Mood Disorders and Suicide

Major Depressive Disorder

a disorder involving at least one major depressive episode with no history of manic or hypomanic episodes

Criteria for Major Depressive Disorder

a person must experience at least 5 symptoms over 2 weeks, representing a change from their normal functioning including depressed mood or loss of interest or pleasure

Typical Symptoms Associated with Depressive & Manic Episodes

depressed mood, loss of interest, weight changes, sleep disturbances, changes in motor activity, fatigue, worthlessness or guilt, difficulty concentrating, and suicidal thoughts

Anhedonia

losing interest or pleasure in previously enjoyable activities

Dysphoria

depressed mood: persistent feelings of sadness, emptiness, or hopelessness

Specifiers for Major Depressive Disorder (MDD)

Psychotic features, catatonia, peripartum onset, and seasonal patterns

Psychotic features

a specifier for MDD involving hallucinations or delusions, such as believing you are responsible for major world problems

Catatonia

a specifier for MDD with significant disturbances in movement or responsiveness, such as remaining motionless or showing unusual physical behavior

Peripartum Onset

A MDD specifier where depression begins during pregnancy or within 4 weeks after childbirth

Persistent Depressive Disorder (PDD) & Dysthymia

a long-lasting form of depression where someone feels depressed most of the day, more days than not, for at least 2 years — 2 years of depressed mood + 2 additional symptoms

Diagnostic Criteria for Persistent Depressive Disorder (PDD)

a person must experience a depressed mood & at least 2 of 6 specific symptoms for a least 2 years, cause significant emotional distress, and cannot be symptom-free for more than 2 months at a time

2 of 6 Symptoms you must have for PDD

Appetite changes, sleep problems (insomnia & hypersomnia), low energy, low self-esteem, poor concentration, and hopelessness

Double Depression

when someone meets the criteria for both MDD & PDD

What two neurotransmitters are involved in depression?

Serotonin (5-HT) and Norepinephrine (NE)

Serotonin

helps regulate mood and emotions — low activity is associated with depression

Norepinephrine

helps regulate energy, alertness, and stress responses — low activity is associated with depression

Name the two Biological factors involved in depression

(1) heredity & genetics (2) Brain circuits = amygdala and the prefrontal cortex

Heredity and Genetics involved in depression

identical twins have about a 38% co-occurrence of lifetime MDD, and genes linked to depression have been found on at least two-thirds of the body’s chromosomes

The two Brain Circuits involved in depression

Amygdala and Prefrontal Cortex

The Amygdala involved in depression

processes emotions and shows increased activity in depression

Prefrontal Cortex involved in depression

regulates behavior, thinking, and emotions — activity may be increased or decreased in depression

What are Behavioral Dimensions (Actions) of Depression?

Negative changes in activities

Cognitive Dimensions (thoughts) of Depression

depression affects how people think about themselves and their experiences — affective forecasting, the cognitive triad

negative thoughts and expectations

Affective Forecasting

a cognitive dimension in depression where you can predict how you will feel about a future experience

Cognitive Triad

A cognitive dimension of depression involving three areas of negative thinking: self, world, & future

Learned Helplessness

when someone believes they have no control over a negative situation and stops trying to change it, even when opportunities become available

Attribution-Helplessness Model

explains how people interpret or assign causes to negative experiences

What are the three attribution dimensions

(1) internal (blaming yourself) vs. external (blaming someone else or chance)

(2) global (I am bad at everything) vs. specific (this is not my strength)

(3) stable (the problem will never change) vs. unstable (the problem is temporary)

What are the treatments for Depression?

medications, alternative treatments, brain stimulation, and cognitive-behavioral therapy

Medications for depression

Mao inhibitors, tricyclic antidepressants, second-generation antidepressants (SSRIs & SNRIs), and ketamine-based drugs

MAO inhibitors

antidepressant medications that block the enzyme monoamine oxidase (MAO), which breaks down neurotransmitters. This increases serotonin and norepinephrine activity. Patients must avoid foods containing tyramine, such as certain cheeses, bananas, and wine, because of potentially dangerous situations.

Tricylic Antidepressants

Antidepressant medications with a three-ring molecular structure that prevent neurons from reabsorbing neurotransmitters (reuptake), allowing them to remain active longer. They do NOT specifically target only one neurotransmitter

Second-Generation Antidepressants

Medications that selectively block the reuptake of certain neurotransmitters to increase their activity in the brain.

SSRIs & SNRIs

SSRIs (Selective Serotonin Reuptake Inhibitors)

a second-generation antidepressant that blocks serotonin reuptake, increasing the amount of serotonin available in the brain

SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors)

a second-generation antidepressant that blocks the reuptake of both serotonin and norepinephrine, increasing their availability in the brain

Ketamine-Based Drugs

medications used for treatment-resistant depression that can provide rapid symptom relief by increasing glutamate activity, which interacts with serotonin and norepinephrine. They are administered under medical supervision and may be combined with other medications.

