mood disorder report 2013

MOOD DISORDER

REPORT BY:JANICE ROSS

INTRODUCTION :• Are syndromes whose predominant

feature is a disturbance in mood.

• The disturbance can take the form of mood that is abnormally low (depression) or abnormally high (mania).

Two key emotions on a continuum:

DepressionA Low, sad state marked by significant levels of sadness, lack of energy, low self worth, guilt, or related symptoms

ManiaA state or episode of euphoria or an exaggerated belief that the world is theirs for the taking.

Types of mood disorder

1.) DEPRESSIVE DISORDERS

A.)MAJOR DEPRESSIVE DISORDER B.)DYSTHYMIC DISORDER2. BIPOLAR DISORDERS

A.) BIPOLAR 1

B.) BIPOLAR 2

C.)CYCLOTHYMIC DISORDER

MOOD DISORDER EPISODES

MAJOR DEPRESSIVE EPISODE (MDE)

MANIC EPISODE

MIXED EPISODE

HYPO MANIC EPISODE

MAJOR DEPRESSIVE EPISODE

A period of at least 2 weeks (nearly every day) during which there is either depressed mood or the loss of interest or pleasure in nearly all activities. In children and adolescents, the mood may be irritable rather than sad.

Frequently presents with tearfulness, irritability, brooding, obsessive rumination, anxiety, phobias, excessive worry over physical health, and complaints of pain.

In extreme case, the episode may include psychotic symptoms, ones marked by a loss of contact with reality, such as delusions or hallucination.

Criteria for Major Depressive Episode

A). 5 (or more) of the following symptoms have been present during the same 2 week period and represent a change from previous functioning; and at least 1 symptom is either (1) depressed mood or (2) loss of interest or pleasure:

1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful)2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.3. Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.

3. Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.4. Insomnia or hypersomnia nearly every day.5. Psychomotor agitation or retardation nearly every day.6. Fatigue or loss of energy nearly every day.7. Feelings of worthlessness or excessive or inappropriate guilt nearly every day.8. Diminished ability to think or concentrate, or indecisiveness nearly every day.9. Recurrent thoughts of death, recurrent suicidal ideation without a plan, or a suicide attempt or a specific plan for committing suicide.

B.) The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C.) The symptoms are not due to the direct physiological effects of a substance or a general medical condition.

D.) The symptoms are not better accounted by Bereavement.

MANIC EPISODE

The elevated mood of a Manic Episode may be described as euphoric, unusually good, cheerful, or high. Although the person's mood may initially have an infectious quality for the uninvolved observer, it is recognized as excessive by those who know the person well.

Is a distinct period during which there is an abnormally and persistently elevated, expansive, or irritable mood. This period of abnormal mood must last at least 1 week (or less if hospitalization is required)

Case Study:First Manic Episode

Alexis was walking the street in a short red dress, fashion gloves, and jewelry. Her face was completely and overly made up with gaudy red lipstick. She was approaching men she didnt know, asking for a light and coming on to them sexually. An older man, concerned for her well-being,notified the police. In the psychiatric emergency room, she was fawning over the police officer, showing off her legs. She kept across the room to stike up coneversations with other-patients-the topics were inappropriate and flirtatious. Her energy had an edge. She kept asking when was she going to be seen, and “whats wrong with this joint that you can’t get served.

Given her disruptive behavior, the attending psychiatrist and the resident evaluated her immediately. During the interview, she told the resident he was hunk and asked him what he was doing later that night. Her speech was rapid and pressured , the doctors couldn’t get a question in edgewise, and whatever answer she gave were not to the question they asked.The answers attending physicians gave her a medication to calm her down until her parents could arrive. As it turns out, she had just maxed out her credit card buying all the clothes, makeup, and jewelry she was wearing. Her parents had called a missing persons report the previous evening and provided more information.Her drugs screen was negative, and there were no other medical reasons for her bizzare behavior.Her family history was positive for bipolar disorder, and this was admitted to the hospital and started a course of Lithium medication she also received psychoeducation about bipolar disorder and lithium and started to help her to adjust to living with her diagnosis.

