Mood Disorders

Announcements:

  • Moodle Quiz

  • Read An Unquiet Mind- discussion on Wednesday after break

Lecture Outline

  • mood

  • internalizing spectrum

  • unipolar mood disorders

  • causal factors of depression

  • treatment of depression

  • bipolar mood disorders

  • causal factors of bipolar

  • treatment of bipolar

Mood

  • Mood

    • Overall emotional experience

      • Fluctuates over time

      • Positive vs. negative valence

      • Associated thoughts

  • Dimensional model of mood reflects

    • Broad clustering of the subjective experience of emotions

    • Intensity

Mood versus Mood Disorder

  • Mood episode

    • relatively long-term time period (a few weeks) where moods are abnormal

    • The building blocks of Mood Disorders

  • Mood Disorder

    • Combination of 1 or more Mood Episodes

    • Can be a combination of Depression and/or Mania

Statistics about Mood Disorders

  • Depression= 7%

    • Lifetime women= 10-25%

    • Lifetime men= 5-12%

  • Persistent Depressive Disorder (Dysthymia) = 2%

  • Premenstrual Dysphoric Disorder= 1.3-1.8%

  • Bipolar Disorders= 1-2%

Signs and Symptoms of Mood Disorder

  • Mood

  • Cognitive

  • Behavioral

Major Depressive Disorder

  • Once someone has had a manic episode, they can no longer ever be diagnosed with Major Depressive Disorder again, only Bipolar, because some treatments of MDD have a negative impact on those with bipolar

Persistent Depressive Disorder (Dysthymia)

  • Persistent depressive disorder (in children and adolescents, mood can be irritable and duration must be 1 year or longer)

  • Depressed mood for most of the day, for more days than not, for 2 years or longer

  • Presence of 2 or more of the following during the same period

    • Poor appetite or overeating

    • insomnia or hypersomnia

    • low energy or fatigue

Depressive Disorder Specifiers

  • With Anxious Distress

  • w mixed features

    • potential for bipolar diagnosis later on

  • w catatonia

    • Individuals not getting out of bed, talking about now feeling sad but feeling empty

  • w melancholic features

    • moment to moment emotional reactivity- not responsive

  • w atypical features

  • w peripartum onset

  • w seasonal pattern

  • w mood-congruent psychotic features

  • w mood-incongruent psychotic features

Premenstrual Dysphoric Disorder

  • Mood fluctuations/disturbance

    • times around menstrual cycle

    • includes other mood disorder symptoms

    • severity, but not duration of other mood disorders

Depression

Demographics of Depression

  • Age

    • symptoms (and terms) change with age

  • Gender

    • 1.5 to 3x as likely to be diagnosed in women

      • Role stress→ “double shift”- gender expectations change in the late 60s early 70s, women were expected to work in the home prior to this, then in the 60s and 70s an increase of women working outside of the home. men and women shared domestic tasks now

      • Men externalize negative affect, and women internalize

  • Culture

    • Symptoms (and terms) change with culture

  • SES

    • Low SES associated with higher rates and longer duration of depression

What Causes Depression

  • Biological factors

    • Genetic Factors

      • Higher risk in relatives

      • 5-HTT Gene (Serotonin transporter protein

  • Neurochemical Factors

    • Abnormal Neurotransmitter Levels: Norepinephrine (low), serotonin (low)

    • Monoamine receptors

    • Hormonal factors: Cortisol

  • Brain Factors

    • Prefrontal cortex (left)- less gray matter, reduced activity

    • Anterior cingulate- dysregulated activity

    • Hippocampus- smaller, less active

    • Amygdala- larger, more active

  • Neuroendocrine Factors

    • Sleep

    • Seasons

  • Psychological Factors

    • Stressful Life events

      • Chronic Stress

      • Major life events

    • Shifts in rewards or punishments

    • Learned helplessness

    • Pessimistic attributional style:

      • Internal (vs external) attributions

      • Stable (vs unstable) attributions

      • Global (vs specific) attributions

        • Linked to depression, low self esteem, hopelessness/helplessness

  • Psychological Factors

    • Cognitive distortions

      • Negative automatic thoughts

      • cognitive biases: magnification, overgeneralization, etc

    • Ruminative Response

      • Intense focus on feelings/symptoms of depression and causes of those symptoms

    • Interpersonal problems

      • E.g. excessive Reassurance

Biological Interventions - Tryclics

  • Widley used (e.g., Tofranil, Elavil)

  • Symptom relief in 60% of people with depression

  • Block reuptake of norepinephrine and other neurotransmitters

  • Problems

    • Takes m4 to 8 weeks for the effects to be known

    • Negative side effects are common

      • dry mouth, sexual dysfunction, blurry vision, constipation

    • Low fatal dosage-3-4 times average daily prescription

Biological Interventions- MAOI’s

  • Monoamine Oxidase (MAO)

    • Enzyme that breaks down monoamine neurotransmitters

  • MAO Inhibitors block monoamine oxidase

    • Similarly effective to tricyclics

  • Problems

    • Side effects similar to tricyclics

      • Plus liver damage, weight gain and low blood pressure

    • Must avoid foods containing tyramine (beer, red wine, cheese, chocolate)

