Depressive and Bipolar Disorders

What distinguishes normal from abnormal mood symptoms?

• Pervasiveness
  

• Absence of situational cues
  

• Additional signs and symptoms
  

• Subjective quality - doesn’t feel like ‘normal sadness’

5 + of following during same 2 weeks & change from previous functioning 

(1) depressed mood most of day, nearly every day (in kids can be irritable)

(2) anhedonia most of day, nearly every day (pleasure)

At least 1 of the first 2 required

(3) Significant weight ↓ (not dieting) or weight ↑, or ↓  or ↑ in appetite nearly every day

(4) insomnia or  hypersomnia nearly every day

(5) psychomotor agitation or retardation nearly every day (observable by others)

(6) fatigue or loss of energy nearly every day

(7) worthlessness or excessive or inappropriate guilt nearly every day

(8) difficulty concentrating, or indecisiveness nearly every day

(9) recurrent thoughts of death, suicidal ideation without a specific plan, or a suicide attempt or specific plan for committing suicide

Need 5 Total Symptoms

Manic Episode

Need A and B (varying)

(A) Distinct period of abnormally & persistently elevated, or irritable mood lasting at least 1 week (or any duration if hospitalized) & increased activity or energy

(B) During mood disturbance, 3+ of following (4+ if mood = irritable):

■↑ self-esteem or grandiosity

■↓ need for sleep

■More talkative than usual or pressure to keep talking

■Flight of ideas/thoughts feel like racing

■Distractibility

■↑ in goal-directed activity or psychomotor agitation

■Excessive involvement in pleasurable activities that have high potential for negative consequences (shopping sprees, sexual indiscretions, etc) 

(C) Marked impairment or  hospitalization necessary to prevent harm to self/others

Hypomanic Episode

▪Hypomanic episode: similar to manic episode but shorter duration (4-6 days) or not severe enough  to cause marked impairment

Hospitalized = automatically counts as manic

Major Depressive Disorder (MDD)

• One or more major depressive episodes

• No manic or hypomanic episodes

• 12-month prevalence = 5-10% of population

  Lifetime prevalence = approximately 18% of population

  W:M = 2:1 (but equal in kids)

  40% have at least one additional episode

Bipolar Mood Disorder

▪Bipolar I Disorder

• Presence of at least one Manic Episode

• Often but not always Major depressive episode (MDE)

▪Bipolar II Disorder

• At least 1 MDE and at least 1 Hypomanic Episode

• Never been a manic episode.

Lifetime prevalence = 1-2.6%; no gender differences; onset in adolescence/early adulthood.

Depression - Etiology

• Genetics

• Neurotransmitters (low serotonin and norepinephrine)

• Stress

• Reduction in reinforcement (behaviorists)

• Maladaptive cognitions

  • Negative views of themselves, the world and the future

  • Negative attributions (stable, global, internal attributions for negative events)

Depression – Treatment

• Antidepressant medication

  • Takes several weeks to work

• Therapy

  • Cognitive behavioral therapy (Aaron Beck)

    • Behavioral therapy = behavioral activation

    • Cognitive therapy = addressing maladaptive cognitions

• Other options

  • Electroconvulsive therapy

  • Light therapy

  • Transcranial magnetic stimulation

Bipolar disorder

• Genetics

• Neurotransmitters (excess norepinephrine and low serotonin during manic phase)

• Treatment = medication (lithium carbonate or anticonvulsant)

  • Therapy can be used as an adjunct to help with medication compliance, self-care, better coping, etc.