CRITERIA FOR MANIC EPISODE

A). A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary).B). 3 (or more) symptoms (4 if the mood is only irritable):1. Inflated self-esteem or grandiosity2. Decreased need for sleep3. More talkative than usual or pressure to keep talking4. Flight of ideas or subjective experience that thoughts are racing5. Distractibility

6. Increase in goal-directed activity or psychomotor agitation7. Excessive involvement in pleasurable activities that have a high potential for painful consequencesC). The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitatehospitalization to prevent harm to self or others, or there are psychotic features.D). The symptoms are not due to the direct physiological effects of a substance or a general medical condition.

MIXED EPISODE A mixed episode is not a disorder itself, but rather is a description of a component of a specific type of bipolar disorder.

A Mixed Episode is characterized by a period oftime (lasting at least 1 week) in which the criteria are met both for a Manic Episode and for a Major Depressive Episode nearly every day.

Individuals may be disorganized in their thinking or behavior. Because individuals in Mixed Episodes experience more dysphoria than do those in Manic Episodes, they may be more likely to seek help.

CRITERIA FOR MIXED EPISODEA. The criteria are met both for a Manic Episode and for a

Major Depressive Episode (except for duration) nearly every dayduring at least a 1-week period.

B. The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activitiesor relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

C. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or othertreatment) or a general medical condition (e.g., hyperthyroidism).

HYPOMANIC EPISODE Distinct period during which there is an

abnormally and persistently elevated, expansive, or irritable mood lasting at

least 4 days

It is not a disorder , but rather is a description of a part of a type of bipolar II disorder. Hypomanic episodes have the same symptoms as manic episodes with two important differences: (1)the mood usually isn't severe enough to cause problems

with the person working or socializing with others or to require hospitalization.

(2) there are never any psychotic features present in a hypomanic episode.

Criteria for Hypomanic EpisodeA. distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual non depressed mood.B. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:

1. inflated self·esteem or grandiosity2. decreased need for sleep (e.g ., feels rested after only 3 hours of sleep)3. more talkative than usual or pressure to keep talking4. flight of ideas or subjective experience that thoughts are racing5. distractibility (i.e., attention too eaS ily drawn to unimportant or irrelevant external stimuli)

6. increase in goal·directed activity (either socially, at work or school, or sexually) or psychomotor agitation7.excessive involvement in pleasurable activities that have a high potent ial for painful consequences (e.g., the person engages in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

C.The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic.D. The disturbance in mood and the change in functioning are observable by others.E. The episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and t here are no psychotic features.F. The symptoms are not due to the direct physiological effects of a substance (e.g., adrug of abuse, a medication, or other treatment) or a general medical condition (e.g ., hyperthyroidism).

DEPRESSIVE DISORDERS

UNIPOLAR DISORDER)

MAJOR DEPRESSIVE DISORDER

A severe pattern of depression characterized by major depressive episodes.

Subtypes of Mdd

Depression with Melancholic Features Depression with Psychotic Features

Depression with Catatonic Features Depression with Atypical Features

Depression with Postpartum Onset

Depression with Seasonal Patterns

Major DepressionMDD, Single episode Absence of mania or hypomania

MDD, Recurrent 2 major depression episodes, separated by at least a 2 month period with more or less normal functioning/mood

Diagnostic criteria forMajor Depressive Disorder

Single EpisodeA. Presence of a single Major Depressive Episode

B. The Major Depressive Episode is not better accounted for by Schizoaffective Disorder and is not superimposed on Schizophrenia, Schizophreniform Disorder, DelusionalDisorder, or Psychotic Disorder Not Otherwise Specified.

C. There has never been a Manic Episode, a Mixed Episode or a Hypomanic Episode.

Note: This exclusion does not apply if all of the manic-like, mixed-like, or hypomanic-like episodes are substance or treatment induced or are due to the direct physiological effects of a general medical condition.

