PSYCH 138 Exam 2

Depressive Disorders

Onset:

• Childhood – rare

• Adolescence/young adulthood – risk increases

• Middle adulthood – risk decreases

• Late adulthood/old age – risk increases

Duration:

• Variable

• If untreated – several months to several years

From Grief to Depression:

• Prior to DSM-5, depression could not be diagnosed during periods of  mourning

• Now with DSM-5, major depression may occur as part of the grieving process

• Acute grief – eventual coming to terms with the meaning of loss

• Complicated grief – persistent acute grief and inability to come to terms with loss

Major Depressive Episode (DSM-5 Criteria)

• Symptoms (5 or more) for at least 2 weeks, nearly every day:

  • Depressed mood (subjective or observed)

  • Markedly diminished interest or pleasure (Anhedonia)

  • Significant weight loss or gain, changes in appetite

  • Insomnia or hypersomnia

  • Psychomotor agitation or retardation

  • Fatigue or loss of energy

  • Feelings of worthlessness or excessive guilt

  • Difficulty concentrating, indecisiveness

  • Recurrent thoughts of death, suicidal ideation

• Clinically significant distress or impairment

• Not attributable to substances or medical conditions

• Physical changes + behavioral/emotional “shutdown”

  • Dysfunctional reward processing

  • Anhedonia 

  • Indicative of low positive affect (not just high negative affect)

• Untreated duration: 4-9 months

• Mood symptoms

  • Sadness

  • Guilt & Shame

  • Excessive Crying

  • Tend to be worse in the morning

  • Anxiety – frequent comorbidity

  • Loss of gratification/joy in living (anhedonia)

  • Loss of pleasure

• Cognitive symptoms

  • Self-criticism

  • Perception of self as a failure

  • Belief in one’s inferiority, inadequacy, and incompetence

  • Attitude of pessimism and hopelessness

  • Concentration difficulties

  • Indecisiveness/ambivalence 

• Motivational symptoms

  • Trouble waking up in the morning

  • Difficulty working

  • Lack of initiative

  • Ambivalence

  • Difficulty in making decisions

  • Psychomotor retardation (in more severe depression)

• Physical symptoms

  • Loss of appetite/food loses its taste

  • Weight loss (moderate & severe depression)

  • Weight gain (mild depression)

  • Sleep disturbance

  • Sexual dysfunction 

  • Somatic symptoms (aches & pains)

  • Vulnerability to physical illness

  • Psychomotor retardation (in more severe depression)

Major Depressive Disorder (MDD)  – 1+ depressive episode

• Recurrent episodes more common than a single episode (rare)

• Specifiers:

  • With psychotic features: Hallucinations, delusions

  • With anxious distress: Significant anxiety symptoms

  • With melancholic features: Lack of pleasure, early morning awakenings

  • With atypical features: Weight gain, hypersomnia, rejection sensitivity

  • With peripartum onset: Occurs around childbirth

  • With seasonal pattern (SAD): Seasonal affective disorder, light therapy as treatment

Persistent Depressive Disorder (Dysthymia) – Depressed mood 2+ years

• Depressed mood for at least 2 years (1 year in children/adolescents)

• Fewer symptoms than MDD but more chronic

Premenstrual Dysphoric Disorder (PMDD) – Depressive symptoms prior to menses, week leading up to period

• Severe mood symptoms before menstruation

• Emotional and physical symptoms

• At least 5 symptoms must be present i the final week before the onset of menses (and improve days after onset, and minimal/absent in week post menses)

  • Marked affect lability

  • Marked irritability

• One or more of the following symptoms must be additionally present

• Controversial diagnosis because nobody knows the exact cause, no major scientific basis, no etiology

  • Advantages – acknowledges difficulties of severe symptoms

  • Disadvantages – pathologized an experience many consider to be normal, so much variability with symptoms

Disruptive Mood Dysregulation Disorder (DMDD) – Temper outbursts + angry/irritable mood in children ages 6-18

• Diagnosed only in children 6-18 years old

• Frequent, severe recurrent temper outbursts in children

• Persistent irritability between episodes

• Criteria for manic/hypomanic episodes are not met

• Designed in part to combat overdiagnosis of bipolar disorder

Bipolar Disorders

Manic Episode (DSM-5 Criteria)

• Symptoms for at least 1 week, nearly every day:

