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Mood Disorders I. DEPRESSION Symptoms: 5+ over 2 weeks • sadness • guilt/remorse/worthlessness • suicidal thoughts • anhedonia (lack of pleasure) • fatigue/lethargy • sleep/appetite change • psychomotor retardation/agitation • impaired cognition (eg, concentration, memory) Many mimicking illnesses - Fatigue/slowness (schizophrenia) use own reaction - Cognition (Alzheimer’s) medications Dysthymia - low-grade depression • 2+ years • Can still function • Feel bad (sleep/appetite, hopelessness, fatigue, concentration, self-esteem) Possible Causes Psychodynamic Theory = “Anger in” • Anger at others (loss) turned inward • New model = excess focus on negative aspects of self Cognitive • Cognitive errors & helplessness • Triad: self, world, future vs.: Depressive realism Humanistic = lack of identity/purpose • when not living authentically, life loses meaning • From lack of unconditional positive regard Learning/Behavioral • Lack of adequate reinforcers - Lose reinforcers -> depression - Depression -> reduce other reinforcers - Friends pull back, reducing reinforcement Biological 1.Genetic basis (diathesis-stress) 2.Deficiency of 1+ neurotransmitter(s) • “catecholamine” & “indolamine” H1s (norepinephrine) (serotonin) • Treatment = increase Explanation is inadequate • Neurotransmitters interact • Difference in time to increase vs. to not feel depressed Current = “permissive hypothesis" • Serotonin regulates other neurotransmitters • Low serotonin = other neurotransmitters fluctuate more widely Integrative Theory Biological Vulnerability Psychological Vulnerability/Poor Coping Stressful Life Event Biological Activate hormones w/effects on neurotransmitters Cognitive Negative attributions Cognitive errors Hopelessness Mood Disorder Social Interpersonal problems & poor social support Treatment General • High recovery rate, even w/o treatment • 6-18 months Exercise - link between regular exercise & reduction in depression • Increase endorphins? • Increase personal mastery? Psychotherapy • Provides support • Helps make changes - Uncover anger towards others - See own interaction style - Find meaning & pleasure • Therapy -> most lasting effects Antidepressant Medication • Extremely effective • 2-3 weeks for effects • May have to try several • Likely relapse if just medication Increase SE, NE, DA • MAOIs = monoamine oxydase inhibitors - prevent breakdown of SE, NE, DA • Tricyclics - block reuptake of SE, & esp. NE • SSRIs = selective serotonin-reuptake inhibitors - block reuptake of SE • Current: use SSRIs & other new drugs • MAOIs: toxicity => dietary restrictions • Tricyclics = danger of overdose Electroconvulsive Therapy (ECT) • Last resort • Can work dramatically • Induces seizure • Memory loss, but usually transient II. Bipolar Disorder Description - “Manic-depressive illness” Mania • Euphoric or irritable mood 3+ over 1 week • Inflated self-esteem - even psychotic • Less sleep (high energy, restless) • Talkative: speech = rapid, pressured, loud • Thoughts: “flight of ideas”; clang assocs • Distractible • Agitation or goal-directed behavior • Judgment: poor, low inhibitions (sex, spending, gambling, reckless driving) Cyclothymic Disorder = cycles of dysthymia & hypomania Hypomania • High energy, low sleep • Good leaders/high achievers usually lifelong • Considered “moody,” “high-strung” • Bipolar I = mania +/- depression • Bipolar II = hypomania + depression - impulsivity & poor judgment Misdiagnosis • Mania is hard to sustain -> irritability - Like unipolar depression • Psychotic aspect => schizophrenia? • Also, some bipolars respond to antipsychotic medication To distinguish bipolar from schizophrenia 1.Bipolar = periods of normal fx & depression Schizophrenia = chronic, gradually deteriorating 2.Bipolar = gregarious Schizophrenia = solitary Possible Causes Psychodynamic • Mania as defense mechanism • Depression = superego overworking • Mania counterbalances low self-esteem of depression • Superego (depression) & ego (mania) shift dominance of personality Biological - strong genetic basis • Risk is for general mood disorder not necessarily Bipolar Disorder • Requires environmental precipitant • Excess of norepinephrine? • Insomnia may trigger manic episodes -> bodily (circadian) rhythms involved Treatment Medication - Lithium carbonate • Therapeutic level is close to toxic level • SSRIs can induce mania Problems 1.Mania can feel good -> quit medication -> deny illness & not seek treatment 2.Sometimes responds to antipsychotics -> increases misdiagnosis • • • • Psychotherapy Treat interpersonal/practical problems Insure adherence to lithium Psychotherapy alone not tested • • • • Good effects of psychotherapy + lithium Family tx + lithium 56% recovered Lithium alone 20% recovered Goals = reduce inter-family conflict, increase support & appropriate behavior III. SUICIDE Myth or reality? 1. People who threaten won’t really do it 2. People commit suicide when they are at the bottom of depression 3. Talking about suicide can give them the idea 4.People who attempt suicide are crazy 5.People who commit suicide really want to die 6.People who attempt suicide just want attention Risk Factors Sex • More women attempt • More men succeed Age • Attempts as young as 2 • Teens (2nd or 3rd leading cause) • Elderly are most likely Ethnicity • Caucasian • Fewer African/Hispanic Americans • More Native Americans Family history • Genetic basis of depression • Social learning Neurobiology • Low levels of serotonin -> impulsivity, instability Psychological disorders • >90% suicides • Alcohol abuse Signs of Suicide Risk Aspects of Depression 1. Lost ability to concentrate 2. Lack of interest in friends (anhedonia) 3. Change in personality 4. Change in sleep & loss of appetite Reckless with own life 5. Sexual promiscuity 6. Alcohol or drug abuse Other 7.Recent loss 8.Giving away of prized possessions (making will) 9.Writing or talking about death 10. Any mention of suicide (or previous attempt) Intervention & Treatment 1. Talk openly -- MOST IMPORTANT 2. Assess the risk - plan (lethal?) - means - time plan, lethal means, time set -> high risk 3. Make contract or Involuntary hospitalization Positive: crisis often passes glad they’ve survived Negative: not their own decision can’t stop suicide, only delay 4. Treatment - after the crisis - Deal with precipitating stressor - Develop better coping - Build social support - Treatment for underlying disorder