Recurrent Episode:A. Presence of two or more Major Depressive Episodes

Note: To be considered separate episodes, there must be an interval of at least2 consecutive months in which criteria are not met for a Major Depressive Episode.

B. The Major Depressive Episode is not better accounted for by Schizoaffective Disorder and is not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified

C. There has never been a Manic Episode, a Mixed Episode or a Hypomanic Episode

Major depressive disorder(Epidemiology)

Lifetime risk:10%-25% for women5%-12% for menGender distribution is: 2:1 W:M25% risk to first degree relatives

(Onset and Course)

Point prevalence:5%-10% for women2%-3% for men

Peak age of onset is late 20sAge range for onset is childhood to late lifeOnset may be sudden or gradual: - Gradual onset often includes weeks-months of subclinical symptoms - Acute onset usually follows within 6 months of a significant stressor50% of patients will experience a subsequent episodeRisk of recurrence increases with age and number of previous episodesAverage number of episodes is 450% recover within 6 months

Major Depressive Disorder(complications & co-morbidity)

15% lifetime suicide risk Depressive pseudodementia -cognitive deficits related to poor concentration and energy - resolves improvement in mood

Substance abuse Anxiety disorders

MDD Subtypes

Seasonal Affective Disorder (SAD)A type of depression that has a seasonal pattern.The episodes of depression tend to occur at the same time each year, usually during the winter.

Prevalence:Three out of four SAD sufferers are women. The main age of onset of SAD is between 18 and 30 years of age. SAD occurs in both the northern and southern hemispheres, but is extremely rare in those living within 30 degrees latitude of the equator. The severity of SAD depends both on a person’s vulnerability to the disorder and his or her geographical location.

Postpartum Depression (PPD)

Persistent and severe mood changes that occur (4weeks) after childbirth.In PDD, symptoms may last a year.

The symptoms are:-extreme sadness - anxiety - suicide-despair - intrusive thoughts-Tearfulness - compulsions- Insomia - panic attacks-feelings of innability to cope.

Women who experience PDD have a 25 to 50% chance of developing it again with subsequent births. A women with a family history of mood disorder appears to be at high risk, even if she herself has not previously had a mood disorder.

Dysthymic Disorder

A chronic pattern of mild depression

The symptoms are the same as those of major depression, but they are less severe.

dysthymia is the consistent persistence of depressed mood. lasts 2 or more years, and the individual is never without symptoms for more than 2 months.

DIAGNOSTIC CRITERIA FOR DYSTHYMIC DISORDER

DYSTHYMIC DISORDER At least 2 yrs. of depressed mood 2 or more vegetative symptomsLifetime risk = 6%; point prevalence = 3%Equal male/female prevalenceAge on onset similar to MDD

Dysthymic Disorder may be associated with Borderline, Histrionic, Narcissistic, Avoidant, and Dependent Personality Disorders. However, the assessment of features of a Personality Disorder is difficult in such individuals because chronic mood symptoms may contribute to interpersonal problems or be associated with distorted self-perception.

“Double Depression”

• Not a diagnosis• Meet diagnostic criteria for both

MDD and Dysthymic Disorder

BIPOLAR DISORDERS

Dramatic mood swings from overly “high” and/or irritable (mania) to sad and hopeless (depression) and possibly back again, often with periods of normal mood in between

There are many patterns of bipolar disorder: some people may have mixed symptoms of both mania and depression at the same time, while others may have more moderate symptoms of mania (hypomania).Some people have only one or two severe episodes of mood disorder while other people might have four or more episodes a year.

Bipolar Disorders: Three Forms

Bipolar IDisorder

Bipolar II Disorder

Cyclothymic disorder (Cyclothymia)

Bipolar I DisorderFull blown mania that alternates with episodes of major depression.

the depressions are as severe as major depressive episodes, whereas for others the episodes of depression are relatively mild and infrequent. Some people diagnosed with bipolar I disorder have mixed episodes in which they experience the full criteria for manic episodes and major depressive episodes in the same day, every day for at least 1 week.

