Disorders of Mood

1. Disorders of Mood Chapter 6

2. 2 key emotions: Depression: Low, sad state in which life seems dark; its challenges overwhelming; no history of mania Mania: State of breathless euphoria or frenzied energy Depression Mania Disorders of Mood

3. “Depression” often used to describe general sadness or unhappiness Clinical depression can bring severe and long-lasting psychological pain that may intensify as time goes by Unipolar Depression

4. Around 8% of adults in any given year As many as 5% suffer from mild forms Around 19% of all adults at some time in their lives Higher among poor Onset: any age How Common Is Unipolar Depression?

5. Women are at least twice as likely as men to experience severe unipolar depression Lifetime prevalence: 26% of women vs. 12% of men Among children, the prevalence is similar among boys and girls How Common Is Unipolar Depression?

6. Criteria for a Major Depressive Episode

7. Major depressive disorder major depressive episode with no history of mania Persistent Depressive Disorder (Dysthymic disorder) longer-lasting (at least two years) but less disabling pattern of depression DSM-5 lists several types of depressive disorders:

8. Premenstrual dysphoric disorder repeatedly experience clinically significant depressive symptoms during the week before menstruation Disruptive mood regulation disorder (children) Characterized by a combination of persistent depressive symptoms and recurrent outbursts of severe temper DSM-5 lists several types of depressive disorders:

9. Stress: trigger for depression Those diagnosed experience a greater number of stressful life events during the month just before the onset of symptoms loss of a loved one, serious threats to important relationships or one’s occupations, severe economic or health problems, events involving humiliation. Minor events may play more of a role in the onset of recurrent episodes than in the initial episode. Stress and Unipolar Depression

10. Twin, adoption, and gene studies suggest that some people inherit a biological predisposition as many as 20% of relatives are depressed, compared with fewer than 10% of the general population Concordance rates for identical (MZ) twins = 46% Concordance rates for fraternal (DZ) twins = 20% May be tied to specific genes (Serotonin-transporter gene) Genetic factors

11. Biochemical factors serotonin and norepinephrine Depression likely involves not just serotonin nor norepinephrine; a complicated interaction is at work, and others may be involved Biological Model

12. Endocrine system / hormone release abnormal levels of cortisol abnormal melatonin secretion deficiencies of important proteins within neurons as tied to depression Biological Model

13. Brain anatomy and brain circuits Emotional reactions of various kinds are tied to brain circuits Likely brain areas include the prefrontal cortex, hippocampus, amygdala, and Brodmann Area 25 Biological Model

14. Immune System When stressed, the immune system may become dysregulated, which some believe may help produce depression Biological Model

15. Usually biological treatment means antidepressant drugs: Monoamine oxidase inhibitors (MAO inhibitors) Tricyclics Second-generation antidepressants SSRI’s- selective serotonin reuptake inhibitors SSNRI’s - selective serotonin norepinephrine reuptake inhibitors What Are the Biological Treatments for Unipolar Depression?

18. Electroconvulsive therapy (ECT) controversial procedure consists of targeted electrical stimulation to cause a brain seizure ~ 6 to 12 sessions spaced over 2 - 4 weeks What Are the Biological Treatments for Unipolar Depression?

19. Brain stimulation Vagus nerve stimulation Transcranial magnetic stimulation Deep brain stimulation What Are the Biological Treatments for Unipolar Depression?

20. Three main models: Psychodynamic model No strong research support Behavioral model Modest research support Cognitive views Considerable research support Psychological Models

21. Learned helplessness - asserts people become depressed when they think that: They no longer have control over the reinforcements (rewards and punishments) in their lives They themselves are responsible for this helpless state Cognitive model

22. Learned helplessness Theory is based on Seligman’s work with laboratory dogs Psychological Models

23. Learned helplessness Attributions: internal/external, global/specific, stable/unstable. Pessimistic attributional style associated with depression. Cognitive model

24. Others suggest attributions lead to depression when they produce a sense of hopelessness one has no control over what will happen and something bad will happen. Internal/external dimension not important. Likely negative consequences will occur and negative inferences about the implication of the event for the self-concept. Cognitive model

25. Beck theorizes four interrelated cognitive components combine to produce unipolar depression: Maladaptive attitudes Cognitive triad Cognitive Distortions Automatic thoughts Beck: Negative thinking

26. Negative Cognitive Triad

27. Cognitive Distortions

28. Beck’s cognitive therapy–designed to help clients recognize and change their negative cognitive processes Increasing activities and elevating mood Challenging automatic thoughts Identifying negative thinking and biases Changing primary attitudes Cognitive modelBeck: Negative thinking

29. Sociocultural theorists propose that depression is greatly influenced by social context that surrounds people family-social perspective multicultural perspective Sociocultural Model

30. Interpersonal therapy (IPT) 4 interpersonal problems depression Interpersonal loss Interpersonal role dispute Interpersonal role transition Interpersonal deficits Sociocultural Model

31. Gender and depression Artifact theory Hormone explanation Life stress theory Body dissatisfaction explanation Lack-of-control theory Rumination theory Sociocultural Model

32. People with a bipolar disorder experience both the lows of depression and the highs of mania Many describe their lives as an emotional roller coaster Bipolar Disorders

33. Criteria for Mania

34. Criteria for Hypomania

35. Bipolar Disorders I and II

36. ~1% and 2.6% adults Equally common in women and men Onset usually occurs between 15 and 44 (~22 years) Diagnosing Bipolar Disorders

37. Cyclothymic Disorder

38. Manic-Depressive Spectrum .

39. Neurotransmitters Overactivity of norepinephrine What Causes Bipolar Disorders?

40. Serotonin: “Permissive theory” May be linked to low serotonin activity: Low serotonin may “open the door” to a mood disorder and permit norepinephrine activity to define the particular form the disorder will take: Low serotonin + Low norepinephrine = Depression Low serotonin + High norepinephrine = Mania What Causes Bipolar Disorders?

41. Ion activity Some theorists believe that irregularities in the transport of these ions may cause neurons to fire too easily (mania) or to stubbornly resist firing (depression) What Causes Bipolar Disorders?

42. Brain structure Basal ganglia and cerebellum Not clear what structural abnormalities play What Causes Bipolar Disorders?

43. Genetic factors Identical (MZ) twins = 40% likelihood Fraternal (DZ) twins and siblings = 5% to 10% likelihood General population = 1 to 2.6% likelihood What Causes Bipolar Disorders?

44. Pharmacotherapy .

45. Do not fully understand how mood stabilizing drugs operate Psychotherapy alone rarely helpful Mood stabilizing drugs alone are not always sufficient 30% or more of patients don’t respond, may not receive the correct dose, and/or may relapse while taking it Treatments for Bipolar Disorder:

46. Rates of Mood Disorders in Writers and Artistshttp://www2.sunysuffolk.edu/hanauej/Abnormal/Web%20pages/manic-depression%20and%20creativity.pdf .