psyc 218 (exam 2) chapter 6: Depression and Bipolar Disorders

depressive disorder

group of disorders marked by unipolar depression

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

bipolar disorder

disorder marked by periods of mania and depression

• mania: state or episode of euphoria or frenzied activity in which people may have exaggerated belief that the world is theirs for the taking

unipolar depression prevalence

• 8% of U.S adults have severe depression in any given year; 5% have milder forms of depression

• 20% of adults will experience depression at some points in their lives

• average age of onset is 19 years old

• higher rate among chronically ill elderly people

• most people will recover within 6 months

depressive disorder symptoms: emotional

feeling miserable, empty, or humiliated

• anhedonia: inability to experience any pleasure at all

depressive disorder symptoms: behavioral

lower energy and productivity levels

significant challenges regulating

• appetite and weight

• sleep

physical agitation or lethargy

depressive disorder symptoms: cognitive

• negative views about self

• blames self for past events

• pessimism

• difficulty with decision making and concentration

depressive disorder symptoms: physical

headaches, dizzy spells, general pain

depressive disorder symptoms: motivational

lacking drive, initiative, and spontaneity

recurrent suicidal thoughts

major depressive disorder

disorder in which a person experiences two or more weeks with five or more depressive symptoms

• depressed mood

• loss of interest or pleasure

• considerable weight change or appetiti change

• insomnia or hypersomnia

• psychomotor agitation or impairment

• fatigue or lethargy

• feelings of worthlessness or excessive guilt

• reduction in concentration or decisiveness

• repeated thoughts of death or suicide

persistent depressive disorder

experiences symptoms of major or mild depression for at least 2 years

• symptoms are not absent for more than 2 months at a time

• presence of 2 or more symptoms

• no history of mania or hypomania

• significant distress or impairment

dysthymic disorder: symptoms are “mild but chronic”

premenstural dysphoric disorder

the symptoms include mood changes and then other typical depressive symptoms-also includes physical symptoms of PMS like breast tenderness, joint pain, bloating, weight gain

• 5 symptoms that are present one week before the onset of menses

  • must include at least 1+ mood symptoms (irritability, anxiety, mood swings)

  • must include 1+ additional symptoms (fatigue, sleep changes, physical symptoms)

controversial addition in the DSM-5

postpartum (peripartum) depression

• symptoms can last up to a year or more

• extreme sadness, despair, tearfulness, insomnia, anxiety, intrusive thoughts, compulsions, panic attacks, inability to cope, suicidal thoughts

  • impact on mother-infant relationship and well-being

• causes

  • triggered by hormonal changes

  • genetic predisposition

  • psychological and social change

• treatment

  • includes self-help groups, medication, CBT, interpersonal psychotherapy

biological model: depression

genetic factors

• family pedigree studies

• twin studies

• gene studies

biochemical factors

• low activity of 2 neurotransmitters: serotonin and norepinephrine

• hormones and HPA pathway

biological treatments: antidepressants

in the 1950s, two main kinds of drugs were used to reduce depression:

• monoamine oxidase inhibitors (MAOIs)

• tricyclics

second-generation antidepressants were later included as an alternative

MAO inhibitors

• works biochemically to slow down the body’s production of MAO

• approx. half of patients who take these see improvement

• leads to a rise in norepinephrine activity and a reduction in depressive symptoms

• can cause rise in blood pressure when combined with certain foods

tricyclics

• act on neurotransmitter reuptake mechanism of key neurons

• block overly vigorous reuptake process and allow serotonin and norepinephrine to remain in the synapse longer

• can produce side effects

• relapse can occur if therapy is ended too quickly after recovery

second-generation antidepressants

• structurally different than original medications

• selective serotonin reuptake inhibitors (SSRIs)

  • increase serotonin activity without affecting norepinephrine or other neurotransmitters

• fewer side effects

brain stimulation

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

• electroconvulsive therapy (ECT)

• transcranial magnetic stimulation

• deep brain stimulation

• vagus nerve stimulation

psychodynamic therapy

seek to bring unconscious grief into consciousness and work through them

• free association

• therapist interpretation

• review of past events and feelings

some successful case reports

limited research support

clients may become discouraged and leave treatment early

cognitive behavioral model

depression=result of problematic behavior and dysfunctional thinking

• behavioral dimension

  • number of life rewards related to presence or absence of depression

  • social rewards are important in decreasing depression

• negative thinking

  • aaron beck’s cognitive triad

  • martin seligman learned helplessness theory: depression occurs when people feel loss of control over life reinforcements

• beck’s cognitive therapy

  • helps people identify and change maladaptive assumptions and ways of thinking

    • challenging automatic thoughts

    • identifying negative thinking and biases

    • changing primary attitudes

  • significant research support in treating depression

family-social perspective

• decline in social rewards impact depression

• people with depression tend to show social deficits including avoiding others

• tied to weak or unavailable social support, isolation, and lack of intimacy

family-social treatments

interpersonal psychotherapy

• interpersonal problems lead to depression including interpersonal loss, interpersonal role dispute, interpersonal role transition, and interpersonal deficits

• helpful when depression is related to social conflicts or social role changes

couple therapy

• CBT and sociocultural techniques used to teach couples specific communication and problem-solving techniques

• more effective than other techniques when one partner is depressed

multicultural perspective

strong link between gender and depression

• women are twice as likely as men to receive diagnosis for depression

possible explanations for gender difference

• artifact theory, hormone explanation, life stress theory, body dissatisfaction explanation, lack of control therapy, rumination theory

depression has been found worldwide although the picture of depression varies by country

in non-western countries, people are more likely to experience physical symptoms than cognitive

• this is changing as countries become more westernized

few differences in depression symptoms or rate of depression among U.S racial groups

multicultural treatments

culturally sensitive therapies will address unique issues that minority groups face

• specific training is needed on cultural values and stressors

• usually used in combination with traditional psychotherapy forms

bipolar disorder

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

people who experience mania experience dramatic changes in mood

• emotional symptoms

• motivational symptoms

• behavioral symptoms

• cognitive symptoms

• physical symptoms

mania symptoms

abnormally and persistently elevated, expansive, or irritable mood and increase in energy

inflated self-esteem

decreased need for sleep

more talkative than usual

flight of ideas

distractibility

increase in goal directed activity

psychomotor agitiation

excessive involvement in high-risk activities (shopping sprees, foolish business investment)

bipolar 1 disorder

manic episode lasts at least 1 week

can also experience major depressive or hypomanic episodes

bipolar 2 disorder

• history of hypomanic and major depressive episode

• hypomania lasts at least 4 days

• no history of manic episode

cyclothymic disorder

for at least 2 years, numerous periods with hypomanic and depressive symptoms

symptoms are present for at least half the time, with no symptoms for less than 2 months at a time

no gender difference

biological causes of bipolar disorder

• neurotransmitter activity: mania may be related to high norepinephrine and low serotonin activity

• ion activity: improper transport of ions between outside and inside of neuron’s membrane

• brain structure: abnormality in hippocampus, basal ganglia, and cerebellum

• genetic factors

  • people may inherit biological predisposition

  • family pedigree studies

  • molecular biology techniques

treatments for bipolar disorder

lithium

• metallic element that occurs in nature as a mineral salt

• very effective in treating bipolar disorder

other mood stabilizers

• includes depakote and tegretol

• some people respond better to drugs or to combination of drugs

still are unsure how it fully operates

therapy is often used on combination with medication

• therapy or medication alone is rarely helpful