Diagnostic Criteria for Bipolar I1. The presence of a manic, or major depressive episode.2. If currently in a hypomanic or depressive episode, history of a manic episode.3. Significant distress or impairment.

Bipolar II Disorder

A type of bipolar disorder marked by mildly manic (hypomanic) episodes and major depressive episodes. Some people with this pattern accomplish huge amounts of work during their manic periods.

Diagnostic Criteria for Bipolar II

1. The presence of a hypomanic, or major depressive episode.2. If currently in a major depressive episode, history of a hypomanic episode. If currently in a hypomanic episode, history of major depressive episode. No history of manic episode3. Significant distress or impairment.

Bipolar I and II

(Course and Onset)a. Peak age of onset is in 20sb. Age range for onset is from teens to 60sc. Symptoms tend to progress rapidly (i.e., a few days)

from pleasantly elevated mood at onset to euphoria to irritability to psychosis. Some cases progress to catatonia.

d. Episodes are often triggered by physical or psychosocial stressors

e. Episodes are often (60%) preceded or followed immediately by a depressive episode

f. >90% of patients have recurrent episodesg. 70-80% of patients return to full function between

episodes; 20-30% have persistent mood instability or functional impairment

h. Episodes occur every 2-3 years for patients in their 20s, gradually increasing in frequency to 1-2 episodes per year for patients in their 50s

Bipolar I and II

Complications:

10-15% lifetime suicide riskSubstance abuse is commonEpidemiology

Lifetime prevalence is 1% of the general adult population Gender distribution is 1:1 Monozygotic twins show ~80% concurrence 25% risk to first-degree relatives Lifetime prevalence is 0.5% (bipolar II)

complications and epidemiology

CYCLOTHYMIC Disorder Cyclothymic Disorder is a chronic, fluctuating mood disturbance involving numerous periods of hypomanic symptoms and numerous periods of depressive symptoms

lasting for 2 years.Individuals with cyclothymic disorder alternate between mild depressive symptoms and hypomanic episodes. However, the chronically fluctuating mood states are, by definition, substantial enough to interfere with functioning. Furthermore, people with cyclothymia should be treated because of their increased risk to develop the more severe bipolar I or bipolar II disorder.

Diagnostic criteria for CYCLOTHYMIC Disorder

A. For at least 2 years, the presence of numerous periods with hypomanic symptoms and numerous periods with depressive symptoms that do not meet criteria for a Major Depressive Episode. Note: In chi ldren and adolescents, the duration must be at least 1 year.B. During the above 2-year period (1 year in children and adolescents), the person hasnot been without the symptoms in Criterion A for more than 2 months at a time.C. No Major Depressive Episode, Manic Episode,or Mixed Episode has been present during the first 2 years of the disturbance.

Note: After the initial 2 years (1 year in children and adolescents) of Cyclothymic Disorder, there may be superimposed Manic or Mixed Episodes (in which case both Bipolar I Disorder and Cyclothymic Disorder may be diagnosed) or Major Depressive Episodes (in which case both Bipolar II Disorder and Cyclothymic Disorder may be diagnosed).D. The symptoms in Criterion A are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.E. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism).F. The symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning.

