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Mood Disorders

Mood Disorders. Mood Disorders. Involve severe and enduring disturbances in emotionality Range from elation to severe depression Depression Bipolar Disorder. Mental Health Resources at UD. Center for Counseling and Student Development 831-2141 Psychological Services Training Center

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Mood Disorders

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  1. Mood Disorders

  2. Mood Disorders • Involve severe and enduring disturbances in emotionality • Range from elation to severe depression • Depression • Bipolar Disorder

  3. Mental Health Resources at UD • Center for Counseling and Student Development • 831-2141 • Psychological Services Training Center • 831-2717 (Sliding scale) • Delaware Help Line • 1-800-464-HELP

  4. Mood Disorders Overview • Symptoms, onset, prevalence (Depression, Bipolar) • Causes (Depression, Bipolar) • Suicidality • Treatment of Depression • Treatment of Bipolar

  5. Depressive Disorders • There are several types: • Major depression • Dysthymia • Double depression • Seasonal Affective Disorder • Postpartum Depression • Childhood Depression

  6. Depressed Mood (Irritable in children) Decreased interest in activities Weight or appetite changes Sleep changes Psychomotor agitation or retardation Fatigue/loss of energy Feelings of worthlessness or excessive guilt Concentration problems Thoughts of death, suicide, or suicide attempt Distress or impairment Not associated grief Symptoms of Major Depression

  7. Onset and Duration • Age of onset = 25 years • Avg episode length = 6 months • Recurrent, especially w/ early onset (50, 70, 90) • Median # of episodes = 4 • Most no treatment • Earlier onset = poorer prognosis, more chronicity, worse response to treatment

  8. Gender Differences • Equal among boys and girls • 2:1 women • 25% female lifetime prevalence (12% male)

  9. Historical Changes • Depression in youth increased 10x (2 generations) • Age of onset is decreasing • 25% of those aged 18-29 one episode (2003) • Symptoms vary by age and culture

  10. Cultural Differences • African American rates similar to Caucasian • Asian Americans lowest rates • 0.8% report lifetime prevalence • 0.8% dysthymia • Less common among recently immigrated Hispanics vs. Hispanic Americans (who have rates similar to Caucasians) • Can cope better? Stress of immigration?

  11. Dysthymia • Chronic (2 years) • Same symptoms, but less severe (but still debilitating) • Entire life • Lifetime prevalence 6% • Few seek treatment • Personality?

  12. Seasonal Affective Disorder • Develops in late fall/early winter • Remits in spring • Prevalence = 3% • Length of day/avg temp? • Iceland low (expect high) • Changes in hormone with seasons? • Melatonin up in winter

  13. Postpartum Depression • During first few weeks post-delivery • (not postpartum blues - 50-80%) • Massive hormone change as trigger? • Other hormone changes similar • Oral contraceptives, puberty, menopause

  14. Childhood Depression • Occurring more frequently & earlier • Is this the same as adult depression? • Different cognitive/emotional development • Gender rates equal until teens • Symptom patterns look different, not as “obvious” • Predictive of adult depression

  15. When Depression is Not Depression • Bereavement (not diagnosed up to 2 months) • Adjustment disorders • Medical conditions • “Depression due to a general medical condition” • Everyone experiences normal sadness • Difficulty coping, interferences with daily activities

  16. What is Bipolar Disorder? • Experience of mania • Excessive energy • Decreased need for sleep • Rapid speech (pressured speech) & movement • Impulsive and/or dangerous behavior • Spending sprees, investments • Unsafe sexual behavior • Hypomania = less severe mania

  17. What is Bipolar Disorder? • Extreme shifts between mania & depression (days to months) • Lifetime prevalence = 1% - 5% • Equal rates across gender, culture • Early onset = more severe & more chronic

  18. Bipolar Disorder • Avg age onset 18 (I) and 22 (II) • 50% patients ill before age 30 (25% by 20) • Course is unpredictable • Diagnosis is often delayed • 10-15% of patients commit suicide • 20-50% will attempt at some point

  19. Bipolar Disorder in Children • Irritability, emotional swings • More chronic (not episodic) • Often misdiagnosed (ADHD, Conduct Disorder)

  20. Causes of Depression and Bipolar Disorder

  21. Biological Dimensions Psychological Dimensions Social and Cultural Dimensions Integrative Theory Causes of Depression

