MOOD DISORDERS

Historical perspective

• Galen – bodily fluids and temperament

• black bile and melancholia

• Endogenous vs. reactive depression

• Neurotic vs. psychotic depression

MOOD DISORDERS

Diagnostic issues

DSM-IV lists 10 mood disorders• Major depressive disorder

• Dysthymic disorder

• Bipolar I

• Bipolar II

• Cyclothymic disorder

• Rapid cycling depression/mania

• Seasonal affective disorder

• Mood disorder with postpartum onset

• Mood disorder due to general medical condition

• Substance-induced mood disorder

MOOD DISORDERS

Diagnostic issues

• a number of “specifiers” (e.g., severity, chronicity) are used in diagnosis

• Two broad categories – unipolar and bipolar

• Two important criteria in diagnosis – duration and severity

MOOD DISORDERS

Diagnostic issues – Types of symptoms

• mood and emotion

• cognitions

• behavior and motivation

• physical

• the experience of depression

MOOD DISORDERS

Unipolar disorders – Major depression

• symptoms include feelings of sadness, loss of interest or inability to experience pleasure, unexplained weight loss, difficulty sleeping, fatigue, difficulty concentrating, feelings of worthlessness or guilt, suicidal thoughts, agitation or slowing down

• typically lasts 6-9 months

MOOD DISORDERS

Unipolar disorders – Major depression

• estimates suggest about 5% of Americans suffer from depression (1-year prevalence rate); 22% lifetime prevalence for major depression

• twice as common in women – biological differences, expression of symptoms, social acceptability, role strain and stress

• estimates are that half of people who recover from major depression will experience another episode; those with 2 or more episodes have 70-80% chance of having another episode

MOOD DISORDERS

Unipolar disorders – Major depression

Problem of underdiagnosis

• no obvious marker for depression

• many symptoms do not obviously point to depression

• stigma associated with diagnosis of depression

MOOD DISORDERS

Unipolar disorders – Dysthymia

• many of the same symptoms as major depressive disorder, but less severe

• dysthymia persists for at least 2 years with only brief times mood returns to normal – chronic sadness

MOOD DISORDERS

Bipolar disorders – Mania

• flamboyance and expansiveness

• extreme or prolonged mania presumed to be psychotic state

• less severe episodes are called hypomanic

• some people experience mania as a “high”

• there can be unipolar mania

MOOD DISORDERS

Bipolar disorders – Bipolar I and II

• Bipolar I – one or more manic episodes and one or more depressive episodes

• Bipolar II – at least one hypomanic episode and one or more episodes of major depression

• Bipolar disorders less prevalent than unipolar, .8-1.6% of population

• age of onset in 20s

• Rapid cycling depression/mania – 4 or more episodes per year

MOOD DISORDERS

Bipolar disorders – Cyclothymia

• long-standing pattern of alternating mood episodes that do not meet criteria for major depression or mania

• criteria include duration of at least 2 years with recurrent periods of mild depression alternating with hypomania

MOOD DISORDERS

Bipolar disorders – Seasonal Affective Disorder (SAD)

• vulnerable to changes in sunlight, especially fall and spring

• prevalence rates of 4-6%, found more often in northern latitudes

• many SAD symptoms opposite of those found in major depression – increase in appetite, weight gain, more sleep

MOOD DISORDERS

Bipolar disorders – Seasonal Affective Disorder (SAD)

• hormone melatonin

• photoherapy

MOOD DISORDERS

Etiology – Psychological models

• Psychodynamic – fixation at oral stage

• mourning and melancholia – introjection of lost loved one, anger turned inwards

• Depressive personality

• Attachment – Bowlby, anaclitic depression, introjective depression

MOOD DISORDERS

Etiology – Psychological models

• Cognitive – Beck – negative cognitive triad

• negative schemata

• cognitive distortions – selective abstraction, arbitrary inference, overgeneralization, magnification and minimization

MOOD DISORDERS

Etiology – Psychological models

• Learned helplessness and causal attributions – Seligman

• Life stress – especially loss experiences

• Interpersonal effects – marital violence, expressed emotion (EE)

• 3 components of EE – criticism, hostility, overinvolvement

MOOD DISORDERS

Etiology – Biological models

• Genetics – first degree relatives of people with unipolar disorder have 30-35% prevalence rate for depression; second degree relatives, 12-15% prevalence rate

• Twin study (McGuffin et al., 1991) – Concordance rates of 53% for MZ twins, 28% for DZ for unipolar disorder

MOOD DISORDERS

Etiology – Biological models

• Twin study (Bertelsen et al., 1977) – Concordance rates of 67% for MZ twins, 20% for DZ for bipolar disorder

• Neurotransmitter deficiencies – catecholamines (NE and serotonin)

• Monoamine hypothesis – shortage of NE, dopamine, and serotonin

MOOD DISORDERS

Etiology – Biological models

• EEG findings – higher alpha readings in left front region

• Sleep disturbances – decrease in slow wave sleep and earlier onset of REM

• MRI and PET studies show increased ventricle size and decreased activity in left lateral prefrontal cortex

MOOD DISORDERS

Treatment – Psychological models

• Depression often improves without treatment

• Cognitive therapy

• Behavioral strategies

• Interpersonal therapy

MOOD DISORDERS

Treatment – Biological models

• Antidepressant therapy – MAOs, tricyclics, selective serotonin reuptake inhibitors (SSRIs)

• Mood stabilizers – lithium carbonate for bipolar

• Combining pharmacotherapy and psychological therapy

• ECT – a controversial treatment

MOOD DISORDERS

SUMMARY

• Mood disorders are very common mental disorders, yet they often go undetected and untreated

• There are gender differences in rates of diagnosed depression

MOOD DISORDERS

SUMMARY

• The 2 main types of mood disorder are unipolar and bipolar

• Within these 2 categories there are wide differences in severity and duration of symptoms

• Biopsychosocial model appears to give the best account of mood disorders

MOOD DISORDERS

SUMMARY

• but, not much on the social origins of depression

• Bipolar appears to have a stronger biological component than unipolar disorders

• There are effective psychological and biological treatments for the different mood disorders