Mood Disorders

An Overview of Mood Disorders Chapter 7 • Gross Deviations in Mood • 2 Fundamental states: Depression & Mania • Depression: “The Low” – Major Depressive Episode Mood Disorders •The most commonly diagnosed & most severe depression •Depressed (or in children, irritable) mood state that lasts at least 2 weeks –Cognitive symptoms •Feelings of worthlessness or inappropriate guilt •Diminished ability to concentrate or indecisiveness – Dysthymic Disorder –Disturbed physical functions (vegetative symptoms) (central to the disorder) •Insomnia or hypersomnia nearly every day •Significant weight loss or gain or change in appetite •Fatigue or loss of energy nearly every day •Psychomotor agitation or retardation –Nearly always accompanied by markedly diminished interest or ability to experience pleasure (anhedonia) from life • Average duration if untreated: 9 months •Similar symptoms to Major Depressive Episode, but milder –Also fewer symptoms: need only 2 of the symptoms, as opposed to 5 in Major Depressive Episode •A persistently depressed (or, in children & adolescents, irritable) mood that continues for at least 2 years –During those 2 years, the individual has never been without the symptoms for more than 2 months at a time •Most people with Dysthymia eventually experience a major depressive episode • Mania: “The High” –Abnormally exaggerated elation, joy, or euphoria OR irritability (common toward the end of the episode) lasting at least 1 week –Cognitive symptoms •Inflated self–esteem or grandiosity •Flight of ideas (too many ideas at once)/ racing thoughts •Distractibility –Physical symptoms •Decreased need for sleep –Behavioral symptoms •More talkative / pressured speech •Psychomotor agitation or increase in goal–directed activity •Excessive involvement in pleasurable activities with a high potential for painful consequences –Average duration if untreated: 3 to 6 months 1 • Hypomanic episode –Less severe version of a manic episode –Does not cause marked impairment in social or occupation functioning Mania Depression The Structure of Mood Disorders • Unipolar Mood Disorder – Either Depression or Mania • Bipolar Mood Disorder – Alternates Between Depression and Mania – Somewhat misleading term • An individual can experience manic • Important to Determine the Course – Temporal Patterning of the Episodes – Important to prevent future episodes, not just relieve current symptoms symptoms but feel depressed or anxious at the same time –Dysphoric Manic or Mixed Episode The Nature of Mood Disorders • Depressive Disorders – Major Depressive Disorder – Dysthymic Disorder – Double Depression Major Depressive Disorder Clinical Description • Major Depressive Episode • No Manic or Hypomanic Episodes • Single episode or Recurrent • Bipolar Disorders – Bipolar I and Bipolar II Disorders – Cyclothymic Disorder 2 Weeks or More Facts and Statistics 2 Dysthymia Clinical Description Double Depression Clinical Description Dysthymia Dysthymia 2 Years or More Major Depression Facts and Statistics Bereavement • Normal grief reaction – Presents with some symptoms characteristic of Major Depressive Episode • Sadness • Insomnia • Poor appetite • Weight loss • Pathological grief reaction / Impacted grief reaction – Bereavement is considered a disorder only if: • Symptoms are still present 2 months after the loss • Or there are severe symptoms, e.g., psychotic features or suicidal ideation Bipolar Disorders Major Features • Experience Both –Manic Episodes –Major Depressive Episodes •Prominent Symptoms: –Intrusive memories & distressingly strong yearnings for the loved one –Avoiding people or places that are reminders of the loved one •Treatment –Help the individual re-experience the trauma under close supervision •Prevention –Mourning rituals Bipolar Disorders: Bipolar I Clinical Description • Major Depressive Episodes alternate with Mania • Full Manic Episodes • “Roller coaster ride from peaks of elation to depths of despair” Major Depression 3 Bipolar Disorders: Bipolar II Clinical Description • Major Depressive Episodes alternate with • Hypomanic Episodes Bipolar Disorders: Cyclothymia Clinical Description •Dysthymic Episodes alternate with Hypomania •Hypomanic Episodes Major Depression Bipolar Disorders • Features of manic or hypomanic episodes • General Facts and Statistics Specifiers Describing Course & Pattern • Longitudinal Course – Past Episodes of Depression or Mania • Rapid-Cycling • Seasonal Pattern – Seasonal Affective Disorder (SAD) Hypomania Dysthmia Feature Specifiers in Mood Disorders Recent Episode and Pattern • • • • Atypical Melancholic Chronic Catatonic –Catalepsy • Psychotic • Postpartum Mood Disorders: Facts and Prevalence • Fundamentally Similar in Children and Adults – But looks different at different developmental stages • In the Elderly • Across cultures • Among the creative • Big overlap between anxiety & depression 4 Mood Disorders: Biological Causes Mood Disorders: Biological Causes Familial & Genetic Influences • Family Studies • Twin Studies Neurotransmitters Sleep and Circadian Rhythms Brain waves • Low levels of serotonin relative to norepinephrine & dopamine – Permissive Hypothesis Endocrine Function • Cortisol (stress hormone) • Dexamethasone Suppression Test (DST) Psychological Causes Social & Cultural Dimensions • Stressful Life Events • Learned Helplessness (Martin Seligman) – Depressive Attributional Style • Internal • Stable • Global • Marital disruption • Gender–role stereotypes • Negative Cognitive Styles – Arbitrary inference • Social Support – Overgeneralization – Beck’s Cognitive Triad • Negative Schema About Self, Immediate world, & Future Deadlier Side of Mood Disorders: Suicide • Statistics in the United States • Risk Factors – Family history of suicide – Extremely low levels of serotonin – Existing psychological disorders – Severe, stressful event that is experienced as shameful or humiliating Treatment of Mood Disorders Medications • Tricyclic Antidepressants – Imipramine (Tofranil) – Amitriptyline (Elavil) – Dangers of Desipramine – Block neurotransmitter reuptake, (esp. norepinephrine) allowing them to pool in the synapse & eventually desensitize or down–regulate the transmission of that neurotransmitter – Side Effects – Lethal if taken in excessive doses • MAO Inhibitors – Block Enzyme MonoAmine Oxidase – Side effects and complications 5 • SSRIs (Paxil, Zoloft, Prozac) • Herbal solutions – Block presynaptic reuptake of serotonin • Pregnancy & nursing • Lithium – Prozac (fluoxetine) • Myths • Side Effects • Newest antidepressants – Venlafaxine – Nefazodone • –St. John’s Wort – Patients who don’t respond can take other mood stabilizers such as carbamezepine Other Medical Treatments • Electroconvulsive Therapy (ECT) • Transcranial magnetic stimuli Psychological Interventions – Beck’s Cognitive Therapy •Teach clients to identify thought distortions & balance thoughts •Underlying negative cognitive schemas are later identified & modified •Socratic, team approach •Thought records •Homework – Hypothesis testing – Activating activities •Activities of mastery •Pleasurable activities – Exercise – Interpersonal Psychotherapy • Focuses on resolving problems in existing relationships & learning to form important new interpersonal relationships • Highly structured, 15-20 weekly sessions • Identify life stressors precipitating the depression • Work collaboratively on interpersonal problems 6