Cyclothymic Disorder Chronic fluctuating mood not meeting

criteria for manic or major depressive episodes

Insidious onset in adolescence or young adulthood followed by chronic course

50% risk of eventual development of bipolar I or bipolar II disorder

Lifetime prevalence is 0.4-1% Treatment is the same as major

depressive disorder and bipolar I disorder

Major Depressive Disorder:Treatment basics

Medications: Selective serotonin reuptake inhibitors

(SSRIs) Tricyclic antidepressants (TCAs) Monoamine oxidase inhibitors (MAOIs) Other: venlafaxine, mirtazapine, nefazodone,

bupropion Psychotherapy:

Cognitive-behavioral therapy (CBT) Interpersonal therapy (IPT) Psychodynamic psychotherapy (e.g.,

psychoanalysis) Other

Electroconvulsive therapy (ECT) Light therapy – primarily for SAD rTMS – currently being investigated

Major Depressive Disorder:Medications

Treatment choice based on: Severity Side effect profile Risk of overdose Other diagnoses (e.g., anxiety) Family history of treatment response

If psychosis is present, this must be treated

Medications may take up to 6 (8? 12?) weeks to be maximally effective

Efficacy 60%-80% overall (50%-60% for each)

Major Depressive Disorder:Psychotherapy

Good evidence for efficacy of CBT and IPT; less for psychodynamic

Psychotherapy may be just as effective as medications in mild-moderate illness

Combination of medications and psychotherapy may be better than either alone

Major Depressive Disorder:Electroconvulsive therapy

(ECT) Up to 80%-90% remission rate with 8-12

treatments; less in tx-resistant depression Up to 50%-80% relapse within 6 months Side effects: transient cognitive problems,

headaches, fatigue Also effective for mania, catatonia May be first line for certain populations

(e.g., medically ill, intensely suicidal, catatonic, pregnancy)

Medication vs. Psychological Treatment of Major Depressive Disorder

NIMH Treatment of Depression Collaborative Research Program (Elkin et al., 1985)» Cognitive therapy vs. Interpersonal Therapy vs.

mediation (imipramine)– Medication more effective than psychotherapy early

in treatment– With less severe MDD, placebo as effective as all

other treatments– With more severe MDD, imipramine more effective

than all other treatments IPT, but not CT more effective than placebo

Later studies (Hollon & DeRubeis, 2003)» CT as effective as medication for severe depression» CT more effective than medication at preventing

relapse

Bipolar Disorders:Treatment basics

Established mood stabilizers are first-line treatment throughout illness: Lithium Valproate Carbamazepine?? Olanzapine?? Lamotrigine??

Combination therapy often required Treatment should continue to prevent

future episodes

Bipolar Disorders:Treatment of manic or mixed

episode Most common choices include:

Lithium (may be preferable in euphoric episode)

Valproate (may be preferable in mixed episode) Olanzapine

If psychosis is present, mood stabilizer often combined with antipsychotic

Use adjunctive treatments as necessary: Benzodiazepines, seclusion and restraint, sleep

aids ECT can be effective

Bipolar Disorders:Treatment of depression

DIFFICULT TO TREAT Optimize mood stabilizer therapy first Lamotrigine has specific efficacy for

bipolar depression May combine mood stabilizers or add

antidepressants, BUT Antidepressants may cause switch into

mania TCAs have highest switch rate Largely unknown risk with other

antidepressants

Bipolar Disorders:

Chronic illness, typically with multiple episodes over lifetime

Major cause of distress and disability (depressive episodes >> manic or hypomanic episodes)

Chronic mood stabilizer therapy can reduce number and severity of episodes over time

BUT Up to 15% of patients will kill

themselves

Etiology

ETIOLOGY OF DEPRESSIVE DISORDER

Stress may be a trigger for depression

People with depression experience a greater number of stressful life events during the month just before the onset of their symptoms

Some clinicians distinguish reactive (exogenous) depression from endogenous depression, which seems to be a response to internal factors

►Today’s clinicians usually concentrate on recognizing both the situational and the internal aspects of any given case


Genetic factors Family pedigree, twin, adoption, and molecular biology gene studies suggest that some people inherit a biological predisposition

Researchers have found that as many as 20% of relatives of those with depression are themselves depressed, compared with fewer than 10% of the general populationTwin studies demonstrate a strong genetic component:

► Concordance rates for identical (MZ) twins = 46% ► Concordance rates for fraternal (DZ) twins = 20%

