mood disorders

overview of mood disoders

  • disturbances that cause subjective discomfort, hinder a persons ability to function, or both

  • why do we have emotions?

  • evolutionary psychiatry

  • emotions improve our reproductive fitness: “emotional benefit our genes far more than they do us”

overview of depression and mania

  • unipolar disorders vs bipolar disorders

  • depressed←——→ mania

  • spectrum

    • unipolar: too much depression or too much mania

    • bipolar: swings back and forth on the contiuum

  • normal mood variation: not static, varies across times

  • three elements: depth (how high or low your mood varies), variability, and reactivity

unipolar disorders

major depressive disorder: depth is extremely low and variability is very low

major depressive episode

  • affective symptoms

    • extreme depression

  • cognitive symptoms

    • rumination

    • negativism

    • death or dying

  • behavioral systems

    • anhedonia

    • psychomotor retardation

  • physiological systems

    • low energy

    • sleep disturbances

    • appetite and weight changes

    • somatic symptoms

  • have to have symptoms for 2 weeks

  • prevalence of depressive disorders

    • MOST common: 19 precent of population at some point

    • onset: mid 20s

    • more women than men (21% vs 12%)

  • controversial developments in mood disorders

    • persistent complex bereavement disorder→ understudy (overcomplicated greif)

    • disruptive mood dysregulation disorder→out of proportion temper outbursts

persistent depressive disorder (dysthymic disorder)

have symptoms for 2 years

Bipolar disorders:

  • manic episode: 1 week

    • exaggerated elation, joy, euphoria

    • 1 week or less→ less: if institutionalized, brought to jail(dont have to wait to say its a manic episode)

    • cognitive symptoms

      • increased self-esteem or grandiosity

      • flight of ideas

      • distractibility

    • physical dysfunction:

      • decrease need for sleep

      • hyperverbal

      • increase goal oriented activities/activities with high chance of bad outcome

    • hypermanic episode (4 days)

  • bipolar disorder I

    • alternating major depressive and manic episodes

    • single manic episode

    • recurrent

      • symptoms free for 2 months

  • bipolar disorder II

    • alternating major depressive and hypomanic episodes

  • cyclothymic disorder

    • alternating mild manic and depressive episodes

      • similar to bipolar II but less severe

      • two years of mood swings, no more than 2 months without symptoms

      • RARE 0.4%

      • 15% to 50% progress to bipolar I or II

etiology of mood disorders:

  • similarities between mood and anxiety disorders: distress

    • both share a “general affective sense of distress”

    • studies have found a high degree of comorbidity between anxiety and mood disorders

    • GAD and MDD share common genetic diathesis

  • mood as a thermostat

    • moos has a purpose (evolutionary)

    • anxiety = smoke alarms, mood = thermostat

    • we have natural set-points

    • problems occur when the ability to regulate mood fails

  • biological perspective:

    • genetics and family studies

      • 5-HTTLPR is a region on the gene which codes for serotonin transportation

      • in humans → it codes as short or long

      • short allele (variation) associated with neurocitism

      • gene x environment interaction

        • short allele + childhood trauma = increased risk for depression

      • medication that works for parents Major Depressive Disorder(MDD) usually works for the child with MMD

    • biochemical

      • deficits in serotonin, norepinephrine, and dopamine

      • tricyclic antidepressants → circa 1950

      • NOTE - casual relationship still speculative

    • REM sleep disturbances

      • too much too little increase risk

      • increased REM associated with depression

  • Psychological models

    • psychodynamic theory of depression:

      • oral stage: needs were either not met or over satisfied. spend their lives searching for love and approval

      • real or imagined loss

      • anger turned inwards

    • behavioral theory of depression:

      • reduction in the amount of reinforcement is the cause and leads to less activity (lewinsohn)

    • cognitive theory of depression

      • founder aaron beck

      • “depressives suffer from a kind of basic thinking that distorts reality”

      • thinking and depression by aaron beck 1963 (founder of cognitive theory of depression)

        • descriptive research

        • thematic content of cognitions

          • occurred in response to things and in “free associations”

