Mood Disorders and Suicide

Chapter 8: Mood Disorders and Suicide

Outline

  1. General Characteristics of Mood Disorders

  2. Psychological Theories of Mood Disorders

  3. Biological Theories of Mood Disorders

  4. Therapies for Mood Disorders

  5. Suicide

Mood Disorders: General Characteristics

  • Intensity and Seriousness: Mood disorders are significantly more serious than typical emotional states that everyone experiences. They involve substantial disturbances in emotional states.

  • Types of Emotional Disturbance:

    • Extreme sadness (depression)

    • Extreme elation or irritability (mania)

  • Impact on Functioning: Mood disorders are disabling, interfering substantially with daily activities and functioning.

  • Associated Psychological Problems: Mood disorders are often associated with other serious psychological issues, such as:

    • Panic attacks

    • Substance abuse

    • Sexual dysfunction

    • Personality disorders

Depression: Signs and Symptoms

  • Emotional Disturbance:

    • Great sadness

    • Feelings of worthlessness and guilt

    • Withdrawal from social interactions

  • Cognitive Symptoms:

    • Self-criticism and self-blame

    • Indecisiveness and slow thinking

    • Persistent thoughts of suicide or death

    • Difficulty in concentrating and solving problems

  • Physical Symptoms (Somatic Disturbance):

    • Changes in sleep and appetite

    • Loss of sexual desire and interest in usual activities

    • Neglect of personal hygiene and appearance

Depression: Cultural Variability

  • Symptoms of depression may vary across cultures.

  • In children, physical symptoms are often the most common early indicators of depression.

  • Approximately 85% of depressed individuals focus on somatic symptoms (Kirmayer et al., 2001).

Mania: Signs and Symptoms

  • Emotional State: Characterized by an intense but unfounded elation, often accompanied by irritability.

  • Behavioral Symptoms:

    • Hyperactivity and talkativeness

    • Flight of ideas and distractibility

    • Impractical, grandiose plans

  • Observation by Others: Symptoms noticeable to others through:

    • Loud, incessant remarks, often filled with puns and jokes

    • Difficulty in conversation due to rapid topic changes

    • Increased need for activity, often irritating to others; poor planning and foresight

Diagnosis: Major Depressive Disorder (MDD)

  • Criteria: Presence of 5 of the following symptoms for at least 2 weeks:

    • Depressed mood most of the day

    • Loss of interest or pleasure in usual activities

    • Significant sleep disturbances

    • Changes in appetite and weight

    • Loss of energy or fatigue

    • Negative cognitive appraisal (feelings of worthlessness)

    • Difficulty in concentration

    • Recurrent thoughts of death or suicide

  • Prevalence:

    • Lifetime prevalence in the U.S. ranges from 5.2% to 17.1% (Kessler et al., 1994; Kessler et al., 2005; Weissman et al., 1996).

  • Gender Differences:

    • MDD is more common in women than in men.

    • This difference is consistent across the lifespan and may relate to factors such as:

    • Higher incidence in teenage girls

    • Different coping mechanisms between genders (women tend to ruminate, while men engage in distraction).

    • Hormonal differences, early stress exposure, and gender societal norms.

Diagnosis: Bipolar Disorder

  • Bipolar I Disorder: Involves episodes of mania and depression.

  • Criteria for Manic Episode:

    • Presence of elevated or irritable mood and increased activity level plus 3 additional symptoms:

    • Increased goal-directed activity

    • Unusual talkativeness

    • Racing thoughts

    • Reduced need for sleep

    • Inflated self-esteem

    • Distractibility

    • Excessive engagement in risky behaviors

  • Prevalence:

    • Lifetime prevalence rate for Bipolar I and II disorders is 4.4% (Kessler et al., 2005).

    • Episodes often recur, with more than 50% seeing recurrence within 12 months.

Variability in Bipolar Disorder

  • Heterogeneity: Bipolar I and Bipolar II disorders present varied symptoms, inconsistent severity and frequency of episodes.

  • Bipolar II Disorder: Involves episodes of major depression accompanied by hypomanic episodes (less extreme than Bipolar I mania).

  • Diagnosis Considerations: Significant variability in experiences, necessitating different treatment approaches.

Bipolar Disorder and Pregnancy

  • Mood Episodes: Both manic and depressive episodes can occur during pregnancy or postpartum (within 4 weeks of childbirth).

  • Postpartum Depression: Affects approximately 12% of mothers post-birth, with predictors including:

    • History of depression

    • Low income and social support

    • Stressors such as interpersonal violence

Psychological Theories of Mood Disorders

Psychoanalytic Theory of Depression

  • Concept: Early issues in childhood develop into depressive tendencies; akin to the process of mourning.

  • Process: Depression is viewed as an over-identification with a lost loved one, where anger is turned inward, leading to self-blaming behaviors.

Cognitive Theory of Depression

  • Concept: Thoughts are biased towards negative interpretations, forming a negative triad of the self, world, and future.

