MOOD DISORDERS

This section explores common signs and behaviors that could indicate depression in a friend.

Definitions:
- Mood: Long-lasting, diffused, non-specific affective experience that includes frequent emotions.
- Examples of moods: Euthymic (normal mood), elated (high mood), depressed mood.

Types:
- Unipolar: Only involves depressive symptoms.
- Bipolar: Involves both depressive and manic symptoms.
Symptoms of Depression Include:
- Sadness.
- Feelings of worthlessness and guilt.
- Withdrawal from social interactions.
- Changes in sleep and appetite.
Symptoms of Mania Include:
- Intense elation or irritability.
- Hyperactivity, talkativeness, and distractibility.

A unipolar disorder characterized by the presence of one or more Major Depressive Episodes (MDE).
Symptoms of MDE:
- Emotional: Depressed mood (irritability in children), feelings of worthlessness and guilt, difficulty concentrating.
- Cognitive: Thoughts of death or suicide, fatigue, weight loss/gain, insomnia/hypersomnia.
- Somatic: Psychomotor retardation/agitation.
- Behavioral: Anhedonia (loss of interest in activities).
Duration: Symptoms must be present for at least 2 weeks nearly every day.
Impairment: Must cause significant impairment in social, occupational, or other areas of functioning.

Symptoms: Must have 3 or more of the following for most days over 2 years without symptom remission for 2 months:
- Emotional: Depressed mood, low self-esteem.
- Cognitive: Hopelessness, fatigue, weight loss/gain/change in appetite, insomnia/hypersomnia, poor concentration.
Comparison with MDD:
- MDD requires at least one MDE, while Dysthymia describes chronic mild depression.

Requires five or more symptoms to be present in the final week before the onset of menstruation, with improvement shortly after menses starts, and minimal or absence of symptoms in the week post-menses.
Symptoms include marked affective lability, irritability, depressed mood, anxiety, anhedonia, and physical symptoms like bloating or breast tenderness.
Affects 2%-5% of women with an unknown etiology; treatment similar to that for MDD.

Severity: mild, moderate, severe, in remission.
With Features:
- Anxious distress.
- Psychotic features (delusions or hallucinations).
- Melancholic features (inability to experience pleasure).
- Seasonal affective disorder (SAD).
- Peripartum onset.

Episodic: Symptoms may dissipate over time.
Recurrent: Future episodes are likely once depression occurs; average number of episodes is 4 (Judd, 1997).
Subclinical Depression: Symptoms of sadness along with 3 other symptoms lasting for 10 days cause significant impairment but do not meet full criteria for depression.

MDD is approximately twice as common in women than men. Reasons include:
- Biological factors: hormonal differences.
- Women are more likely to experience sexual abuse and chronic stressors.
- Women often ruminate more, while men are likely to distract themselves.

Variation in symptoms across cultures.
- Latinx cultures show more complaints of nerves/headaches.
- Asian cultures show weakness/fatigue/poor concentration complaints.
- Co-morbidity: 2/3 of individuals with MDD also meet criteria for anxiety disorders.

Genetic Factors: Heritability estimates are around 37%.
Neurotransmitter Factors: Low levels of norepinephrine, dopamine, and serotonin have been linked with depression; high levels of norepinephrine and dopamine in mania.
Neuroendocrine Factors: Overactivity of HPA axis linked to high cortisol levels.
Social Factors: Increased stressful life events associated with onset, and interpersonal difficulties leading to relapses.
Cognitive Factors: Negative cognitive styles and learned helplessness contributed to the development of MDD.

Psychotherapy: Cognitive-Behavioral Therapy (CBT), Interpersonal Psychotherapy (IPT), and Mindfulness-based approaches.
Biological Treatments:
- Antidepressants:
  - SSRIs, SNRIs, tricyclics, and MAO inhibitors.
- Electroconvulsive Therapy (ECT): Considered highly effective for severe depression but carries stigma.
- Transcranial Magnetic Stimulation (TMS): New generation intervention for depression.
- Deep Brain Stimulation: Emerging treatment with promising early data on effectiveness.

Identify and challenge negative thoughts and cognitive errors.
Use of behavioral activation including monitoring activities and scheduling pleasant events.
Implementation of a thought diary to track emotions and cognitive patterns.
Encourage alternative perspectives to develop more balanced views.

Jill, a teacher dealing with grief, demonstrates withdrawal and guilt, alongside emotional and cognitive symptoms of depression.
Carol, a college student experiencing post-breakup sadness, presents with sleep disturbances and pervasive feelings of inadequacy.

Mood disorders, specifically Depression, encompass a range of symptoms, causes, and treatments which require a nuanced understanding to address effectively. Treatment must be tailored to individual patient needs, considering the interplay of biological, psychological, and social factors.