        • characteristics of depressive cognitions (NOTE: not just the content of the thought but thinking patterns in general)

          • automatic

          • plausibility to patient → patients believed thoughts in head

          • preservation → thinking about the thoughts again and again

            • unable to not think about something else

        • depression is in the thoughts not in the genetics

  • etiology of mood disorders(aaron beck):

    • early childhood experiences can lead to the formation of dysfunctional beliefs

    • which in turn lead to negative self views and automatic thoughts

    • which in turn lead to depression

      • triad of mood disorders (Aaron Beck) → cognitive model

    • learned helplessness and depression → cognitive schemas: Seligman(person)

      • depression results from loss of control

      • attribution style

        • people who feel helpless make speculations (causal attributions) about why they are helpess

        • internal/external, stable/unstable, global/specific

          • example: walking and trip on the side walk

            • internal: i am a klutz

            • stable: i am always gonna keep failing

            • global: no matter where i go i will fall

            • external: the sidewalk had a crack in it

            • unstable: not gonna fall next time

            • specific: it is only this piece of concrete that i will fall

    • seligman dog experiment

      • some dogs were placed in a chamber where they received electric shocks from which they could not escape (the non-escape condition)

      • the dogs in the escape group could escape the shocks by pressing a panel with their nose.

      • in the second phase, the animals were placed in a shuttle box divided by a barrier in the middle so that the dogs could jump in order to escape the shocks. only the dogs that had learned to escape in the previous phase tried to jump. the other dogs did not attempt to

      • when the the dogs in the “non-escape” condition were given the opportunity to escape the shocks by jumping across a partition, most failed even to try; they seemed just to give up and passively accept any chocks the experiments chose to administer

      • in comparison, dogs who were previously allowed to escape the shocks tended to jump the partition and escape the pain.

treatment of mood disorders:

  • approximately 85% of people who receive treatment for depression improve

  • 4 types of treatment: work well in combination

    • medication

    • psychotherapy

    • electroconvulsive therap

    • transcranial magnetic stimulation (TMS)

  • medication: major depressive disorder

    • selective serotonin reuptake inhibitors(SSRI)→ prevent reabsorption of serotonin into neighboring cells

    • time: does not take effect right away →2-4 weeks before medication reaches full effect

      • depends on person and type of medication prescribed

    • side effects

      • close to 50% of people who take medication stop because of side effects

      • blood pressure, glucose level, sexual side effects (ED, and decrease sex drive)

    • 50% of sample respond to first antidepressant; 70% to the second and 90% to the third

    • treatment non-responders = chronic depression or misdiagnosis

      • chronic depression → cannot be treated by medication

  • medication: bipolar disorder

    • lithium (naturally occurring metallic element)

      • very small therapeutic window → must give exact right amount of medication for it to work without side effects

    • anticonvulsant: anti-seizure medication

    • atypical antipsychotics: only be used when person is in a manic episode

    • electroconvulsive therapy(ECT)

  • psychotherapy

    • cognitive therapy:

      • identify errors in thinking

      • correct negative cognitive schemas

    • behavioral activiation:

      • increased positive events

      • exercise

  • electroconvulsive therapy (ECT)

    • what is it?

      • brief electrical current

      • temporary seizures

        • the longer the seizures, the more effective the treatment

      • 6-10 treatments

        • typically done in an operating room→ put patient under general anesthesia

      • high efficiency → severe depression

    • few side effects

    • effectiveness is 70% to 90% but studies vary

      • once it is effective, patient has decreased need for medication

    • need to consider cost-benefit analysis

      • advantage: effective

      • disadvantage:

        • not effective forever, some people might have to get it redone every 6-12 months (not all)

        • side effects: memory loss (for 24-48 hours), headaches

  • transcranial magnetic stimulation (TMS)

    • around for 10 years, novel antidepressant treatment

    • mechanism of action (how it works) is not clearly understood

      • variation in diagnostic criteria

      • lack of solid biomarkers in depression

    • “the effect size TMS antidepressant efficacy is at least comparable to those of antidepressant medications”

    • outpatients office, put electromagnetic coil into certain parts of brain and fire magnetic field