1. Mood
Disorders

2. 33 Happy Moments Write 33 Happy Moments!
Background of “33 Happy Moments”
Chin Shengt'an's Thirty Three Happy Moments (17th century), "moments when the spirit is inextricably tied up with the senses." (Supposedly written while Chin was stuck in a temple for 10 days due to rain.)
Referred to in Lin Yutang’s The importance of living (1937) in which Lin describes happiness as “sensuous” – meaning coming from the senses. And that we recognize that we must enjoy/honor the senses throughout our lives (30,000 mornings).
Relate this to Kathe’s talk

3. The continuums of Mood Disorders
Unipolar - Bipolar
Chronic - Acute
Agitated – Slow
Neurotic – Psychotic

4. Depression symptoms Diagnostic Exercise
What are the symptoms and diagnosis?
Case studies on the video clips
VHS -- Program 8 (Mood Disorders)
Faces DVD

5. Depression symptoms Cognitive Physiological and Behavioral Emotional
Poor concentration, indecisiveness, poor self-esteem, hopelessness, suicidal thoughts, delusions, memory problems
Physiological and Behavioral
Sleep or appetite disturbances, psychomotor problems, fatigue,
Emotional
Sadness,anhedonia (loss of interest or pleasure in usual activities), irritability

6. Severity and diagnosis
Major Depression
Dysthymic Disorder
5 or more symptoms including sadness or loss of interest or pleasure
3 or more symptoms including depressed mood
At least 2 weeks in duration
At least 2 years in duration
Number of symptoms
Duration

7. Depressive Disorders Double Depression Clinical Description Dysthymia
Major
Depression

8. Feature Specifiers in Mood Disorders
Melancholic
Occurs within Major Depressive Episode
Near-complete absence of the capacity for pleasure
Strong biological component (e.g., psychomotor retardation; early morning awakening; significant anorexia)

9. Postpartum Onset Onset within four weeks following birth
Spontaneous crying long after the usual duration of “baby blues” (3-7 days postpartum)
Lability of mood -- can be of a psychotic nature
Suicidal ideation

10. Seasonal Pattern SAD Episodes during certain seasons (usually winter)
Typically characterized by anergy, hypersomnia, overeating, weight gain, and a craving for carbos

11. Bipolar Disorders Major Features Experience Both
Manic Episodes
Major Depressive Episodes
Roller Coaster of Mood

12. Bipolar Disorders Mania and Hypomania Elevated Mood
Decreased need for sleep
Grandiosity
Increased Activity
More talkative

13. Causes of Mood Disorders
Biological
Psychological
Socio-cultural

14. Biological Factors in Mood Disorders
Genetic contribution (heritable vulnerability in mood disorders). Example: Bipolar

15. Biological Factors in Mood Disorders
Neurotransmitters
Monoamines – Dopamine, Norepinephrine, Serotonin
Evidence
Reserpine (hypotensive agent)  breakdown of monoamine storage in vesicles  depression
Antidepressants work on increasing MAs
MAO Inhibitors
SSRIs
Decreased CSF levels of 5-HIAA in patients with severe depression (and in completed suicides, post-mortem analysis)

16. Biological Factors in Mood Disorders
Endocrine Factors
Stress and its neurochemical impacts
Chronic glucocorticoid exposure  monoamine depletion & hippocampal cell atrophy (memory dysfunction)

17. Biological Factors in Mood Disorders
Brain factors
Activity in the multi-nodal depression “circuit” (i.e., connections between and among the PFC, nucleus accumbens, overactive anterior cingulate cortex [Cg25])
Deep Brain Stimulation for Treatment-Resistant Depression Helen S. Mayberg, Andres M. Lozano, Valerie Voon, Heather E. McNeely, David Seminowicz, Clement Hamani, Jason M. Schwalb, and Sidney H. Kennedy Neuron, Vol 45, , 03 March 2005

18. Biological Factors (in concert with behavioral factors) in Mood Disorders
Brain factors
Effort-driven Rewards Center
Nucleus accumbens-striatum-PFC (emotion-movement-thinking)
Lifestyle-depression link (hypothesis regarding increasing depression with decreasing effort / use of our hands)

19. Mood Disorders: Psychological Causes Stressful Life Events
Learned Helplessness
Rumination
Attributional Style / Negative cognitions
Internal (“I blew it”)
Stable (“I’ll blow it again”)
Global (“”I blow it in tons of situations”)

20. Socio-cultural Causes
Mood Disorders:
Socio-cultural Causes
CD Article (neighborhood characteristics)

21. Social-cultural support

22. Treatments for Mood Disorders
Men get depression DVD clips (treatment section)

23. Biological Treatments for Mood Disorders
Medication (prescribed and herbal)
Electroconvulsive therapy (ECT)
Repetitive transcranial magnetic stimulation
Vagus nerve stimulation
DBS
Light therapy
Exercise

24.                                              
See “Manufacturing Depression”

25. Treatment of Mood Disorders Medications Tricyclic Antidepressants
MAOI’s
SSRI’s
Herbal (e.g., St. John’s Wort)
Lithium
Anti-convulsants

26. Psychological Treatments for Depression
Behavioral Therapy
Increase positive reinforcers and decrease aversive events by teaching the person new skills for managing interpersonal situations and the environment
Cognitive-Behavioral Therapy
Challenge distorted thinking and help the person learn more adaptive ways of thinking and new behavioral skills
Interpersonal
Existential
Psychodynamic Therapy
Help the person gain insight to unconscious factors to facilitate change in self-concept and behaviors

27. Cycle of Psychological Treatments
The risk of suicide and life interference can be reduced by shortening the duration of MDEs with effective acute-phase treatments, including pharmacotherapy, interpersonal psychotherapy, and cognitive–behavioral therapy . We define acute-phase treatments as those applied during an MDE with the goal of reducing depressive symptoms and producing initial remission. Responders to some acute-phase treatments (e.g., CT) may receive some protection from relapse–recurrence , but prevalent relapse–recurrence after successful antidepressant treatments has long been recognized as a serious limitation of these interventions Consequently, continuation-phase treatments (e.g., pharmacotherapy, interpersonal psychotherapy, CT) may be applied to sustain remission of an MDE and reduce the probability of relapse–recurrence. Continuation-phase treatments can match the “modality” used in the acute phase or differ in modality compared with the acute-phase treatment (e.g., acute-phase pharmacotherapy followed by C-CT
Vittengl et al., JCCP, Vol 75(3), Jun pp