Mood Disorders

Major Depressive Disorder

Five or more symptoms present for two weeks or more:

Disturbed Mood depressed mood

anhedonia (reduced interest or pleasure)

Disturbed Cognitive Functions trouble concentrating

feelings of worthlessness

thoughts of death / suicide

Major Depressive Disorder

Disturbed Physical (vegetative) Functions weight loss / gain

sleep problems

psychomotor disturbance

lack of energy

Major Depressive Disorder

How long does depression last if untreated? 4 to 9 months

90% chance gone in 5 years

Are men or women more likely to be depressed? women are twice as likely as men to have major

depression

Gender differences in depression

Cultural effects: gender roles encourage mastery in males, dependence in females

the way in which a person responds to the onset of a depressed mood

rumination vs. distraction

Depression across the lifespan:

rate of depression rises dramatically in adolescence

average age of onset 25 - 29

depression closely related to anxiety - almost all depressed patients are also anxious

Persistent Depressive Disorder (Dysthymia)

Dysthymic Disorder: symptoms of major depression are milder

but remain unchanged for at least two years

can last 20 – 30 years – median duration of 5 years

79% with dysthymia have had a major depressive episode

Double Depression: both major depressive disorder and

dysthymia

Seasonal Affective Disorder

(SAD)

depressive episode begins in the fall and ends with beginning of spring

more common in northern climates

Phototherapy – exposure to bright light

Grief

Acute

Integrated

Complicated

Suicide

11th leading cause of death in the US

more common among Caucasians than African Americans and Hispanics

higher rates among the elderly than other groups.

women are 3 times more likely to attempt suicide

males are 4 to 5 times more likely to commit suicide

Importance of Assessment

Suicidal desire – Ideation

Suicidal capability – Past attempts

Suicidal intent - Plan

Risk & Protective Factors

Biological Theory and Treatment

• low levels of serotonin and norepinephrine

• permissive hypothesis: when serotonin levels are low, other neurotransmitters can range more widely

Anti-depressants

tricyclic - prevents reuptake of norepinephrine and serotonin (e.g., Imipramine, Amitriptyline)

SSRI - (selective serotonin reuptake

inhibitor) blocks the reuptake of serotonin (e.g., Prozac)

MAO inhibitors - elevate level of norepinephrine and serotonin by blocking deactivating enzyme (e.g., Nardil)

Electroconvulsive Therapy (ECT):

shock is delivered to the brain

transcranial magnetic stimulation:magnetic coil delivers electromagnetic

pulse to the brain.

Cognitive Theories and Treatment

Depressive Cognitive Triad (Beck, 1967):

1) self

2) world

3) future

Interpersonal Psychotherapy (IPT)

Depression stems from problems in relationships.

We develop cyclical maladaptive patterns (CMPs) of relating to others from our interaction with others.

These patterns get played out in adult relationships including with the therapist.

Therapy seeks to identify and treat these CMPs.

Efficacy of Psychological Treatment of Mood

Disorders

CBT and IPT Outcomes

Comparison with medications

Bipolar and Related Disorders

http://www.youtube.com/watch?v=R87GfrbXQmU

Bipolar and Related Disorders

Manic Episode: period of abnormally elevated mood (at least one week)inflated self-esteem

decreased need for sleep

extremely talkative

racing thoughts

distractible

increase in goal-directed activity and/or pleasurable activities

Types

Bipolar I: At least one manic episode. Often alternate manic episodes with major depressive episodes.

Bipolar II: alternate hypomanic episodes with major depressive episodes

Cyclothymia: at least two years – periods of hypomania and depressive symptoms

Specifiers

Rapid cycling : at least four manic or depressive episodes within a year

Mixed episode : criteria met for both a manic episode and major depressive episode for at least a week

Medications for Bipolar Disorder

lithium bicarbonate

anticonvulsants (e.g.,depakote, lamictal)