MOOD DISORDERS

PSYCHIATRIC FOUNDATION

PSYCHIATRIC FOUNDATION

• Mood disorders are disturbances of emotions that are severe or prolonged enough to cause impairment of functioning.  

  • These conditions are magnifications of our normal reactions.

• The magnified states in mood disorders are mania and depression.

  • Mania – a period of abnormally high emotion and activity

  • Depression – a period of extreme sadness and helplessness

TYPES OF MOOD DISORDERS

MAJOR DEPRESSIVE DISORDER (UNIPOLAR DEPRESSION)

The most common mood disorder, and one of the more common psychological disorders in general.

Everyone gets depressed, so how do we know when normal depression crosses the line into major depressive disorder?

A person may be suffering from major depressive disorder when five of the following nine symptoms have been present for two or more weeks:

• Depressed mood most of the day, nearly every day

• Little interest or pleasure in almost all activities

• Significant changes in weight or appetite

• Sleeping more or less than usual

• Agitated or decreased level of activity

• Fatigue or loss of energy

• Feelings of worthlessness or inappropriate guilt

• Diminished ability to think or concentrate

• Recurrent thoughts of death or suicide

The symptoms must also produce distress or impaired functioning to qualify as indicators of MDD.

Also, with MDD, there is no apparent reason, or trigger, for the emotions.

Research suggests that the lifetime prevalence rate of depression is between 7 and 18%.  

Evidence suggests that the prevalence of depression is increasing, particularly in more recent age cohorts, and that it is 2X as high in women as in men.

DYSTHYMIC DISORDER

• Dysthymic disorder shares many of the symptoms of MDD, but doesn’t quite have the same overwhelming feel.

• Sufferers of this disorder may feel the same symptoms, but less intensely and for a longer period (at least 2 years).

  • They rarely require hospitalization.

BIPOLAR DISORDER

• People with bipolar disorder also experience the oppressive down periods of MDD; however, these periods alternate with manic episodes in which the person is unrealistically optimistic and displays wildly hyper behavior.

• During mania, a person may go long periods without sleeping, experience changeable, racing thoughts, be easily distracted, and set impossible goals.

  • Mania is sometimes also associated with bouts of creative energy.

• Bipolar disorder affects a little over 1%-2% of the population and is equally as common in males and females

The Depressed Brain

- PET scans show that brain energy consumption rises and falls with manic and depressive episodes.

Victims of Bipolar Disorder?

• No one knows for sure, but some people suspect that Vincent van Gogh was bipolar.

• His life alternated between periods of blazing creativity – sometimes he finished more than a painting a day – and periods of deep depression.  He committed suicide in 1890.

• The world's most famous nurse, Florence Nightingale, is believed to have suffered from a bipolar disorder that caused long periods of depression and remarkable bursts of productivity.

Bipolar I vs. Bipolar II Disorder

Bipolar I Disorder  

• Manic Episodes, plus:

• Usually with at least one Depressive Episode

Bipolar II Disorder

• Depressive Episodes, plus:

• At least 1 Hypomanic Episode

Hypomanic

Same criteria for mania, except:

• Lasts at least 4 days

• Not severe enough to cause impairment in functioning, no hospitalization needed, no psychotic features… although there is a clear change in behavior or functioning that is not the person’s “normal” and is noticeable to others

CYCLOTHYMIC DISORDER

• Cyclothymia is basically borderline bipolar disorder (milder than bipolar)

• Includes:

  • Hypomanic symptoms (not full mania), plus: 

  • Depressive symptoms (not full depression)

• Lasts for at least 2 years

MAJOR DEPRESSIVE DISORDER

DYSTHYMIC DISORDER

BIPOLAR I DISORDER

BIPOLAR II DISORDER

CYCLOTHYMIC DISORDER

OTHER TYPES OF “DEPRESSIONS”

• Seasonal Affective Disorder

• Double Depression (Dysthymia + Major Depression)

• Post-partum depression

ETIOLOGY OF MOOD DISORDERS

“Possible causes”

What causes mood disorders?

• Again, biology and environment interact as possible contributors to mood disorders.

• Stress also seems to play a role, providing a trigger that sparks mood disorders when other factors are present

BIOMEDICAL APPROACH

• Heredity – twin studies show that many mood disorders run in families. The rate of depression is higher in identical (50%) than fraternal twins (20%).

• Brain function – Depressed people have depressed brains.  Brain scans indicate that the brain is less active during major depression. 

• Also, certain neurotransmitters (serotonin and norepinephrine) are lacking during times of depression. 

  • Prozac and other antidepressant medications help restore proper levels of these neurotransmitters.

SOCIAL - COGNITIVE APPROACH

•  Attributions – When things go wrong, we try to explain them.  Depressed people are likely to believe the following explanations (attributions):

  • Stable – The bad situation will last for a long time

  • Internal – This happened because of my actions, not someone else’s, and not because of the circumstances

  • Global – My explanation applies to many areas of my life

• Learned helplessness – People develop a sense of helplessness when subjected to events over which they have little or no control.  As they acquire this feeling of helplessness, they give up and no longer try to improve their situation, because they learned in the past that efforts to improve the situation will not work.  This, by itself, can produce depression.

  • Learned helplessness may also explain why women suffer higher rates of depression than men do.  Women are more likely to be abused and twice as likely to feel overwhelmed.  This may explain women’s higher levels of learned helplessness and depression.

HUMANISTIC APPROACH

• Not enough life meaning

• Not enough authentic choices that lead to self-fulfillment

• Connection of personal identity to others’ evaluation of ourselves, or to certain events (e.g., role at work), so that when these persons or events leave, there is loss and depression

• Obstacles to self-actualization path

BEHAVIORAL APPROACH

• Few rewards in life, many punishments

• Interactional theory (James Coyne)

  • Person acts depressed, which makes others annoyed or stressed by person, which makes others less likely to provide positive reinforcement and rewards to person, which makes person depressed…

  • Interpersonal inadequacies and poor social skills may lead to a scarceness of life’s reinforcers and frequent rejection.

SOCIOCULTURAL APPROACH

• Cultural differences in symptom expression

• Different rates among different groups

• Higher rates among women

• Higher rates among single, divorced people

• Lower rates with social support

• Higher rates for younger adults

• Higher rates for lower socioeconomic status

PSYCHODYNAMIC APPROACH

• Parents fail to nurture person or they provide excessive gratification of needs

• Actual or symbolic loss of the parent or loved one

• Regression to oral stage

• Introjection of loved one (Introjection – The process of incorporating the characteristics of a person or object unconsciously into one's psyche, often as a defense mechanism)

• Angry feelings towards loved one  guilt + self-hatred 

• Shifting dominance between superego (guilt and worthlessness) and ego (asserts its strength and is elated and self-confident).