  • Cognitive Biases Identified:

    • Arbitrary inference

    • Selective abstraction

    • Overgeneralization

    • Magnification and minimization

  • Beck’s Theory: Proposes a bidirectional model of negative thoughts leading to depression.

Learned Helplessness Theory

  • Concept: An individual’s passivity and sense of inadequate control often arise from traumatic experiences that were unsuccessfully managed.

  • Attribution Styles:

    • Global attributions

    • Stable factors

    • Internal characteristics

Biological Theories

Genetic Factors

  • Bipolar Disorder: Concordance rates can be as high as 80%. Heritability studies indicate a strong genetic influence.

  • Major Depressive Disorder: Estimated heritability is around 35%. Family history can increase risk for unipolar depression.

  • Environmental Factors: Gene-environment interactions considered, especially with serotonin transporter genes.

Neurochemistry

  • Chemical Levels:

    • Decreased norepinephrine and dopamine are linked to depression.

    • Increased levels are linked to mania.

  • Serotonin Theory: Serotonin is crucial for regulating mood disorders and may indicate both depression and mania.

Neuroimaging Studies

  • Affected Brain Areas: Key structures include the amygdala, hippocampus, prefrontal cortex, and anterior cingulate.

  • Hippocampal Volume: Decreased in individuals with mood disorders.

Neuroendocrine System

  • HPA Axis: Plays a role in mood disorders, often showing elevated cortisol levels in depressed individuals.

  • Thyroid Issues: Thyroid function disorders often accompany bipolar patients and may induce manic states.

Therapies for Mood Disorders

Psychological Therapies

Psychodynamic Therapy

  • Addresses the repressed sense of loss due to internally directed anger. Aims to achieve insight and facilitate emotional release.

  • Meta-analysis: Indicates that brief psychodynamic therapy can be as effective as antidepressants for mild MDD.

Cognitive and Behavioral Therapies

  • Focuses on changing clients' perceptions of events and self. Encourages proactive behaviors.

  • Less effective for individuals with chronic depression or high levels of neuroticism.

Mindfulness-Based Cognitive Therapy

  • Aims to prevent relapses by helping individuals step back from distressing thoughts and emotions.

  • Proven to reduce relapse rates significantly, especially after repeated episodes.

Biological Therapies

Electroconvulsive Therapy (ECT)

  • Considered a dramatic intervention for severe depression. Can act faster than antidepressants and psychotherapy when effective.

Drug Therapy

  • Commonly used for treating mood disorders, often combined with psychotherapy.

  • Types of Medications:

    • Tricyclic antidepressants (e.g., Tofranil, Elavil)

    • Selective serotonin reuptake inhibitors (SSRIs) (e.g., Prozac)

    • Mood stabilizers for bipolar disorder (lithium)

  • Potential Side Effects: Include issues like heart problems, hypotension, and gastrointestinal disturbances.

Suicide

Myths and Misconceptions about Suicide

  • Talking about Suicide: May not encourage thoughts of suicide; individuals often seek relief by discussing it.

  • Seriousness of Talk: Always take talk about suicide seriously; dismissing it may escalate risk.

  • Attention-Seeking: Attempts for help often misconstrued through attention-seeking. They are usually genuine calls for support.

  • Desire for Death: Suicidal individuals typically do not want to die but seek relief from emotional pain.

Statistics and Facts

  • Suicide Rates: Contrary to belief, highest rates occur in springtime, not Christmas.

  • Demographics: Males exhibit higher suicide rates, often linked to methods used and access to means.

  • Youth Impact: Suicide is a leading cause of death in Canadian youth aged 15-24.

Risk Factors for Suicide

  • Suicidal Ideation: Refers to thoughts and intentions of self-harm or death.

  • Suicide Attempts: Attempts can be planned or unplanned and often relate to underlying mental health issues

  • Psychological Factors: Risk factors include psychological disorders, early loss, isolation, or crises.

  • Protective Factors: Include social support, resilience, and coping strategies that help mitigate risk.

Interventions and Prevention

  • Treating Underlying Disorders: Essential in addressing suicidal thoughts and behaviors.

  • Suicide Prevention Programs: Implemented at community and governmental levels to address and mitigate risks.

Conclusion

  • Overall Understanding: Understanding both mood disorders and suicidality is crucial for diagnosis, treatment, and supporting individuals at risk.

  • Complex Interactions: Mood disorders have multifaceted causes and require comprehensive approaches in both therapeutic and preventive strategies.

The psychoanalytic theory suggests that experiences during childhood can shape our emotional responses later in life. When children face difficulties or losses—like the separation from a caregiver or the loss of a loved one—they develop feelings and responses that can lead to depression as adults. This process can be likened to mourning, where the profound sadness stemming from such experiences becomes deeply embedded.

In this theory, when a person becomes depressed, it's thought that they might unconsciously identify too closely with someone they've lost, causing them to experience their loss as if it were their own fault. Instead of expressing anger about this loss outwardly, they may direct that anger inward toward themselves. This self-directed anger can manifest in feelings of worthlessness and guilt, where the individual may blame themselves for the loss or for their current emotional state.