Chapter 7 Mood Disorders and Suicide

1. Chapter 7Mood Disorders and Suicide

2. An Overview of Depression and Mania • Mood Disorders • “Depressive disorders” • “Affective disorders” • “Depressive neuroses” • Gross deviations in mood • Depression • Mania

3. An Overview of Depression • Major depressive episode • Extreme depression • 2 weeks • Cognitive symptoms • Physical dysfunction • Anhedonia • Duration - 4 to 9 months, untreated

4. An Overview of Mania • Manic episode • Exaggerated elation, joy, euphoria • 1 week, or less • Cognitive symptoms • Physical dysfunction • Duration – 3 to 6 months, untreated • Hypomanic episode

5. Structure of Mood Disorders • Unipolar disorders • Depression or mania alone • Typically depression • Bipolar disorders • Depression and mania • Mixed episodes

6. Structure of Mood Disorders • Diagnostic considerations • Accompanying symptoms • Overlap between disorders • Severity • Course • Recurrent • Alternating • Seasonal

7. Depressive Disorders: An Overview • Major Depressive Disorder • No mania/hypomania • Single episode • Rare • Recurrent • 4 episodes (lifetime) • Duration – 4 to 5 months

8. Major Depressive Disorder • Onset • Low until early teens • Mean age = 30

9. Depressive Disorders: An Overview • Dysthymic Disorder • Milder symptoms • 2+ years • Chronic • Persistent

10. Dysthymic Disorder • Onset = early 20’s • Early onset = before 21 • Greater chronicity • Poor prognosis • Stronger familial component • Median duration = 5 years • Depends on comorbidity

11. Dysthymic Disorder

12. Depressive Disorders: An Overview • Double Depression • Major depressive episodes and dysthymic disorder • Dysthymia first • Severe psychopathology • Poor course • High recurrence rates

13. Grief and Depression • Depression frequently follows loss • 62% after death • Pathological or Complicated Grief • Severity of symptoms • Dysfunction • Persistence of symptoms

14. Bipolar I Disorder: An Overview • Alternating major depressive and manic episodes • Single manic episode • Recurrent • Symptom free for 2 months

15. Bipolar I Disorder: An Overview • Statistics • Onset = age 18 • Childhood • Chronic • Suicide

16. Bipolar II Disorder • Alternating major depressive and hypomanic episodes • Statistics • Onset = age 19 to 22 • Childhood • Chronic

17. Cyclothymic Disorder • Alternating manic and depressive episodes • Less severe • Persists longer • Chronic symptoms • Adults = 2+ years • children and adolescents= 1+ year

18. Cyclothymic Disorder • Statistics • Onset = age 12 or 14 • Chronic • Lifelong • Female>Male • Risks for Bipolar I/II

19. Additional Defining Criteria • Symptom Specifiers • Atypical • Melancholic • Chronic • Catatonic • Psychotic • Mood congruent/ incongruent • Postpartum

20. Additional Defining Criteria

21. Additional Defining Criteria • Course Specifiers • Longitudinal course • Rapid cycling pattern • Seasonal pattern • Depression vs. mania • Melatonin • Phototherapy • CBT

22. Prevalence of Mood Disorders

23. Prevalence of Mood Disorders • Children and Adolescents • Similar to adults • Symptom presentations • Prevalence • Early childhood • Adolescence • Misdiagnosis • ADHD • Conduct disorder

24. Prevalence of Mood Disorders • Elderly • Prevalence may depend on setting • Symptom profile • Female : Male = 1:1 • Diagnostic difficulty • Comorbidities

25. Prevalence of Mood Disorders • Across Cultures • Similar prevalence among US subcultures • Exceptions • Physical or somatic symptoms • Comparability

26. Prevalence of Mood Disorders • Among the creative • Higher prevalence • Melancholia • Mania • Gender differences

27. Overlap of Anxiety and Depression • More alike than different • Almost all depressed persons are anxious • Not all anxious persons are depressed • Negative affect • Core symptoms of depression • Anhedonia • Slowing • Negative cognitions

28. Causes of Mood Disorders : Biological • Familial and Genetic Influences • Family Studies • Adoption Studies • Twin Studies • Bipolar • Unipolar • Higher concordance with higher severity • Higher heritability for females

29. Causes of Mood Disorders : Biological

30. Depression and Anxiety: The Same Genes? • Shared genetic vulnerability • High familial heritability • Same genetic factors • General predisposition • Except mania?