  • Abnormally elevated, expansive, or irritable mood

  • Increased goal-directed activity or energy

  • 3 or more of the following (4 if irritable mood only):

    • Inflated self-esteem or grandiosity

    • Decreased need for sleep

    • More talkative than usual or pressured speech

    • Racing thoughts (flight of ideas)

    • Distractibility

    • Increase in goal-directed activity or psychomotor agitation

    • Excessive risky behaviors

• Clinically significant distress or impairment

• Not due to substances or medical conditions

• Untreated duration → 3-4 months

• Hypomanic episode (less severe)

  • Does not cause marked impairment in functioning

  • Need only last 4 days

Bipolar I Disorder

• At least 1 manic episode (may include depressive episodes but not required)

Bipolar II Disorder

• Alternating at least 1 hypomanic episode + 1 major depressive episode

• No full manic episodes

Cyclothymic Disorder

• Chronic mood fluctuations (2+ years)

• Hypomanic and depressive symptoms that do not meet full criteria for episodes

Mixed Features

• Depressive episodes with some manic symptoms or vice versa

IV. Suicide & Risk Factors

Suicidal Ideation vs. Attempts vs. Completion

• Suicidal Ideation: Thoughts of death or self-harm

• Suicide Attempt: Non-fatal self-injury with intent to die

• Suicide Completion: Death by suicide

Risk Factors

• Psychological Disorders: Depression, Bipolar Disorder, Schizophrenia

• Previous Suicide Attempt

• Family History of Suicide

• Substance Abuse

• Stressful Life Events (e.g., loss of job, relationship breakup)

• Access to Lethal Means

• Lack of Social Support

• Hopelessness

Prevention & Intervention

• Crisis Intervention (Hotlines, therapy, hospitalization if necessary)

• Cognitive Behavioral Therapy (CBT)

• Medication (Antidepressants, Mood Stabilizers)

• Social Support & Community Resources

Suicide & Risk Factors

Suicidal Ideation vs. Attempts vs. Completion

• Suicidal Ideation: Thoughts of death or self-harm

• Suicide Attempt: Non-fatal self-injury with intent to die

• Suicide Completion: Death by suicide

Risk Factors

• Psychological Disorders: Depression, Bipolar Disorder, Schizophrenia

• Previous Suicide Attempt

• Family History of Suicide

• Substance Abuse

• Stressful Life Events (e.g., loss of job, relationship breakup)

• Access to Lethal Means

• Lack of Social Support

• Hopelessness

Prevention & Intervention

• Crisis Intervention (Hotlines, therapy, hospitalization if necessary)

• Cognitive Behavioral Therapy (CBT)

• Medication (Antidepressants, Mood Stabilizers)

• Social Support & Community Resources

Mood Disorders & Suicide (Chapter 7)

I. Review of Mood Disorders

• Mood disorders involve gross deviations in mood (depression, mania, or both).

• Categories:

  • Depressive Disorders (Unipolar)

  • Bipolar & Related Disorders (Depressive & Manic Episodes)

• Sex differences

  • Females are 2x more likely

• Depressive Episodes: At least 2 weeks of symptoms, absence of manic/hypomanic episodes

• Manic/Hypomanic Episodes: Periods of elevated mood, increased energy

• Major Depressive Disorder (MDD): At least one depressive episode

II. Depressive Disorders

Persistent Depressive Disorder (PDD)

• Criteria:

  • Depressed mood for most of the day, for at least 2 years

  • Never symptom-free for more than 2 months

  • Can include major depressive episodes

• Symptoms (at least 2 required):

  • Poor appetite or overeating

  • Insomnia or hypersomnia

  • Low energy, self-esteem, or concentration

  • Feelings of hopelessness

• Specifier types:

  • Pure dysthymic syndrome (mild symptoms without major depressive episodes)

  • Double depression (mild symptoms + intermittent major depressive episodes)

  • Persistent major depressive episodes (lasting 2+ years)

Premenstrual Dysphoric Disorder (PMDD)

• Depressive symptoms appear before menstruation and improve after onset

• Requires at least 5 symptoms, including:

  • Mood swings, irritability, anxiety, depression

  • Fatigue, appetite changes, sleep issues, bloating

Disruptive Mood Dysregulation Disorder (DMDD)

• Only diagnosed in children (ages 6-18)

• Frequent severe temper outbursts (3+ per week)

• Persistent irritability between outbursts

III. Bipolar Disorders

Bipolar I Disorder

• At least one manic episode (7+ days or hospitalization required)