Adoption studies also have implicated a genetic factor in cases of severe unipolar depression Using techniques from the field of molecular biology, researchers have found evidence that unipolar depression may be tied to specific genes


Biochemical factors

NTs: serotonin and norepinephrine ► In the 1950s, medications for high blood pressure were found to cause depression

► Some lowered serotonin, others lowered norepinephrine

► The discovery of truly effective antidepressant medications, which relieved depression by increasing either serotonin or norepinephrine, confirmed the NT role

► Depression likely involves not just serotonin nor norepinephrine… a complex interaction is at work, and other NTs may be involved

Depressive Disorder Etiology

Biochemical factors Endocrine system / hormone release

► People with depression have been found to have abnormal levels of cortisol

► Released by the adrenal glands during times of stress

► People with depression have been found to have abnormal melatonin secretion

► “Dracula hormone”

► Other researchers are investigating whether deficiencies of important proteins within neurons are tied to depression

Depressive Disorder Etiology

Biochemical factors

Model has produced much enthusiasm but has certain limitations:

► Relies on analogue studies: depression-like symptoms created in lab animals

► Measuring brain activity has been difficult and indirect

► Current studies using modern technology are attempting to address this issue

Depressive Disorder Etiology Brain anatomy and brain circuits

Biological researchers have determined that emotional reactions of various kinds are tied to brain circuits

► These are networks of brain structures that work together, triggering each other into action and producing a particular kind of emotional reaction

► It appears that one circuit is tied to GAD, another to panic disorder, and yet another to OCD

Although research is far from complete, a circuit responsible for unipolar depression has begun to emerge

► Likely brain areas in the circuit include the prefrontal cortex, hippocampus, amygdala, and Brodmann’s Area 25


Psychological Perspective

Three main models:

Psychodynamic model► No strong research support

Behavioral model► Modest research support

Cognitive views► Considerable research support


Psychological PerspectivePsychodynamic view

Link between depression and grief► When a loved one dies, an unconscious process begins and the mourner regresses to the oral stage and experiences introjection – a merging of his/her own identity with that of the lost person

► For most people, introjection is temporary► If grief is severe and long-lasting, depression results► Those with oral stage issues (unmet or excessively met needs) are at greater risk for developing depression

► Some people experience “symbolic” (or imagined) loss► Newer psychoanalysts (object relations theorists) propose that depression results when people’s relationships leave them feeling unsafe and insecure


Psychological Perspective Psychodynamic view

Strengths:► Studies have offered general support for the psychodynamic idea that depression may be triggered by a major loss (e.g., anaclitic depression)

► Research supports the theory that early losses set the stage for later depression

► Research also suggests that people whose childhood needs were improperly met are more likely to become depressed after experiencing a loss


Psychological Perspective Psychodynamic view

Limitations:► Early losses and inadequate parenting don’t inevitably lead to depression and may not be typically responsible for development of depression

► Many research findings are inconsistent

► Certain features of the model are nearly impossible to test



Behavioral view Depression results from changes in rewards and punishments people receive in their lives

► Lewinsohn suggests that the positive rewards in life dwindle for some people, leading them to perform fewer and fewer constructive behaviors, and they spiral toward depression

Research supports the relationship between the number of rewards received and the presence or absence of depression

► Social rewards are especially important



Behavioral viewStrengths:

► Researchers have compiled significant data to support this theory

Limitations:► Research has relied heavily on the self-reports of depressed subjects

► Behavioral studies are largely correlational and do not establish that decreases in rewards are the initial cause of depression



Cognitive views Two main theories:

► Negative thinking

► Learned helplessness



Cognitive views

2. This negative thinking typically takes three forms, called the cognitive triad:► Individuals repeatedly interpret (1) their experiences, (2) themselves, and (3) their futures in negative ways, leading to depression


Psychological Perspective Cognitive views

Negative thinking► Beck theorizes four interrelated cognitive components combine to produce unipolar depression:

