chapter 6: depressive and bipolar disorder

Major Depressive Episode

A period of at least 2 weeks with at least 5 depressive symptoms, including depressed mood or loss of interest or pleasure.

Anhedonia

Loss of interest or pleasure in activities.

Unipolar Depression (Major Depressive Disorder)

A pattern of depression without a history of mania or hypomania.

Gender Differences in Unipolar Depression

Women are at least twice as likely as men to receive this diagnosis.

Depression in Children and Adolescents

Rates are similar for boys and girls in childhood, but girls become about twice as likely to experience depression during adolescence.

Stress and Depression

Stressful life events can trigger depression and affect the body's stress and immune systems.

Exogenous (Reactive) Depression

Depression that follows identifiable external stressors or negative life events.

Endogenous Depression

Depression that appears to arise primarily from internal biological factors rather than external stressors.

Postpartum Depression

A major depressive episode beginning during pregnancy or within 4 weeks after childbirth.

Baby Blues

Mild, temporary sadness and moodiness after childbirth, affecting up to 80% of new mothers.

Persistent Depressive Disorder (Dysthymic Disorder)

A long-lasting depressed mood accompanied by at least two other symptoms, such as fatigue, low self-esteem, or hopelessness. At least 2 years in adults or 1 year in children and adolescents.

Premenstrual Dysphoric Disorder (PMDD)

Depressive and related symptoms that appear before menstruation and improve shortly after menstruation begins.

Symptoms of PMDD

Mood swings, irritability, depressed mood, hopelessness, anxiety, poor concentration, fatigue, and sleep or appetite changes.

Seasonal Affective Disorder (SAD)

A pattern of depression that recurs during particular seasons, most commonly winter.

Melatonin

A hormone associated with seasonal depression that is secreted in greater amounts during darker months.

Light Therapy (Phototherapy)

Treatment using bright light, commonly used for seasonal affective disorder.

Genetic Factors in Unipolar Depression

Depression runs in families; identical twins have a higher concordance rate than fraternal twins. Identical twins have a 38% concordance rate, compared with 20% for fraternal twins.

Serotonin and Norepinephrine

Neurotransmitters whose reduced activity is associated with unipolar depression.

Glutamate

A neurotransmitter involved in stimulating neurons and promoting neural connectivity; it is also associated with depression.

Depression-Related Brain Circuit

A network involving the prefrontal cortex, hippocampus, amygdala, and subgenual cingulate.

Prefrontal Cortex

A brain area involved in higher-level thinking that is important in the depression-related brain circuit.

Hippocampus

A brain structure involved in memory that is associated with depression.

Amygdala

A brain structure involved in processing emotions that is associated with depression.

Subgenual Cingulate (Brodmann Area 25)

A brain region particularly associated with depression.

Electroconvulsive Therapy (ECT)

A treatment that uses a brief electrical stimulus to induce a controlled seizure in the brain. Approximately 50–80% of severely depressed patients improve after a course of 6–12 sessions. Its exact mechanism is unknown, but it may recalibrate neurotransmitter activity and connections within the depression-related brain circuit.

Monoamine Oxidase Inhibitors (MAOIs)

Antidepressants that block the enzyme that breaks down serotonin and norepinephrine, increasing their availability.

MAOI Dietary Precaution

People taking MAOIs must avoid tyramine-rich foods because they can cause dangerously high blood pressure.

Tricyclic Antidepressants

Medications that block the reuptake of serotonin and norepinephrine, allowing them to remain in synapses longer.

Second-Generation Antidepressants

Newer antidepressants that target specific neurotransmitters and generally produce fewer uncomfortable side effects than older medications.

Selective Serotonin Reuptake Inhibitors (SSRIs)

Antidepressants that specifically block serotonin reuptake.

SSRIs vs. Tricyclics

They have similar overall effectiveness, but SSRIs generally cause fewer and less severe side effects.

Ketamine-Type Treatments

Treatments associated with glutamate activity that may improve brain connectivity within hours.

Vagus Nerve Stimulation (VNS)

An implanted device sends electrical signals through the vagus nerve to the brain to help relieve depression.

Transcranial Magnetic Stimulation (TMS)

A noninvasive treatment that uses magnetic currents to stimulate neurons, particularly in the prefrontal cortex.

Deep Brain Stimulation (DBS)

A surgical treatment using implanted electrodes to send electrical signals to a targeted brain region, such as the subgenual cingulate.

Introjection

An unconscious process in which a person internalizes aspects of a lost person and may direct anger inward.

Behavioral Activation Therapy

Treatment that schedules pleasurable activities, reinforces constructive behaviors, and builds social skills.

