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Transcript
Chapter 7
Mood Disorders and
Suicide
Amber Gilewski
Tompkins Cortland Community College
Major Depressive Episode




Extremely depressed mood lasting at
least 2 weeks
Cognitive symptoms – Feelings of
worthlessness, indecisiveness
Disturbed physical functioning
Anhedonia – Loss of pleasure/interest in
usual activities
Mania and Hypomania

Symptoms
-elated joy, euphoria
-excessive or extraordinary activity
-rapid speech
*Criteria for manic episode
-duration of 1 week
-irritability towards the end
-anxiousness and depression
-if left untreated, lasts 3-6 months
*Hypomanic episodes – less severe
Depressive Disorders

Major Depressive Disorder
• Single episode – Highly unusual
• Recurrent episodes – More common
• Median # of episodes = 4 with duration of
4-5 month
• Mean age of onset = 25-29 years old
• Age appears to be decreasing
Persistent Depressive Disorder
(Dysthymia)




Symptoms are milder than major depression
Persists for at least 2 years (1 year for children &
adolescents)
No more than 2 months symptom free
Symptoms can persist unchanged over long periods
(≥ 20 years)

Late onset – Typically in the early 20s

Early onset – Before age 21
• Greater chronicity
• Poorer prognosis
“Double Depression”

Major depressive episodes AND dysthymia

Dysthymic disorder often develops first

Associated with severe psychopathology

Associated with a problematic future course
Bipolar I Disorder

Alternations between full manic episodes &
depressive episodes

Average age on onset is 18 years

Can begin in childhood

Tends to be chronic

Suicide is a common consequence
Bipolar II Disorder





Alternations between major depressive &
hypomanic episodes
Average age on onset is between 19 - 22
years
Can begin in childhood
10 to 13% of cases progress to full bipolar I
disorder
Tends to be chronic
Cyclothymic Disorder

Chronic version of bipolar disorder

Manic & major depressive episodes are less severe


Manic or depressive mood states persist for long
periods
Must last for at least 2 years (1 year for children &
adolescents)

Average age on onset is 12 to 14 years

Most are female

High risk for developing bipolar I or II disorder
Prevalence of Mood Disorders

16% lifetime prevalency for Major Depression

Females are twice as likely to have major depression

Bipolar disorders equally affect males and females

High rates amongst Native Americans

Most depressed persons are anxious

Not all anxious persons are depressed
Causes of Mood Disorders:
Biological dimensions


Family & twin studies – runs in families
Mood disorders are related to low levels of
serotonin

Endocrine system – cortisol

Sleep disturbances/circadian rhythms
Mood Disorders:
Psychological Dimensions




Stress is strongly related to mood disorders
The relation between context of life events
and mood
Reciprocal-gene environment model:
depressed persons putting themselves in high
risk situations
Beck proposed cognitive errors
Treatment of Mood Disorders:
Tricyclic Medications

Widely used (e.g., Tofranil, Elavil)

Block reuptake of NE and serotonin

Therapeutic effects can take 2-8 weeks

Negative side effects are common

May be lethal in excessive doses
Treatment of Mood Disorders:
MAO Inhibitors

Monoamine oxidase (MAO)




Block Monoamine Oxidase
This enzyme breaks down
serotonin/norepinephrine
Slightly more effective than tricyclics
Must Avoid Foods Containing Tyramine

Examples include beer, red wine, cheese
Treatment of Mood Disorders:
SSRIs

Specifically block reuptake of
serotonin

Fluoxetine (Prozac) is the
most popular SSRI

Negative side effects are
common

SSRIs pose no unique risk of
suicide or violence
www.londonstimes.us/toons/index_medical.html
Treatment of Mood Disorders:
St John’s Wort





www.jadeandpearl.com/.../jp0040St,John.jpg
Herbal solution for
depression
Works as well as low doses
of other antidepressants
Alters serotonin function
Few side effects
No prescription needed in
the U.S.
Treatment of Mood Disorders:
Lithium


Lithium Is a Common Salt

Primary drug of choice for bipolar disorders

Can be toxic
Side Effects May Be Severe


Dosage must be carefully monitored
Why Lithium Works Remains Unclear
Psychological Treatments


Cognitive Therapy

Addresses cognitive errors in thinking

Also includes behavioral components
Interpersonal Psychotherapy


Focuses on problematic interpersonal
relationships
Therapy and medication may be equally effective
The Nature of Suicide:
Facts and Statistics

11th Leading Cause of Death in the United States

Overwhelmingly a White and Native American
Phenomenon

Suicide Rates Are Increasing, Particularly in the Young
and Elderly

Gender Differences

Males complete suicide more often than females

Females attempt suicide more often than males
Suicide:
Risk Factors, Prevention, & Treatment

Suicide in the Family

Low Serotonin Levels

Preexisting Psychological
Disorder

Alcohol Use and Abuse

Past Suicidal Behavior

Experience of a
Shameful/Humiliating
Stressor

Predicting suicide:
difficult, but ask
appropriate questions

Prevention measures
-Suicide contract: may
help prevent suicide
-Curriculum based
programs: education &
prevention

Treatments for those at
risk: problem solving,
CBT, coping, etc.