Clinical Psychology: Mood Disorders and Depression
Clinical Psychology - Mood Disorders: Depression
Overview of Mood Disorders
Definition of Mood Disorders:
Include disorders characterized by significant alterations in mood.
Sources:
DSM-IV: Defined mood disorders.
DSM-5: Separate sections created for categorizing mood disorders:
Depressive disorders
Bipolar and related disorders
Understanding Mood Disorders
Concept of Disorder:
Mood disorders exist on a continuum:
Severity
Duration
Normal to maladaptive responses to sadness, including:
Normal_ Sad_ Despair
Maladaptive conditions impact functioning and well-being.
Types of Mood Disorders
Divided into two main categories:
Depressive Disorders:
Major Depressive Disorder
Persistent Depressive Disorder (Dysthymia)
Bipolar & Related Disorders:
Bipolar I
Bipolar II
Cyclothymia
Mood Episodes
Three Building Blocks of Mood Episodes:
Major Depressive Episode
Manic Episode
Hypomanic Episode
Major Depressive Episode (MDE)
Symptoms of MDE:
Dysphoria/Sadness
Anhedonia: Loss of interest or pleasure
Presence of 3-4 of these additional symptoms:
Weight loss/gain and/or appetite disturbance
Insomnia or hypersomnia
Psychomotor agitation and/or retardation
Fatigue or loss of energy
Feelings of worthlessness or excessive/inappropriate guilt
Diminished concentration or indecisiveness
Thoughts of death or suicide
DSM-5 Requirement:
Five of the symptoms must be present within the past two weeks.
Depressive Specifiers
Specific types of depression include:
Melancholic
Atypical
Mood congruent psychosis
Mood incongruent psychosis
Peripartum onset
Seasonal pattern (requires at least two major depressive episodes occurring at the same time annually, typically winter)
Bereavement Considerations
DSM-IV Stance:
No diagnosis of major depressive disorder if it occurs within two months after the loss of a loved one.
Modern Perspectives (DSM-5):
Redefines bereavement, stating that significant depression can indicate a mental illness irrespective of loss period.
Persistent Depressive Disorder (Dysthymia)
Symptomatology:
Depressed mood for most of the day, more days than not, lasting at least two years involving:
Poor appetite or overeating
Insomnia or hypersomnia
Low energy or fatigue
Low self-esteem
Poor concentration or difficulty making decisions
Feelings of hopelessness
Premenstrual Dysphoric Disorder (PDD)
General Overview:
Severe form of PMS caused by hormone fluctuations.
Symptoms start late in luteal phase and end shortly after menstruation begins.
Prevalence:
75% of women experience minor symptoms, 20-50% PMS, 3-5% meet PDD criteria.
Epidemiology of Major Depression
Lifetime Prevalence Statistics:
Total: 16.6%
For women: 20-25%
For men: 9-12%
12-month Prevalence:
Total: 6.7%
For women: 5-9%
For men: 2-3%
Prevalence varies across cultures with sex differences observed at puberty.
Factors Contributing to Increased Risk in Women
Possible reasons include:
Hormonal or genetic influences
Societal roles leading to a sense of lack of control or helplessness
Adolescent pressures:
Stressful life events contributed to vulnerability.
Pessimistic cognitive styles and increased ruminative tendencies.
Increased body dissatisfaction due to secondary sexual characteristics.
Sample Characteristics of Study Participants
Study comprised of 135 individuals aged 8-15, mean age 11.85, SD=2.13.
Split into:
8-12 years (n=85)
13-15 years (n=50)
Gender distribution:
48.15% male
51.85% female
Mean diary entries recorded: 18.99, SD=2.15.
Emotional Regulation Across Age and Sex
Observational data on negative and positive affect:
Evaluations of emotional regulation methods varying by age and sex with specific references to dampening and rumination styles at different developmental stages.
Prevalence of Depression by Age Cohort
Reported percentage of individuals experiencing depression in specific age brackets with the highest prevalence observed in older age groups.