Maladaptive Attitudes

Self-defeating beliefs formed through experience that contribute to negative thinking.

Cognitive Triad

Negative views of one's experiences, oneself, and one's future.

Errors in Thinking

Distorted reasoning, such as minimizing positive events or exaggerating negative ones.

Automatic Thoughts

Quick, recurring negative thoughts about oneself, one's circumstances, or one's future.

Learned Helplessness

The belief that one cannot control outcomes in life and is responsible for being helpless.

Attribution-Helplessness Theory

The idea that attributing negative events to internal, global, and stable causes contributes to depression.

Cognitive-Behavioral Therapy (CBT)

Therapy that changes unhelpful thoughts and behaviors; approximately 50–60% of clients show significant improvement or complete symptom elimination.

Exercise as a Depression Treatment

Exercise can improve mood in mild to moderate depression, particularly when combined with psychotherapy or medication.

Acceptance and Commitment Therapy (ACT)

A therapy that uses mindfulness and acceptance to help people recognize negative thoughts without being controlled by them and act according to personal values.

Interpersonal Psychotherapy (IPT)

A therapy that addresses interpersonal loss, role disputes, role transitions, and interpersonal deficits. The text describes IPT as highly effective, with a success rate of approximately 50–60%, comparable to CBT.

Couples Therapy for Depression

Can be highly effective when depression is linked to relationship or marital conflict.

Artifact Theory

Proposes that men and women may be equally prone to depression, but depression is less likely to be recognized in men.

Hormones

Hormonal changes during puberty, pregnancy, and menopause may contribute to depression.

Life Stress Theory

Proposes that women's greater exposure to certain stressors, including discrimination, victimization, and unequal caregiving burdens, contributes to higher depression rates.

Body Dissatisfaction Theory

Proposes that unrealistic cultural body ideals contribute to depression among women and girls.

Lack-of-Control Theory

Proposes that experiences such as abuse and harassment can foster helplessness and increase depression risk.

Rumination Theory

Proposes that women are more likely to dwell on negative feelings, potentially prolonging depressed moods.

Treatment of Mild Depression

As presented in the text, psychotherapy and/or exercise may be preferred; light therapy is an option for seasonal depression.

Manic Episode

A period of abnormally elevated, expansive, or irritable mood and increased energy lasting at least 1 week.

Symptoms of Mania

Grandiosity, reduced need for sleep, increased talking, racing thoughts, distractibility, increased activity, and risky behavior.

Hypomanic Episode

A less severe period of elevated or irritable mood and increased energy lasting at least 4 consecutive days, without marked impairment, hospitalization, or psychosis.

Bipolar I Disorder

A disorder characterized by at least one full manic episode; depressive episodes may also occur. Full manic episodes in bipolar I can include delusions or hallucinations.

Bipolar II Disorder

A disorder involving hypomanic episodes and major depressive episodes, with no history of full mania.

Bipolar Disorder Prevalence

The text reports that approximately 1–2.8% of adults experience bipolar disorder at a given time, with up to 4.4% experiencing it during their lifetime. Bipolar disorders are approximately equally common in men and women.

Cyclothymic Disorder

A milder, long-term pattern of hypomanic symptoms and depressive symptoms that do not meet the full criteria for manic or major depressive episodes. At least 2 years in adults or 1 year in children and adolescents.

Bipolar Twin Studies

Identical twins have a reported concordance rate of 40–70%, while fraternal twins and siblings have a reported likelihood of 5–10%. Bipolar disorders have a strong genetic component; identical twins show much higher concordance than fraternal twins.

Neurotransmitters in Bipolar Disorder

Norepinephrine, serotonin, glutamate, and dopamine.

Sodium Ions in Bipolar Disorder

Sodium ions carry electrical impulses along axons; irregular sodium transport may contribute to neurons firing too easily or resisting firing.

Bipolar Disorder Brain Areas

The hippocampus, basal ganglia, cerebellum, raphe nuclei, striatum, amygdala, and prefrontal cortex.

Mood Stabilizers

Medications used to help control mood episodes in bipolar disorder, including lithium and certain antiseizure medications. Not following a prescribed medication regimen; reasons may include side effects, feeling cured, missing manic euphoria, or fearing reduced creativity.

Lithium

A mood stabilizer that affects intracellular signaling, increases BDNF, and may support gray matter and hippocampal volume.

Adjunctive Psychotherapy

Psychotherapy used alongside medication to support treatment and improve medication adherence.

BDNF (Brain-Derived Neurotrophic Factor)

A protein that supports neuron health and is increased by lithium, according to the text.

Most Common Mood Disorder

Unipolar depression, also called major depressive disorder.