Chapter 6: Depressive and Bipolar Disorders

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 exaggerated beliefs, such as the world is theirs for the taking.

Unipolar Depression:

Depression w/o a history of mania.

Bipolar Disorder:

Disorder marked by alternating or intermixed periods of mania and depression.

Mania:

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

How many of U.S. adults are diagnosed with unipolar depression?

8% in any given year.

• May have increased post-pandemic to 25%

How many adults experience unipolar depression at some point in their lives?

20%

• Mild or severe is higher among people of limited economic means than people of affluence.

Severe depression is higher among who?

Adults under the age of 65 years.

Symptoms of Depression:

• Experience little pleasure; anhedonia.

• Typically lose the desire to pursue their usual activities.

• Less active, less productive

• Hold negative views of themselves; pessimistic

• Headaches, indigestion, dizzy spells; general pain

Major Depressive Episode:

For a 2-week period, person displays an increase in depressed mood for the majority of each day and/or a decrease in enjoyment or interest across most activities for the majority of each day.

In extreme cases of major depressive episodes is it possible for someone to have a loss of contact with reality?

Yes, they may experience delusions(bizarre ideas w/o foundation) and hallucinations.

Major Depressive Disorder:

A severe pattern of depression that’s disabling and not caused by such factors as drugs or a general medical condition.

• May be described as seasonal, catatonic(excessive or little activity), or melancholic(unaffected by pleasurable events).

Persistent Depressive Disorder:

A chronic form of unipolar depression marked by ongoing and repeated symptoms of either major or mild depression. Significant distress or impairment.

• During the 2-year period, symptoms aren’t absent for more than 2 months at a time.

Can a stressful event trigger an episode?

Yes, 80% of severe episodes occur within a month or two of a significant negative event.

Reactive (exogenous) depression:

Follows clear-cut external stressful event.

Endogenous Depression:

A response to internal factors.

Postpartum (peripartum) Depression:

A disorder in which a major dperessive episode typically begins within four weeks after delivering a child; many cases begin during pregnancy.

Symptoms of Postpartum Depression:

Extreme sadness, despair, anxiety, instrusive thoughts, compulsions, panic attacks, suicidal thoughts, and severe temper.

Causes of Postpartum Depression:

• Triggered by hormonal changes of childbirth

• Genetic predisposition

• Psychological and social change

Treatment for Postpartum Depression:

• Self-help groups

• Antidepressant medications, cognitive-behavioral therapy, interpersonal psychoptherapy, or combination of these.

• Treatment helps most women if it’s sought out.

Biological model of Unipolar Depression:

• Family pedigree studies

• Twin studies

• Gene studies

• Molecular biology

Family pedigree studies for Unipolar Depression:

Relatives of a person with depression should have a higher rate of depression than the population.

Twin Studies:

If an identical twin has unipolar depression, there’s a 38% chance the other twin will have it.

If a fraternal twin has unipolar depression, the other twin has a 20% chance.

Molecular Biology in unipolar depression:

Unipolar depression may be tied to genes on at least two-thirds of the body’s 23 chromosomes.

What three neurotransmitters are low in unipolar depression?

Serotonin, norepinephrine, and glutamate and how they interact.

Glutamate reflects and helps produce what?

Could reflect or help produce dysfunction of a depression-related circuit in the brain.

• Research focuses on interactions between serotonin and norepinephrine and including glutamate.

Stress studies indicate what in Unipolar Depression?

Hypothalamic-pituitary-adrenal (HPA) axis brings overreactivity and heightened horomone activity found in depressed people either reflect or help produce dysfunction.

Do people with Unipolar Depressive disorder have a depression-related circuit?

Yes, it contributes to dysfunction and includes prefrontal cortex, hippocampus, amygdala, and subgenual cingulate.

Do people with unipolar depression have irregular activity and blood flow rate?

Yes, they have irregular activity and blood flow rate in various brain locations.

• Subgenual cingulate is particularly small and active, hippocampus is undersized.

Do people with unipolar depression have inteconnectivity/communication issues between various brain circuits?

Yes, they often cause issues.

Is pathological neurotransmitter activity often an issue in unipolar depression?

Yes, it might be the result of dysfunction between the circuit’s various structures or, the cause of such circuit dysfunction.