31. Causes of Mood Disorders : Biological • Neurotransmitter Systems • Serotonin - depression • The “permissive” hypothesis • Dopamine • Norepinephrine • Dopamine - mania

32. Causes of Mood Disorders : Biological • Endocrine System • “Stress hypothesis” • Overactive HPA axis • Neurohormones • Elevated cortisol • Suppressed hippocampal neurogenesis • Dexamethasone suppression test (DST)

33. Causes of Mood Disorders : Biological • Sleep and Circadian Rhythms • REM sleep • Reduced latency • Increased intensity • Decreased slow wave sleep • Sleep deprivation effects

34. Causes of Mood Disorders : Biological • Brain Wave Activity • Indicator of vulnerability? • Greater right side anterior activation • Less alpha wave activity

35. Causes of Mood Disorders : Psychological • Stressful life events • Context • Meaning • Timing • Effects of stress • Poorer treatment response • Delayed remission • Trigger for episode or relapse

36. Causes of Mood Disorders : Stress • Reciprocal-gene environment model • Stress triggers depression • Depressed individuals create or seek out stressful situations • Interaction with vulnerability • Genetic • Psychological

37. Causes of Mood Disorders : Psychological • Learned Helplessness (Seligman) • Lack of perceived control • Depressive Attributional Style • Internal • Stable • Global • Also characterizes anxiety

38. Causes of Mood Disorders : Psychological • Sense of hopelessness • Lack of perceived control • Will not regain control • Pessimism • Before or after?

39. Causes of Mood Disorders : Psychological • Negative Cognitive Styles • Cognitive Theory of Depression (Beck) • Cognitive errors in depression • Negative interpretations • Types of Cognitive Errors • Arbitrary inference • Overgeneralization

40. Causes of Mood Disorders : Psychological • Beck’s Depressive Cognitive Triad

41. Causes of Mood Disorders : Psychological • Cognitive Theory of Depression (Beck) • Negative schemas • Automatic thoughts • Treatment implications • Correcting the errors

42. Causes of Mood Disorders : Psychological • Cognitive Vulnerability for Depression • Pessimistic explanatory style • Negative cognitions • Hopelessness attributions • Interactions with: • Biological vulnerabilities • Stressful life events

43. Mood Disorders: Social and Cultural Dimensions • Marriage and Interpersonal Relationships • Relationship disruption precedes depression • Strongest effects for males • Martial conflict vs. marital support • Gender differences in causal direction

44. Mood Disorders: Social and Cultural Dimensions • Mood Disorders in Women • Prevalence: Females > males • True for all mood disorders • Except bipolar

45. Mood Disorders: Social and Cultural Dimensions • Mood Disorders in Women • Gender roles • Perceptions of uncontrollability • Socialization • Access to resources

46. Mood Disorders: Social and Cultural Dimensions • Social Support • Related to depression • Lack of support • predicts late onset depression • Substantial support • predicts recovery for depression (not mania)

47. Integrative Theory of Mood Disorders • Shared biological vulnerability • Psychological vulnerability • Exposure to Stress • Social and interpersonal relationships

48. Integrative Theory of Mood Disorders

49. Treatment of Mood Disorders • Changing the chemistry of the brain • Medications • ECT • Psychological treatment

50. Treatment : Antidepressant Medications • Tricyclics (Tofranil, Elavil) • Frequently used for severe depression • Block reuptake/down regulate • Norepinephrine • Serotonin • 2 to 8 weeks to work • Many negative side effects • Lethality