Mood Disorders

Major Depressive Disorder  Five or more symptoms present for two weeks or more:  Disturbed Mood  depressed mood  anhedonia (reduced interest or pleasure)  Disturbed Cognitive Functions  trouble concentrating  feelings of worthlessness  thoughts of death / suicide

Major Depressive Disorder  Disturbed Physical (vegetative) Functions  weight loss / gain  sleep problems  psychomotor disturbance  lack of energy

Major Depressive Disorder  How long does depression last if untreated?  4 to 9 months  90% chance gone in 5 years  Are men or women more likely to be depressed?  women are twice as likely as men to have major depression

Gender differences in depression  Cultural effects: gender roles encourage mastery in males, dependence in females  the way in which a person responds to the onset of a depressed mood  rumination vs. distraction

Depression across the lifespan:  rate of depression rises dramatically in adolescence  average age of onset  depression closely related to anxiety - almost all depressed patients are also anxious

Persistent Depressive Disorder (Dysthymia)  Dysthymic Disorder:  symptoms of major depression are milder but remain unchanged for at least two years  can last 20 – 30 years – median duration of 5 years  79% with dysthymia have had a major depressive episode  Double Depression:  both major depressive disorder and dysthymia

Seasonal Affective Disorder (SAD)  depressive episode begins in the fall and ends with beginning of spring  more common in northern climates  Phototherapy – exposure to bright light

Grief  Acute  Integrated  Complicated

Suicide  11th leading cause of death in the US  more common among Caucasians than African Americans and Hispanics  higher rates among the elderly than other groups.  women are 3 times more likely to attempt suicide  males are 4 to 5 times more likely to commit suicide

Importance of Assessment  Suicidal desire – Ideation  Suicidal capability – Past attempts  Suicidal intent - Plan

Risk & Protective Factors

Biological Theory and Treatment low levels of serotonin and norepinephrine permissive hypothesis : when serotonin levels are low, other neurotransmitters can range more widely

Anti-depressants  tricyclic - prevents reuptake of norepinephrine and serotonin (e.g., Imipramine, Amitriptyline)  SSRI - (selective serotonin reuptake inhibitor) blocks the reuptake of serotonin (e.g., Prozac)  MAO inhibitors - elevate level of norepinephrine and serotonin by blocking deactivating enzyme (e.g., Nardil)

Electroconvulsive Therapy (ECT):  shock is delivered to the brain  transcranial magnetic stimulation:  magnetic coil delivers electromagnetic pulse to the brain.

Cognitive Theories and Treatment  Depressive Cognitive Triad (Beck, 1967): 1) self 2) world 3) future

Interpersonal Psychotherapy (IPT)  Depression stems from problems in relationships.  We develop cyclical maladaptive patterns (CMPs) of relating to others from our interaction with others.  These patterns get played out in adult relationships including with the therapist.  Therapy seeks to identify and treat these CMPs.

Efficacy of Psychological Treatment of Mood Disorders  CBT and IPT Outcomes  Comparison with medications

Bipolar and Related Disorders

Bipolar and Related Disorders  Manic Episode: period of abnormally elevated mood (at least one week)  inflated self-esteem  decreased need for sleep  extremely talkative  racing thoughts  distractible  increase in goal-directed activity and/or pleasurable activities

Types  Bipolar I: At least one manic episode. Often alternate manic episodes with major depressive episodes.  Bipolar II: alternate hypomanic episodes with major depressive episodes  Cyclothymia: at least two years – periods of hypomania and depressive symptoms

Specifiers  Rapid cycling : at least four manic or depressive episodes within a year  Mixed episode : criteria met for both a manic episode and major depressive episode for at least a week

Medications for Bipolar Disorder  lithium bicarbonate  anticonvulsants (e.g.,depakote, lamictal)