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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)