1. Maladaptive attitudes

Self-defeating attitudes are developed during childhood

Beck suggests that upsetting situations later in life can trigger an extended round of negative thinking



Negative thinking

3. Depressed people also make errors in their thinking, including:

► Arbitrary inferences

► Minimization of the positive and magnification of the negative

4. Depressed people experience automatic thoughts

► A steady train of unpleasant thoughts that suggest inadequacy and hopelessness



Strengths:► There is significant research support for Beck’s model:

High correlation between the level of depression and the number of maladaptive attitudes

Both the cognitive triad and errors in logic are seen in people with depression

Automatic thinking has been linked to depression

Limitations:► Research fails to show that such cognitive patterns are the cause and core of unipolar depression



Cognitive views

Learned helplessness ► Theory asserts that 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

ETIOLOGY OF DEPRESSIVE DISORDERPsychological Perspective

Cognitive views Learned helplessness

► Theory is based on Seligman’s work with laboratory dogs

Dogs subjected to uncontrollable shock were later placed in a shuttle box

Even when presented with an opportunity to escape, dogs that had experienced uncontrollable shocks made no attempt to do so

Seligman theorized that the dogs had “learned” to be “helpless” to do anything to change negative situations, and drew parallels to human depression



Learned helplessness ► There has been significant research support for this model

Human subjects who undergo helplessness training score higher on depression scales and demonstrate passivity in laboratory trials

Animal subjects lose interest in sex and social activities

In rats, uncontrollable negative events result in lower serotonin and norepinephrine levels in the brain



Learned helplessness ► Recent versions of the theory focus on attributions

Internal attributions that are global and stable lead to greater feelings of helplessness and possibly depression

Example: “It’s all my fault” [internal]. “I ruin everything I touch” [global] “and I always will” [stable].

If people make other kinds of attributions, this reaction is unlikely

Example: “She had a role in this also” [external], “the way I’ve behaved the past couple weeks blew this relationship” [specific]. “I don’t know what got into me – I don’t usually act like that” [unstable].

Cognitive viewsLearned helplessness

Some theorists have refined the helplessness model yet again in recent years; they suggest that attributions are likely to cause depression only when they further produce a sense of hopelessness in an individual





Learned helplessness ► Strengths:

Hundreds of studies have supported the relationship between styles of attribution, helplessness, and depression

► Limitations: Laboratory helplessness does not parallel depression in every way Much of the research relies on animal subjects The attributional component of the theory raises particularly difficult questions in terms of animal models of depression


Sociocultural Views Sociocultural theorists propose that unipolar depression is greatly influenced by the social context that surrounds people

This belief is supported by the finding that depression is often triggered by outside stressors

There are two kinds of sociocultural views:

►The family-social perspective

►The multicultural perspective


Sociocultural Views The Family-Social Perspective

The connection between declining social rewards and depression (as discussed by the behaviorists) is a two-way street

► Depressed people often display social deficits that make other people uncomfortable and may cause them to avoid the depressed individuals

► This leads to decreased social contact and a further deterioration of social skills


Sociocultural Views The Family-Social Perspective

Consistent with these findings, depression has been tied repeatedly to the unavailability of social support such as that found in a happy marriage

► People who are separated or divorced display three times the depression rate of married or widowed persons and double the rate of people who have never been married

► There also is a high correlation between level of marital conflict and degree of sadness that is particularly strong among those who are clinically depressed


Sociocultural Views The Multicultural Perspective

Two kinds of relationships have captured the interest of multicultural theorists:

► Gender and depression

A strong link exists between gender and depression

Women cross-culturally are twice as likely as men to receive a diagnosis of unipolar depression

Women also appear to be younger, have more frequent and longer-lasting bouts, and to respond less successfully to treatment



Various theories have been offered:

► The artifact theory holds that women and men are equally prone to depression, but that clinicians often fail to detect depression in men

► The hormone explanation holds that hormone changes trigger depression in many women

► The life stress theory suggests that women in our society experience more stress than men



