Psychopathology Ch 7: Depressive and Bipolar Disorder

Types of Depression

• Major Depression

• Persistent Depressive Disorder

• Premenstrual Dysphoric Disorder

types of Mania

• Bipolar I

• Bipolar II

• Cyclothymia

depression

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

mania

State or episode of euphoria or frenzied activity in which people may have an exaggerated belief that the world is theirs for the taking

Depressive disorders

Group of disorders marked by unipolar depression

Unipolar depression

Depression without a history of mania

Bipolar disorder

Disorder marked by alternating or intermixed periods of mania and depression

demographics of unipolar depression

•Lifetime prevalence: 26 percent of women versus 12 percent of men

•Among children, the prevalence is similar among boys and girls.

•Approximately 85 percent of people with unipolar depression recover, some without treatment.

emotional symptoms (depression)

•Feeling miserable, empty, or humiliated

•Experiencing little pleasure

motivational symptoms (depression)

Lacking drive, initiative, and spontaneity

behavioral symptoms (depression)

Less active, less productive

cognitive symptoms

•Hold negative views of themselves

•Blame themselves for unfortunate events

•Pessimistic

physical symptoms (depression)

Headaches, dizzy spells, or general pain

persistent depressive disorder

•Symptoms are mild but chronic.

•Depression is longer lasting but less disabling

•Consistent symptoms for at least two years

double depression

When persistent depressive disorder leads to major depressive disorder

reactive depression

stressful events may trigger episodes. 80% of severe episodes occur after a significant event.

endogenous depression

depression caused by internal factors, such as genetics or imbalances in the body's biochemical processes, rather than external triggers, such as environmental stressors.

biological model of depression

Studies of genetic factors, biochemical factors, brain circuits, and the immune system

genetic factors of depression

• Family pedigree studies

• Twin studies

• Gene studies

biochemical factors of depression

low activity of two neurotransmitters: serotonin and norepinephrine

brain circuit factors of depression

• The brain circuit involved in unipolar depression includes the prefrontal cortex, hippocampus, amygdala, and subgenual cingulate, among other structures.

• irregular activity in various brain locations in addition to irregular NT activity

immune system factors of depression

under intense stress, dysregulation occurs.

• Slower functioning of lymphocytes, increased pro-inflammatory cytokines production, and greater inflammation

• Viral and inflammatory theories are receiving attention in many psychiatric disorders

biological treatment for depression

antidepressant drugs (MAO inhibitors, tricyclic antidepressants, ketamine-based antidepressants, second-gen antidepressants—SSRIs, SNRIs) or brain stimulation (electroconvulsive therapy, TMS, deep brain stimulation, vagus nerve stimulation)

synaptic activity during depression

the reuptake process is too active, removing too many NTs before they can bind to a receiving neuron. 

MAO inhibitors

increases activity level of NT serotonin and norepinephrine by preventing their degradation in the synapse

• Iproniazid; tyramine

Tricyclic antidepressants

prevents NT (norepinephrine and serotonin) reuptake of key neurons, enabling them to remain in the synapse longer and bind to receiving neurons

• Imipramine; Tofranil

second-generation antidepressants

• SSRIs that increase serotonin activity only

  • Fluoxetine/Prozac; sertraline/Zoloft; escitalopram/Lexapro

• SNRIs that increase norepinephrine only

  • atomoxetine/strattera

• Serotonin-norepinephrine reuptake inhibitor that increases both serotonin and norepinephrine activity

  • venlafaxine/effexor

brain stimulation

biological treatments that directly or indirectly stimulate certain areas of the brain

• electroconvulsive therapy

• vagus nerve stimulation

• transcranial magnetic stimulation

• deep brain stimulation

ketamine-based antidepressants

increases activity of glutamate, may aid in new neural pathway development. it alleviates depression quickly, used for those unresponsive to other drugs or suicidal, short term impact

• esketamine

Electroconvulsive therapy (ECT):

A treatment for depression in which electrodes attached to a patient’s head send an electrical current through the brain, causing a convulsion

Vagus nerve stimulation

A treatment for depression in which an implanted pulse generator sends regular electrical signals to a person’s vagus nerve; the nerve then stimulates the brain

Transcranial magnetic stimulation (TMS)

A treatment in which an electromagnetic coil, which is placed on or above a patient’s head, sends a current into the individual’s brain