Recurrence Statistics for Major Depressive Disorder (MDD)
Risks of Recurrence:
Following one MDE: 50-60% probability of another occurrence.
After two episodes: 70% probability.
After three episodes: 90% probability.
5% will transition to Bipolar Disorder during their course.
Up to 15% of individuals will die by suicide.
Cumulative Probability of Recurrence after Recovery
Statistical representation:
An increasing trend in the probability of recurrence with the number of years post-recovery from an MDE.
Increased Risk Factors for MDE Onset or Relapse
Previous significant factors include:
Multiple prior MDEs
Double depression (combination of MDD and dysthymia)
Prolonged individual MDE duration
Family history of affective disorders
Remaining residual symptoms post-recovery
Presence of comorbid anxiety or substance abuse issues
Female gender
Being never married or divorced
Experiencing unemployment or disability
Living in poverty.
Elderly Population Considerations
Noted Aspects:
Depression seen as prevalent among the elderly, possibly linked to circumstances such as empty nest syndrome explaining psychological changes associated with aging.
Major Depressive Disorder Comorbidity Rates
High comorbidity rates of 72% characterized by:
59% comorbidity with anxiety disorders
24% with substance use disorders
30% with impulse control disorders.
Diathesis-Stress Model
Conceptual Framework:
Illustrates interaction between biological and environmental factors leading to depression.Diagram Annotations:
Different outcomes based on the presence or absence of diathesis under levels of environmental stress.
Understanding Diathesis in Mood Disorders
Biological Model Factors Include:
Genetic Factors:
Twin studies indicate MDD in Dizygotic (DZ) twins at 10% and Monozygotic (MZ) twins at 40%; Bipolar Disorder (BP) shows 12% in DZ twins and 62% in MZ twins.
Variance in genetic influence:
MDD accounts for 37% variance; BP accounts for 80%.
Key Neuroanatomical Regions in Mood Disorders
Highlighted Functions and Regions:
Reward sensitivity often has decreased volume and reduced activity in cognitive control areas.
Specific dopamine pathways are implicated in reward and pleasure responses.
Examination of Neurotransmitters
Key Monoamines Involved in Mood Regulation:
Norepinephrine
Serotonin
Dopamine
Sunlight, Sleep & Circadian Rhythms
Relationship with:
Seasonal Affective Disorder (SAD) due to lack of sunlight exposure.
Sleep patterns, hormone secretions (i.e., cortisol), and circadian rhythm disorders associated with depressive states.
Psychological Factors in Depression
The Role of Rumination:
Rumination as a cognitive response style involving repetitive contemplation of internal emotional states and their repercussions.
Environmental Stress Factors Associated with Depression
Severe life events contributing to onset or exacerbation of depressive symptoms include:
Death of loved ones
Divorce/separation
Serious illnesses or accidents (self or others)
Job or role changes
Moves or changes in residence
Exposure to burglary.
Social Learning and Behavioral Theory Perspectives
Lewinsohn's Contributions:
Recognizes negative feedback from stressful life events leading to the loss of reinforcement and subsequent downward spirals in behavior.
Interpersonal Theory in Depression
Coyne/Joiner's Insights:
Deterioration in interpersonal support systems potentially elicited by individual behavior leading to experiences of rejection.
Learned Helplessness Theory
Seligman's Model:
Examines operant conditioning wherein subjects experience uncontrollable conditions leading to learned helplessness and resultant depressive symptoms.
Reformulated Helplessness Theory**
Attributional theory analyzes responses to adverse events based on:
Internal vs. external attributions
Global vs. specific interpretations
Stable vs. unstable considerations of causation.
Summary: Depression Take Home Points
Characterized as:
An episodic mood disorder with high frequency and heterogeneity.
Influenced by biological and psychological vulnerabilities including cognition, reward processing, and emotion regulation.
Stress plays a significant role, especially in the onset of initial episodes.