Immune system in unipolar depression:

Under intense stress, dysregulation of the immune system contributes to depression.

• Slower functioning of lymphocytes, increased (pro-inflammatory cytokines)CRP production, and greater inflammation.

Biological treatments for unipolar depression:

• Brain stimulation

• MAO inhibitors

• Tricyclics

• Second-generation antidepressants

• Ketamine-based drugs

Brain Stimulation for Unipolar Depression:

Electroconvulsive therapy(ECT)

• 65-140 volts of electricity are passed through. Results in a brain seizure for 15-70 seconds.

MAO inhibitors for Unipolar Depression:

Increase in activity level of NTs serotonin and norepinephrine.

• Slows body’s production of enzyme monoamine(MAO).

Iproniazid; tyramine:

Found to make the patients happier.

• Must stick to a strict diet, avoid foods containing tyramine(cheeses, bananas,). Otherwise, it cost their blood pressure.

Tricyclics for Unipolar Depression:

Acts on neurotransmitters reuptake mechanism of key neurons.

• Inhibits the overly vigorous reuptake by allowing serotonin and norepinephrine to remain in their synpases for longer.

Selective Serotonin Reuptake Inhibitors (SSRIs):

Increase serotonin activity w/o affecting other neurotransmitters(norepinephrine).

• Fluoxetine/Prozac; sertaline/Zoloft; Escitalopram/Lexapro

Selective norepinephrine reuptake inhibitors that only increase norepinephrine:

Atomoxetine/Strattera

Selective norepinephrine reuptake inhibitors that increases both serotonin and norepinephrine:

Venlafaxine/Effexor

Ketamine-based drugs for unipolar depression:

Alleviates depression quickly, bringing relief to those who’re unresponsive to other kinds of treatment, suicidal, and does well under other drugs and psychotherapies.

• FDA approved Esketamine/Spravato a nasal spray for depressed individuals.

Ketamine-based drugs increase what neurotransmitter?

Increases glutamate

• Improves connectivity between the structures in the circuit more directly or completely.

Cog-beh model focus on what in Unipolar Depression:

Depression results from problematic behavior and dysfunctional thinking.

Behavioral Dimension for Unipolar Depression:

Number of life rewards related to presence or absence of depression.

• Strong relationship between positive life events and and feelings of life satisfaction and happiness.

Negative Thinking for Unipolar Depression:

Beck: Unipolar depression is produced by a combination of maladaptive attitudes, cognitive triad, errors in thinking, and automatic thoughts.

Do people with unipolar depression minimize and magnify experiences?

Yes, they often minimize positive experiences and magnify issues.

• Error in thinking; illogical thinking processes.

Automatic Thoughts:

A steady train of unpleasant thoughts that suggest they’re inadequate and their situation is hopeless.

• Happen like a reflex.

Ruminative responses during…

depressed moods are linked to longer feelings of dejection and increased likelihood of later clinical depression.

Learned helplessness:

Depression occurs when people believe they have no control over life’s reinforcements(rewards and punishments) and assume responsibility for this helpless state.

Attribution-helplessness theory:

Internal (global and stable) attribution of present

• Lack of control → feel helpless to prevent future negative outcomes → depression

  • I am inadquate at everything, and I always will be

Behavioral Activation for Unipolar Depression:

• Reintroduction to pleasurable events/activities

• Consistently reward non-depressive behaviors and withhold rewards for depressive ones.

• Help clients improve social skills.

Beck: Cognitive Therapy:

Phase 1: Increasing activities and elevating mood; behavioral technique.

Phase 2: Challenging automatic thoughts

Phase 3: Identifying negative thinking and biases

Phase 4: Changing primary(maladaptive) attitudes

Acceptance and commitment therapy(ACT):

Clients increasingly accept their negative thoughts for what they are and work around them.

Sociocultural model of unipolar depression:

Unipolar depression influenced by social context and often triggered by outside stressors.

Family-social perspective for Unipolar Depression:

Social deficits(repeated reassurance, etc.) may cause avoidance by others, thereby decreasing their soical contacts and rewards.

• A decline in social rewards impacts depression.

Weak or unavaliable support, isolation, and lack of intimacy are tied to what?