Various theories have been offered:► The body dissatisfaction theory state that females in Western society are taught, almost from birth, to seek a low body weight and slender body shape – goals that are unreasonable, unhealthy, and often unattainable

► The lack-of-control theory picks up the learned helplessness research and argues that women may be more prone to depression because they feel less control than men over their lives


Sociocultural Views

The Multicultural Perspective

Various theories have been offered:

►The self-blame explanation holds that women are more likely than men to blame their failures on lack of ability and to attribute their successes to luck – an attribution style that has been linked depression

► The rumination theory holds that people who ruminate when sad – keep focusing on their feelings and repeatedly consider the causes and consequences of their depression – are more likely to become depressed and stay depressed longer


Sociocultural Views

The Multicultural Perspective Each explanation offers food for thought and has gathered just enough supporting evidence to make it interesting (and just enough contrary evidence to raise question about its usefulness)


Sociocultural Views

The Multicultural Perspective Two kinds of relationships have captured the interest of multicultural theorists:

► Cultural background and depression

Depression is a worldwide phenomenon, and certain symptoms seem to be constant across all countries, including sadness, joylessness, anxiety, tension, lack of energy, loss of interest, and thoughts of suicide

Beyond such core symptoms, research suggests that the precise picture of depression varies from country to country



Depressed people in non-Western countries are more likely to be troubled by physical symptoms of depression than by cognitive ones

As countries become more Westernized, depression seems to take on the more cognitive character it has in the West



Within the United States, researchers have found few differences in depression symptoms among members of different ethnic or racial groups, however, sometimes striking differences exist in specific populations living under special circumstances

► In a study of one Native American village, lifetime risk was 37% among women, 19% among men, and 28% overall

► These findings are thought to be the result of economic and social pressures

Bipolar Disorders Etiology

Throughout the first half of the 20th century, the search for the cause of bipolar disorders made little progress

More recently, biological research has produced some promising clues

These insights have come from research into NT activity, ion activity, brain structure, and genetic factors

Bipolar Disorders Etiology► Neurotransmitters

≈After finding a relationship between low norepinephrine and unipolar depression, early researchers expected to find a link between high norepinephrine levels and mania

≈This theory is supported by some research studies; bipolar disorders may be related to over activity of norepinephrine


Neurotransmitters► Because serotonin activity often

parallels norepinephrine activity in unipolar depression, theorists expected that mania would also be related to high serotonin activity

► Although no relationship with HIGH serotonin has been found, bipolar disorder may be linked to LOW serotonin activity, which seems contradictory…

Neurotransmitters ► This apparent contradiction is

addressed by the “permissive theory” about mood disorders:

►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



Ion activity► Ions, which are needed to send incoming messages to nerve endings, may be improperly transported through the cells of individuals with bipolar disorder

►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)

► There is some research support for this theory


Brain structure

► Brain imaging and postmortem studies have identified a number of abnormal brain structures in people with bipolar disorder; in particular, the basal ganglia and cerebellum among others

► It is not clear what role such structural abnormalities play


Genetic factors► Many experts believe that people inherit a biological predisposition to develop bipolar disorders

► Family pedigree studies support this theory; when one twin or sibling has bipolar disorder, the likelihood for the other twin or sibling increases:

► Identical (MZ) twins = 40% likelihood

► Fraternal (DZ) twins and siblings = 5% to 10% likelihood

► General population = 1 to 2.6% likelihood

Bipolar Disorders Etiology Genetic factors

Recently, genetic linkage studies have examined the possibility of “faulty” genes

► Other researchers are using techniques from molecular biology to further examine genetic patterns

► Such wide-ranging findings suggest that a number of genetic abnormalities probably combine to help bring about bipolar disorders

mood disorder report 2013

Education

irritable mood

mood disorderreport

depressed mood or2 loss

periodof abnormal mood

types of mood disorder1

loss of energy

retardation nearlyevery

major depressive episodea