2 Years or More Facts and Statistics Major Depression Bereavement •Prominent Symptoms: • Normal grief reaction –Intrusive memories & distressingly strong yearnings – Presents with some symptoms characteristic of for the loved one Major Depressive Episode • Sadness –Avoiding people or places that are reminders of the • Insomnia loved one • Poor appetite •Treatment • Weight loss –Help the individual re-experience the trauma under • Pathological grief reaction / Impacted grief close supervision reaction •Prevention – Bereavement is considered a disorder only if: • Symptoms are still present 2 months after the loss –Mourning rituals • Or there are severe symptoms, e.g., psychotic features or suicidal ideation Bipolar Disorders Bipolar Disorders: Bipolar I Clinical Description Major Features • Major Depressive Episodes • Experience Both alternate with Mania –Manic Episodes –Major Depressive Episodes • Full Manic Episodes • “Roller coaster ride from peaks of elation to depths of despair” Major Depression 3 Bipolar Disorders: Bipolar II Bipolar Disorders: Cyclothymia Clinical Description Clinical Description • Major Depressive Episodes •Dysthymic Episodes alternate with alternate with • Hypomanic Episodes Hypomania Hypomanic Episodes • Hypomania Major Depression Dysthmia Feature Specifiers in Mood Disorders Bipolar Disorders Recent Episode and Pattern Features of manic or hypomanic • • Atypical episodes • Melancholic • General Facts and Statistics • Chronic • Catatonic –Catalepsy • Psychotic • Postpartum Specifiers Describing Course Mood Disorders: Facts and Prevalence & Pattern • Longitudinal Course • Fundamentally Similar in Children and Adults – Past Episodes of Depression or Mania – But looks different at different developmental stages • Rapid-Cycling • In the Elderly • Across cultures • Seasonal Pattern – Seasonal Affective Disorder (SAD) • Among the creative • Big overlap between anxiety & depression 4 Mood Disorders: Biological Causes Mood Disorders: Biological Causes Familial & Genetic Influences • Family Studies Sleep and Circadian Rhythms • Twin Studies Neurotransmitters Brain waves • Low levels of serotonin relative to norepinephrine & dopamine – Permissive Hypothesis Endocrine Function • Cortisol (stress hormone) • Dexamethasone Suppression Test (DST) Psychological Causes Social & Cultural Dimensions • Stressful Life Events • Learned Helplessness (Martin Seligman) • Marital disruption – Depressive Attributional Style • Internal • Stable • Gender–role stereotypes • Global • Negative Cognitive Styles • Social Support – Arbitrary inference – Overgeneralization – Beck’s Cognitive Triad • Negative Schema About Self, Immediate world, & Future Deadlier Side of Mood Disorders: Suicide Treatment of Mood Disorders Medications • Statistics in the United States • Tricyclic Antidepressants –Imipramine (Tofranil) • Risk Factors –Amitriptyline (Elavil) – Family history of suicide –Dangers of Desipramine – Extremely low levels of serotonin –Block neurotransmitter reuptake, (esp. norepinephrine) allowing them to pool in the synapse & eventually – Existing psychological disorders desensitize or down–regulate the transmission of that – Severe, stressful event that is experienced as shameful neurotransmitter or humiliating – Side Effects –Lethal if taken in excessive doses • MAO Inhibitors –Block Enzyme MonoAmine Oxidase –Side effects and complications 5 • SSRIs (Paxil, Zoloft, Prozac) • Herbal solutions –St. John’s Wort – Block presynaptic reuptake of serotonin • Pregnancy & nursing – Prozac (fluoxetine) • Lithium • Myths – Patients who don’t respond can take other mood • Side Effects stabilizers such as carbamezepine • Newest antidepressants Other Medical Treatments – Venlafaxine • Electroconvulsive Therapy (ECT) – Nefazodone • Transcranial magnetic stimuli • Psychological Interventions – Beck’s Cognitive Therapy – Interpersonal Psychotherapy •Teach clients to identify thought distortions & • Focuses on resolving problems in balance thoughts existing relationships & learning to form Underlying negative cognitive schemas are later • important new interpersonal relationships identified & modified •Socratic, team approach • Highly structured, 15-20 weekly •Thought records sessions •Homework • Identify life stressors precipitating the – Hypothesis testing depression – Activating activities • Work collaboratively on interpersonal •Activities of mastery •Pleasurable activities problems – Exercise 6.