  22. Familial and Genetic Influences • 36-44% heritable women, 18-24% men (major depression) • Stronger genetic influences bipolar

  23. Familial and Genetic Influences • Certain pattern most genetic, depression: • Early age of onset • Greater number of episodes • Long longest episode • More impairment • Suicidality • Probably polygenic

  24. Neurotransmitter Systems • Low relative levels of serotonin • Serotonin = regulation of emotional reactions • Indirect evidence • Metabolites of serotonin & norepinephrine lower • Drugs increasing serotonin help • Drugs decreasing serotonin ruin the effects of antidepressants • Receptors abnormal (PET)

  25. Neuroendocrine Influences • Hormonal diseases can = depression • E.g. Hypothyroidism • Cortisol (stress hormone) is elevated • May not be specific to depression • Hormones likely associated with post-partum depression

  26. Circadian Rythyms & Sleep Disturbances • Excess vs. lack • Falling asleep, waking up, early waking • Circadian rythym: Our normal daily pattern of biological changes (hormones)

  27. How do depressed people sleep? • Shortened REM latency (quick) • Sooner, longer, more intense • Expense: deep sleep • Energy restoring

  28. Sleep of Nondepressed Individuals

  29. Sleep for Depressed

  30. Sleep Disturbances • Early awakening an early marker? • General poor sleepers? • Influence treatment? • Sleep as predictor • Reduced REM latency more pronounced in absence of stressful life event • A biological process that can bring on depression alone?

  31. Psychological Perspectives on Depression • Stressful Life Events • Learned Helplessness • Negative Cognitive Styles • Behavioral Approaches

  32. Stressful Life Events • Strongly related to onset • 80% of depressive episodes, in community samples, preceded by event • Stronger predictor initial episode • Poorer response to treatment • Longer recovery • Increased chance recurrence

  33. Stressful Life Events • Relationship breakup • 10x increase over twin • Humiliation • 20x increase in depressive episode than a twin with same genes, but no event

  34. Learned Helplessness Model • Seligman’s dogs • Learned helplessness: depression as a result of aversive situations which we cannot control • Or, attributions of lack of control

  35. Learned Helplessness Model • Attributions: • Internal/external • Global/specific • Stable/unstable • Worst combination: • Internal + global + stable • “It is all my fault, always. Additional bad things will always be my fault”

  36. Cognitive Model (Beck) • Development of depression • How do we think about ourselves? • How do we think about the world?

  37. Cognitive triad (Self, World, Future) Self Future World

  38. Cognitive Model (Beck) • Depression = interpreting many events in negative ways • Cognitive errors • Overgeneralization • Arbitrary influence

  39. Cognitive Model (Some Examples) • Normal disappointments are unbearable • I am deficient, especially at handling stress that other people can handle • My future is hopeless. My stress will never end and there is nothing I can do to help

  40. The Behavioral Component • Behaviors reinforce/maintain depressive feelings • E.g. withdraw from society b/c depression leaves people with little energy • BUT withdrawing from society minimizes chance they will experience fun and feel better • A cycle -> behaviors maintain symptoms

  41. Social and Cultural Influences • Marital Relations • Gender Differences • Social Support

  42. Marital Relations • Strongly related to depression • Marriage seems to have greater impact on men’s depression • Depression may erode relationships

  43. Gender Differences • 70% of individuals with depression are women • Consistent across cultures • Uncontrollability, due to socialization? • Differences in rumination • Social disadvantages

  44. Social Support • Major buffer • Brown et al: of women experiencing a stressful event, only 10% of those who became depressed had a confidante • Faster recovery

  45. Causes of Bipolar Disorder • Biological Dimensions • Psychological Dimensions • Social and Cultural Dimensions • Integrative Theory

  46. Familial and Genetic Influences • Stronger genetic than depression • Risk in 1st degree relatives 10x general pop. • Attempts to isolate genes unsuccessful

  47. Neurotransmitters • Depression = low levels serotonin & NP • Mania = high levels of NP • Lithium reduces NP • No evidence serotonin is involved

  48. Sleep and Circadian Rhythms • Bipolar patients show sensitivity to light • More suppression of melatonin when exposed to light at night • Regulates sleep • Insomnia can trigger manic episodes

  49. Stressful Life Events • Also strong relationship • Especially early mania • Can also prevent recovery • Upward spiral of positive events • Severe will trigger for 50% • Disrupted social interactions worst

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