Deep brain stimulation (DBS)

A treatment that works much like a pacemaker, sending electrical signals to the brain to help reduce brain activity to a typical level and recalibrate the depression-related brain circuit

psychodynamic model of depression

•Regression to an earlier stage of development

•Introjection of feelings for the symbolic or imagined lost object

•peoples relationships leave them feeling unsafe and insecure

•Eventually becoming depressed

cognitive-behavioral view of depression

depression results from problematic behaviors and dysfunctional thinking.

theoretical perspectives

• behavioral dimension

  • large reduction in positive life rewards cause fewer positive behvaiors/loss of social rewards

• negative thinking

  • (Beck:) maladaptive attitudes, cognitive triad, errors in thinking, and automatic thoughts

• complex cognitive and behavioral factor interplay

  • learned helplessness: people beleive they have no control over life’s reinforcements

Beck’s cognitive triad

• Negative view of experiences

• Negative view of oneself

• Negative view of the future

behavioral activations

• Reintroduce pleasurable activities

• Consistently reward nondepressive behaviors and withhold rewards for depressive ones

• Improve social skills

Beck’s cognitive-behavioral therapy 

1.Increasing activities and elevating mood

2.Challenging automatic thoughts

3.Identifying negative thinking and biases

4.Changing primary attitudes

Cognitive-behavioral treatment of depression

behavioral activation, Beck’s CBT, and acceptance and commitment therapy (ACT)

sociocultural model of depression

• Depression is influenced by social context and often triggered by outside stressors

  • Family-social perspective

  • Multicultural perspective

• Lack of social rewards

  • Separation, divorce, widowhood

  • COVID isolation

• multicultural perspective: depression is worldwide, women are wtice as likely as men to receive a diagnosis and they appear younger, have longer lasting bouts, and respond less successfully to treatment

sociocultural treatment for depression

family-social treatments: Interpersonal psychotherapy

Interpersonal psychotherapy (IPT)

useful or people who are depressed who are struggling with social conflicts or undergoing changes in their careers or social roles.

• Interpersonal loss

• Interpersonal role dispute

• Interpersonal role transition

• Interpersonal deficits

gender and depression explanations

• Detection: easier in women

• Hormone changes: women

• Life stress: more for women

• Body dissatisfaction: women are taught in society to seek lower body weight/unhealthy

• Lack of control: learned helplessness, women are prone

• Rumination: women more likely to ruminate when mood darkens

bipolar disorders

• Involve lows of depression and highs of mania

• Shift between extreme moods

• Have dramatic impact on relatives and friends

emotional symptoms of bipolar

Active, powerful emotions in search of an outlet

motivational symptoms of bipolar

Need for constant excitement, involvement, companionship

Behavioral symptoms

Very active—move quickly; talk loudly or rapidly; flamboyance is not uncommon

cognitive symptoms of bipolar

Show poor judgment or planning; may have trouble remaining coherent or in touch with reality

physical symptoms of bipolar

High energy level—often in the presence of little or no rest

demographics of bipolar

• Worldwide, 1% to 2.8% of all adults have bipolar disorder at any given time: 4.4% have it at some point in life.

• Onset between the ages of 15 and 44 years

• No gender differences

• Higher rates in low-income populations

Cyclothymic disorder

• Numerous periods of hypomanic symptoms and mild depression symptoms

• Symptoms continue for at least 2 years, with typical moods for days or weeks in between

• May evolve into bipolar I or bipolar II

NT activity in bipolar

Mania may be related to high norepinephrine activity along with a low level of serotonin activity.

ion activity in bipolar

Improper transport of ions back and forth between the outside and the inside of a neuron’s membrane.

brain structure and circuitry in bipolar

Brain imaging and postmortem studies have identified irregular brain structures—in particular, the basal ganglia and cerebellum.

genetic factors in bipolar

People inherit a biological predisposition to develop

biological treatment for bipolar

lithium, antiseizure drugs (e.g., lamotrigine (Lamictal), carbamazepine (Tegretol), and valproate (Depakote)), and antipsychotic drugs

adjunctive psychology

• Individual, group, or family therapy

• Doubles likelihood that people with bipolar disorders continue to take medicine properly

• Helps reduce hospitalizations, improve social functioning, increase patients’ ability to obtain and hold a job