• Major depressive episodes may occur but are not required

Bipolar II Disorder

• Alternating major depressive and hypomanic episodes

• Never a full manic episode

Cyclothymic Disorder

• Mild depressive and hypomanic symptoms for 2+ years

• Symptoms never meet full criteria for MDD or mania

IV. Etiology of Mood Disorders

• Biological Factors:

  • Genetic influence (higher in females, family history increases risk)

  • Neurotransmitter imbalance (low serotonin)

  • Elevated cortisol (stress hormone)

• Psychological Factors:

  • Learned helplessness (Seligman)

    • Lack of perceived control→ decreased attempt to improve situation

    • Depressive Attributional style (hopelessness)

      • Internal attributions → negative outcomes– one’s own fault

      • Stable → Future negative outcomes– bad things will always be one’s own fault

      • Global attributions→ belief that negative events will disrupt many life activities

  • Cognitive distortions (negative self-view, overgeneralization)

    • Negative coping style

      • Commit cognitive errors

      • Tendency towards negative interpretation of life events

        • Interpreting a text message too far

    • Types of cognitive errors

      • Arbitrary inference– overemphasis on negative aspects of mixed situations

      • Overgeneralization– negatives apply to all situations

    • Depressive cognitive triad

      • Think negatively about oneself, the world, and the future

• Social & Cultural Factors:

  • Marital relationships

    • Dissatisfaction strongly related to depression (especially for men)

  • Lack of social support strongly related to depression

  • Women in all cultures tend to experience major depressive episodes more often than men

V. Treatment of Mood Disorders

Medications

• Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Prozac)

  • Block reuptake of serotonin (increasing levels)

  • Suicidal thoughts initially

  • Lowered risk for birth complications when used during pregnancy

• Mixed Reuptake Inhibitors (SNRIs) (e.g., Effexor)

  • Block reuptake of BOTH serotonin and norepinephrine

  • Less side effects

• Tricyclic Antidepressants (e.g., Elavil) – more side effects

  • May be lethal in excessive doses

  • Block reuptake of norepinephrine and other 

• Monoamine Oxidase Inhibitors (MAOIs) – dietary restrictions

  • Block monoamine oxidase (enzyme that breaks down serotonin/norepinephrine)

  • Dangerous in combination with 

    • Beer, red wine, cheese

    • Cold medicine

• Lithium – first-line treatment for bipolar disorder GOLD STANDARD FOR BIPOLAR

  • Lithium carbonate = a common salt

  • Mood stabilizer – treats depressive and manic episodes

  • Effective for 50% of patients

  • Toxic in large amounts

Other Treatments

• Electroconvulsive Therapy (ECT) – for medication-resistant depression

  • Electrical current applied to brain to change patterns

  • Temporary seizure

  • 6-10 outpatient treatments

  • Side effects – short term memory loss

• Transcranial Magnetic Stimulation (TMS) – fewer side effects than ECT

• Psychosocial Therapies

  • Cognitive Behavioral Therapy (CBT) – addresses negative thought patterns

  • Interpersonal Therapy (IPT) – improves relationships

VI. Suicide

Statistics & Risk Factors

• 11th leading cause of death in the U.S. (likely underreported)

• 3rd leading cause of death among teenagers

• 2nd leading cause of death among college students

  • 12% of college students consider suicide in a given year

• Males complete suicide more often; females attempt more

  • Male completion rates higher

  • Female attempt rate higher

  • Due to lethality methods

• Risk factors include:

  • Mental health conditions (depression, bipolar, schizophrenia)

  • Chronic illness, pain, past attempts

  • Access to lethal means (firearms, medication)

Protective Factors

• Access to mental health care

• Social support

• Coping & problem-solving skills

Prevention & Treatment

• Risk assessment & safety planning

• Cognitive Behavioral Therapy (CBT) reduces risk

• Crisis resources:

  • 988 Suicide & Crisis Lifeline

  • Trevor Project (LGBTQ+ support)

  • Veterans Crisis Line

VII. Key Takeaways

• Mood disorders involve significant disruptions in emotional regulation

• Bipolar disorders differ from depression due to manic/hypomanic episodes

• Multiple biological, psychological, and social factors contribute to mood disorders

• Effective treatments include medication, therapy, and lifestyle interventions

• Suicide prevention relies on early intervention and access to mental health resources