Alternative Treatments for Depression

Aerobic exercise, supplements, and phototherapy

Phototherapy

an alternative treatment of depression that uses exposure to bright light to reduce depressive symptoms, particularly depression associated with seasonal patterns

Brain Stimulation Treatments for Depression

Electroconvulsive Therapy (ECT) & Repetitive Transcranial Magnetic Stimulation (rTMS)

Electroconvulsive Therapy (ECT)

a brain stimulation treatment for depression that uses controlled electrical stimulation to produce a brief seizure in the brain, helping reduce symptoms of severe depression

Repetitive Transcranial Magnetic Stimulation (rTMS)

a brain stimulation treatment for depression that uses magnetic pulses to stimulate areas of the brain involved in mood regulation

Treating Depression through the Cognitive-Behavioral Therapy (CBT)

a form of psychotherapy that helps individuals recognize and change negative thoughts and behaviors contributing to depression — behavioral activation, thought challenging, and identifying negative thinking patterns

Behavioral Activation

a CBT technique that encourages individuals to participate in enjoyable or rewarding activities to improve their mood and help treat depression

Thought Challenging

a CBT technique that helps individuals question negative or unrealistic thoughts and replace them with more balanced beliefs and help treat depression

Identifying Negative Thinking Patterns

a CBT technique that teaches individuals to recognize harmful thinking patterns that contribute to depression and help treat depression

Manic Episode

a period of unusually elevated, unrestrained, or irritable mood with continually increased energy or activity lasting at least 1 week, nearly every day.

Seven Typical Symptoms of a Manic Episode (Mania)

Grandiosity, decreased need for sleep, excessive talking, racing thoughts, distractibility, increased activity, and risky behaviorsG

Grandiosity

An exaggerated sense of importance or ability

Criteria for a Manic Episode

Requires at least 3 symptoms, or 4 of the 7 if the mood is only irritable → causes significant impairment, may require hospitalization, or may involve psychosis

lasts for 7 days and severe

Hypomanic Episode

a less severe form of mania lasting at least 4 consecutive days — same symptoms as mania

Does NOT cause marked impairment or hospitalization

Does NOT involve psychosis

4 days and less severe

Bipolar I Disorder

A mood disorder involving at least one manic episode. Hypomania or MDD episodes before are not required for diagnosis

Bipolar II Disorder

a mood disorder involving both major depressive episodes AND hypomanic episodes and NO history of a manic episode

Cyclothymic Disorder

a chronic mood disorder involving repeated depressive and hypomanic symptoms that do not meet the full criteria for MDD, manic, or hypomanic episodes — symptoms must last at least two year and chronic mood fluctuates

What are the four main potential biological factors/causes of bipolar disorders?

Biological factors include genetics, neurotransmitters, ion activity (sodium ions, NA+), and brain structure and circuitry (prefrontal cortex & amygdala)

Genetics: a potential cause of bipolar disorders

bipolar disorders have a strong genetic component, with a 40-70% co-occurrence in identical twins. They are believed to be polygenic

Neurotransmitters as a potential cause of biplor disoders

norepinephrine, serotonin, glutamate, and dopamine have been both increased and decreased across studies

Ion Activity as a potential cause of bipolar disorders

irregularities in ion activity within neurons can lead to neurons firing too easily (resulting in mania) or resisting firing (resulting in depression)

Brain Structure and Circuitry as a potential cause of bipolar disorders

Prefrontal cortex (regulation of cognition, behavior, and emotion) is underactive during mania, while the amygdala (emotional functioning) is overactive

Treatments for Bipolar Disorders

Lithium and Adjunctive Psychotherapy

Lithium

a treatment for bipolar disorder that is a naturally occurring element that has mood-stabilizing effects — Too high a dose can lead to lithium toxicity, causing—among many severe symptoms—vomiting, diarrhea, seizures, and even death

Ajunctive Psychotherapy

a treatment for bipolar disorders that includes social functioning with a focus of medication adherence

What factors are considered in the assessment of suicidality?

Hopelessness, intent to act on suicidal thoughts, a specific suicide plan, and means to carry out their plan

Suicide Risk Factors

Characteristics or experiences associated with an increased likelihood of suicidal behavior → previous suicide attempt, access to a contemplated method, hopelessness, mental health disorder, previous psychiatric hospitalization, and gender differences (men are more likely to die by suicide, women make more suicide attempts)

Protective Factors Against Suicide

family support, reasons for living, and treatment engagement

Methods to Prevent Suicide

safety planning, seeking emergency care, crisis lines, and hospitalization