Chapter 14

1. Chapter 14 Depression and Suicidal Behavior

2. Range of Emotions • A person with a mood disorder experiences emotions that are extreme and, therefore, abnormal.

3. Major Depression: An Overview • Major depressive episode: Overview and defining features • Extremely depressed mood lasting at least two weeks • Cognitive symptoms – feelings of worthlessness, indecisiveness • Disturbed physical functioning (sleep and eating) • Anhedonia – loss of pleasure/interest in usual activities

4. Major Depression: An Overview • Major depressive disorder • Single episode – highly unusual • Recurrent episodes (2 or more major depressive episodes separated by at least 2 months of no depression) – more common • From grief to depression • Pathological or impacted grief reaction

5. Major Depression: An Overview Mean age is 30 3-5% of children and adolescents Typical first episode is 4-9 months if untreated Females outnumber males in MDD by age 14

6. Mood Disorders: Familial and Genetic Influences • Family studies • Rate is high in first-degree relatives (2-3 x greater) • Twin studies • Concordance rates are high in identical twins (2-3 x) • Severe mood disorders have strong genetic influence • Heritability rates are higher for females compared to males; 40% women and 20% men for depression

7. Mood Disorders: Neurobiological Influences • Neurotransmitter systems • Low Serotonin and its relation to other neurotransmitters causes mood disorders • Permissive hypothesis – when serotonin is low, other neurotransmitters are “permitted” to become dysregulated

8. Learned Helplessness Learned helplessness (LH)- Lack of perceived control over life events • LH and a depressive attributional style • Internal attributions • Negative outcomes are one’s own fault • Stable attributions • Believing future negative outcomes will be one’s fault • Global attribution • Believing negative events will disrupt many life activities

9. Beck’s Cognitive Theory • Negative coping styles • Types of cognitive errors • Arbitrary inference – overemphasize the negative • Overgeneralization – negatives apply to all situations • Magnification • Minimization • catastrophizing

10. Cognitive distortions • All-or-nothing thinking (splitting) – Conception in absolute terms, like "always", "every", "never", and "there is no alternative". (See also "false dilemma" or "false dichotomy".) • Overgeneralization – Extrapolating limited experiences and evidence to broad generalizations. (See also faulty generalization and misleading vividness.) • Magical thinking - Expectation of specific outcomes based on performance of unrelated acts or utterances. (See also wishful thinking.) • Mental filter (arbitrary inference)– Inability to view positive or negative features of an experience, for example, noticing only a tiny imperfection in a piece of otherwise useful clothing. • Disqualifying the positive – Discounting positive experiences for arbitrary, ad hoc reasons. • Jumping to conclusions – Reaching conclusions (usually negative) from little (if any) evidence. Two specific subtypes are also identified: • Mind reading – Sense of access to special knowledge of the intentions or thoughts of others. • Fortune telling – Inflexible expectations for how things will turn out before they happen. • Magnification and minimization – Magnifying or minimizing a memory or situation such that they no longer correspond to objective reality. This is common enough in the normal population to popularize idioms such as "make a mountain out of a molehill." In depressed clients, often the positive characteristics of other people are exaggerated and negative characteristics are understated. There is one subtype of magnification: Catastrophizing – Inability to foresee anything other than the worst possible outcome, however unlikely, or experiencing a situation as unbearable or impossible when it is just uncomfortable. • Emotional reasoning – Experiencing reality as a reflection of emotions, e.g. "I feel it, therefore it must be true." • Should statements – Patterns of thought which imply the way things "should" or "ought" to be rather than the actual situation the person is faced with, or having rigid rules which the person believes will "always apply" no matter what the circumstances are. Albert Ellis termed this "Musturbation". • Labeling and mislabeling – Limited thinking about behaviors or events due to reliance on names; related to overgeneralization. Rather than describing the specific behavior, the person assigns a label to someone or himself that implies absolute and unalterable terms. Mislabeling involves describing an event with language that is highly colored and emotionally loaded. • Personalization – Attribution of personal responsibility (or causal role or blame) for events over which a person has no control

11. Treatment of Mood Disorders: Selective Serotonergic Reuptake Inhibitors (SSRIs) • Specifically block reuptake of serotonin • Fluoxetine (Prozac) is the most popular SSRI • SSRIs pose some risk of suicide particularly in teenagers • Negative side effects

12. Psychosocial Treatments • Cognitive-behavioral therapy • Addresses cognitive errors in thinking • Also includes behavioral components

13. The Nature of Suicide: Facts and Statistics • 11th leading cause of death in the United States- maybe two to three times higher • Overwhelmingly a white and Native American phenomenon Suicidal ideation - thinking seriously about suicide Suicidal plan – formulation of a specific method Completed suicide Accidents leading cause of death in adolescents 15 to 24. parasuicide– person survives; same as attempted

14. The Nature of Suicide: Facts and Statistics • Gender differences • Males are more successful at committing suicide than females • Females attempt suicide more often than males

15. The Nature of Suicide: Risk Factors • Risk factors • Suicide in the family • Sudden changes in behavior • Giving away possessions • Preexisting psychological disorder • Alcohol use and abuse • Stressful life event • Past suicidal behavior • Suicide contagion • Treatment • Take all suicide threats and attempts seriously • Seek to reestablish communication • Provide emotional support