Troubled or unhappy marriage. That may lead to depression and remained depressed for longer.

Can social isolation and imposed soical distancing lead to depression?

Yes, the sense of loneliness that emerges during long periods of isolation can lead to depression.

• Recognized by people in these situations as they try to improve.

Interpersonal psychotherapy(IPT)

A treatment for unipolar depression that’s based on the belief that clarifying and changing one’s interpersonal problems helps lead to recovery.

• Useful for those who have social conflict or undergoing role changes.

Artifact Theory:

Holds that women and men are equally prone to depression but that clinicians often fail to detect depression in men.

• However, most women are no more willing or able than men

Hormone Explanation:

Hormone changes trigger depression in women(puberty, pregnancy, and menopause).

• Social and life events can account for depression.

Life Stress Theory:

Most women in our society are subject to more stress than most men.

• Poverty, menial jobs, discrimination, etc.

Body Dissatisfaction Explanation:

Most Western girls are taught to have an unattainable low body weight and slender body type.

• Most with EDs have a likelihood of depression.

Lack-of-Control Theory:

Women may be more prone to depression than most men due to feeling less control over their lives.

• Due to victimization of any kind

Rumination Theory:

Women are more likely than men to ruminate when they experience low moods.

Multicultural Treatments:

• Cultural training and heightened awareness of their clients cultural values and culture-related stressors.

• Development of comfortable bicultural balance.

• Recognition of impact of own and dominant culture.

Do genetically inherited biological predispositions influence depression?

Yes, significant early life trauma and/or inadequate parenting can also influence depression.

• Overly reactive brain-body stress route, and a dysfunctional depression-related brain circuit.

Symptoms of mania:

• Seek constant excitement, involvement, and companionship.

• Move quickly as if they don’t have enough time.

• Clouded judgment shown by poor judgment and planning.

• Significantly energetic despite little sleep.

Cyclothymic Disorder:

Milder form of bipolar disorder

• Continues for 2 or more years, interrupted by occasional normal moods lasting for only days or weeks

Neurotransmitters Activity in bipolar disorder:

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

Ion Activity in bipolar disorder:

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

• Resulting in neurons firing too easily and mania.

Brain imaging and postmortem studies have identified a number of what in bipolar disorder?

Irregular brain structures in the basal ganglia and cerebellum.

• Also found smaller amount of gray matter in the brain.

Many theorists believe that people inherit what?

A biological predisposition to develop bipolar disorders.

Molecular biology techniques for bipolar disorder:

A variety of genes located on at least 13 different chromosomes.

Lithium:

A metallic element that occurs in nature as a mineral salt and is an effective treatment for bipolar disorders.

• Incorrect dosage could lead to lithuim toxcitiy(posioning).

Antiseizure drugs/Mood stablizing drugs:

• lamotrigine (Lamictal),

• carbamazepine (Tegretol), and

• valproate (Depakote)

Antipsychotic drugs:

Originally used to treat schizophrenia. Effects unfold sooner than mood-stablizers.

Mood stabilizers do help reduce what?

Suicidal ideation, however other symptoms of depression linger.

What might be the reason lithium and antiseizure drugs help?

Possible that the drugs change synaptic activity by operating within neurons.

Mood-stablizing drugs increase what?

Production of brain-derived neurotrophic factor(BDNF).

• Increases the health and functioning of those cells and thus reduce bipolar symptoms.

• Functioning and communication between key structures in the brain.

Lithuim increases what in bipolar disorder?

Increases the size of the hippocampus and the amount of gray matter.

Cognitive Triad:

The three forms of negative thinking. The triad consists of a negative view of one’s experiences, oneself, and the future.

Maladaptive attitudes:

In life a number of failures is inevitable, such maladaptive attitudes are inaccurate and set the stage for all kinds of negative thoughts and reactions.

Errors in Thinking:

Draw arbitary inferences—negative conclusions based on little evidence.

Major Depressive Episode Checklist:

• Daily insomnia or hypersomnia

• Daily agitation or decrease in motor activity

• Daily fatigue or lethargy

• Daily feelings or worthlessness or excessive guilt

• Daily reduction in concentration or decisiveness

• Repeated focus on death or suicide, a suicide plan, or a suicide attempt.