    • Bad interactions with many other prescription meds

Biological Interventions- SSRI’s

  • Specifically block reuptake of serotonin

    • Fluoxetine (Prozac) is the most popular SSRI

  • No more effective than other meds, but:

    • Faster symptom relief (2-6)

    • less severe side effects

    • overdose is typically not fatal

    • also relieves anxiety, reduces binge eating, reduces obsessions and compulsions

  • Problems

    • side effects- agitation, jitteriness, nausea, decreased sex drive

    • increased suicidality in some people (especially children and adolescents)

Biological Interventions- Newer Meds

  • Other medications have been developed for treating depression

    • SSNRIs

      • Block reuptake of serotonin and norepinehprine

      • e.g. Cymbalta, Effexor

      • Side effects may be more varied than SSRIs

    • Wellbutrin/Zyban

      • Blocks reuptake norepinephrine and dopamine

      • Can help with cognitive and psychomotor symptoms of depression

      • Sometimes used to treat low sex drive caused by other meds

Biological Interventions- Electroconvulsive Therapy

  • Electroconvulsive Therapy (ECT)

    • Involves applying brief electrical current to brain

    • Results in temporary seizures

    • Usually 6 to 10 treatments are required

  • Side effects: short-term memory loss

  • Uncertain Why ECT works

  • Relapse is common

Biological Interventions- Other treatments

  • Light therapy

    • Helps with seasonal affective disorder

  • Brain/nerve stimulation

    • rTMS

    • Deep Brain Stimulation

    • Vagal Nerve stimulation

Psychological Interventions- Psychodynamic Therapy

  • Depression results form unconscious grief over real or imagined losses, compounded by excessive dependence on other people

  • Therapy uses same basic procedures for all psychological disorders:

    • Free association

    • Therapist interpretation

  • Research has mixed findings

Psychological Interventions- Behavioral Therapy

  • Depressed mood is result of lack of positive reinforcemnt in dat-to-day life

  • Use behavioral principles to change this

    • Reintroduce pleasurable activities

    • Appropriately reinforce/punish behavior

    • Teach social skills

    • Teach “mood management” skills for stress

  • Only limited effectiveness when 1 technique is applied

    • Combine 2 or 3= better results

Psychological Interventions- Cognitive Therapy

  • Depression cause by a pattern of negative thinking

    • Maladaptive attitudes→ “cognitive triad”

      • Negatively viewing oneself, the world, and the future

    • These biased views combine with illogical thinking to produce automatic thoughts

  • Therapy=Identity and Change negative thinking

  • 4 Phases (usually 6-16 sessions):

    • Increase activates and elevate mood (behavioral)

    • Identify negative thinking and biases

    • Challenge automatic thoughts

    • Change primary attitudes/beliefs

Psychological Intervention-Interpersonal Therapy

  • Interpersonal Therapy (IPT)

    • This model holds that four interpersonal problems may lead to depression and must be addressed

      • Interpersonal loss

      • Interpersonal role dispute

      • interpersonal role transition

      • Interpersonal deficits

    • Studies suggest that IPT is as effective as cognitive therapy treating depression

Psychological Interventions- Couples therapy

  • The main type of couples therapy is behavioral marital therapy (BMT)

    • Focus is on developing specific communication and problem-solving skills

  • If marriage is conflictual, BMT is as effective as other therapies for reducing depression

Bipolar Mood Disorder- Manic Episode

  • Must have manic or hypomanic mood episodes

  • Manic episodes include at least 1 week of abnormal and persistent

    • Elevated,

    • Expansive, or

    • Irritable Mood

Hypomanic Episode

  • DSM Criteria same as manic episode except:

    • A period of persistently elevated, expansive, or irritable mood, lasting at least 4 days

    • Not severe enough to cause marked impairment in functioning or require hospitalization. No psychotic features

Bipolar 1 Disorder

  • Major depressive episode + manic episode

Bipolar 2 Disorder

  • Major depressive episode+ hypomanic episode

Cyclothymic Disorder

  • Hypomania+ mild depression

Contributing Factors

  • Biological factors

    • strong genetic link

    • Dysregulation of monoamines

      • Increase during mania

      • Decrease during depression

    • Abnormal brain structure

      • Amygdala and Prefrontal cortex

    • Abnormal brain activation

      • Striatum

        • Part of reinforcement system (ex: scrolling through tiktok)

What Causes Mania?

  • Psychological Factors

    • Reward sensitivity

    • Stress

    • Rhythm/routine change

Treatments for Bipolar Disorder

Biological Interventions

  • Lithium is a common salt

    • Primary drug of choice for bipolar disorders?

    • Acts as a “mood stabilizer”

      • Reduces suicidality

    • Side effects may be severe

      • Dosage must be carefully monitored

    • Why lithium works remains unclear

  • Anticonvulsants are also effective

    • Tegretal, Depakote

  • Atypical antipsychotics also used

    • Zyprexa, Geodon

Psychotherapy

  • Therapy focuses

    • Education

    • medication management

    • Social skills

    • relationship issues

    • depressive symptoms

    • maintaining daily stability

  • Research suggests it helps

    • reduce hospitilization

    • improves social functioning

    • increases clients’ ability to obtain and hold a job