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AnOverviewofMoodDisorders

•  ExtremesinNormalMood

– Natureofdepression– Natureofmaniaandhypomania

•  DSM‐IVDepressiveDisorders

– Majordepressivedisorder

– Dysthymicdisorder

– Doubledepression

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AnOverviewofMoodDisorders

•  DSM‐IVBipolarDisorders– BipolarIdisorder– BipolarIIdisorder– Cyclothymicdisorder

MajorDepression:AnOverview

•  MajorDepressiveEpisode

– Depressedmood

– Anhedonia– CogniAvesymptoms

– VegetaAvesymptoms

•  MajorDepressiveDisorder

– Singleepisode– Recurrentepisodes

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Dysthymia:AnOverview

•  OverviewandDefiningFeatures– Depressedmoodforatleast2years

– Mild

– Chronic•  FactsandStaAsAcs– Lateonset–early20s– Earlyonset–Beforeage21,poorerprognosis

DoubleDepression:Overview

•  OverviewandDefiningFeatures– Majordepressiveepisodesanddysthymicdisorder

– Dysthymicdisordertypicallyfirst

•  FactsandStaAsAcs– Severepsychopathology– Pooroutcome

– Mostdifficulttotreat

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BipolarIDisorder:AnOverview

•  OverviewandDefiningFeatures– Fullmanicepisodesandmajordepression

•  FactsandStaAsAcs– Averageageononsetis18years– Chronic– Suicideiscommon

BipolarIIDisorder:AnOverview

•  OverviewandDefiningFeatures– Hypomanicepisodesandmajordepression

•  FactsandStaAsAcs– Averageageononsetis22years– Only10to13%ofcasesprogresstobipolarI

– Chronic

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CyclothymicDisorder

•  OverviewandDefiningFeatures– Mildermaniaanddepression

– PaTernmustlastforatleast2years

•  FactsandStaAsAcs– HighriskfordevelopingbipolarIorII– Mostarefemale

– Averageageononsetisearlyadolescence

TheBipolarSpectrum

M m

d

D

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CourseofMoodDisorders

MajorDepressionMnemonic

•  SIGECAPS•  Sleep•  Interest•  Guilt•  Energy•  ConcentraAon•  AppeAte•  Psychomotor•  Suicide

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MoodDisorders:CharacterisAcs

Major Depressive Disorder

Dysthymic Disorder

With melancholic features With atypical features

With psychotic features With catatonic features

With postpartum features With seasonal onset (SAD)

Bipolar Disorders

Cyclothymic Disorder

Depression Mania

melancholic atypical

psychotic catatonic

postpartum seasonal onset

Mood Disorders: Subtypes

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AddiAonalFactsandStaAsAcs

•  LifeAmePrevalence– About7.8%ofUSpopulaAon

•  SexDifferences– MDD:2:1WomentoMen

– Bipolardisorders:1:1•  MostDepressedPersonsareAnxious,NotAllAnxiousPersonsareDepressed

GeneAcInfluences

•  StrongfamilialinheritancepaTernsforbothMajorDepressionandBipolar

•  SerotoninTransportergene(5‐HTT)isONEcandidate

•  DepressioninMDDandBipolarhavesamegeneAcs

•  ManiahasaseparategeneAcinfluence

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GeneAcInfluences

NeurobiologicalInfluences

•  NeurotransmiHerSystems– Serotonin– Permissivehypothesis

•  TheEndocrineSystem– CorAsolandDexamethasonesuppressiontest(DST)

•  SleepandCircadianRhythms– Sleepdisturbance=hallmark

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LearnedHelplessness

•  AnimalResearch(Seligman&Maier,1967):–  Dogslearntoavoidshockbyjumpingabarrier.–  Dogswhopreviouslycannotcontrolshockdonotsubsequentlylearntoavoidshock.

–  Instead,thesedogsbecome‘Helpless’

Shock Safe

Bar

rier

Shock Shock

Bar

rier

PsychologicalDimensions(LearnedHelplessness)

•  TheLearnedHelplessnessTheoryofDepression–  Relatedtolackofperceivedcontroloverlifeevents

•  DepressiveAHribuAonalStyle–  InternalaTribuAons–NegaAveoutcomesareone’sownfault

–  StableaTribuAons–BelievingfuturenegaAveoutcomeswillbeone’sownfault;pessimism

–  GlobalaTribuAon–BelievingnegaAveeventswilldisruptmanylifeacAviAes

–  Allthreedomainscontributetoasenseofhopelessness

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I suck! The world

sucks!

We’ll always suck!

Beck’sCogniAveTriad

Beck’sCogniAveModel(1967)(Early) Experience

Formation of Depressogenic Schemas

Critical Incidents

Schemas Activated

Negative Automatic Thoughts (NATs)

Symptoms

Behavioural Cognitive

Motivational Affective

Somatic

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DepressiveCogniAonsNegative Cognitive Triad:

(Pessimistic views of the self, the world & the future)

Depressogenic (Negative) Schema: Triggered by negative life events.

(e.g. “I must be the best at everything”)

Cognitive Biases (Systematic Logical Errors):

• Arbitrary Inference - The prof. Must think I’m stupid because I got a “D”. • Selective Abstraction - I did poorly because I’m stupid. • Overgeneralization - I got a “D” on the test. I’m going to flunk out of school. • Magnification & Minimization - That “A” was a fluke. • Personalization - The prof. Didn’t call on me; he must think I’m dumb. • Absolutistic Dichotomous Thinking - If I don’t get an “A” I’m a loser. • Should & Must Statements - I have to get the highest grade.

Depression

AnIntegraAveTheory

•  SharedBiologicalVulnerability–  OveracAveneurobiologicalresponsetostress

•  ExposuretoStress–  StressacAvateshormonesthataffectneurotransmiTersystems

–  Stressturnsoncertaingenes,affectscircadianrhythms,awakensdormantpsychologicalvulnerabiliAes(i.e.,negaAvethinking),contributestosenseofuncontrollability(i.e.,helplessness),fostersasenseofhelplessnessandhopelessness

•  SocialandInterpersonalSupportareModerators

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Gene‐EnvironmentInteracAons

•  Murphyetal.(2001)– Micewithaltered5‐HTTsuscepAbletostress

•  Suomiandcolleagues,Bennetetal.(2002)– Macaqueswith5‐HTTsgenesuscepAbletostressANDshowlowerserotoninlevels

•  Haririetal.(2002)– Humanswith5‐HTTsshowINCREASEDamygdalaacAvaAontofearfulsAmuli

•  Caspietal.(2003)

Dr. Fred Rose

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Treatment:TricyclicMedicaAon

•  WidelyUsed(e.g.,Tofranil,Elavil)

•  BlockReuptakeofNorepinephrineandOtherNeurotransmiHers

•  Takes2to8WeeksfortheTherapeuAcEffectstobeKnown

•  NegaAveSideEffectsAreCommon

•  MaybeLethalinExcessiveDoses

MonoamineOxidaseInhibitors(MAO‐I)

•  BlocksMonoamineOxidase

– Monoamineoxidase(MAO)isanenzymethatbreaksdownserotonin/norepinephrine

•  MAOInhibitorsAreSlightlyMoreEffecAveThanTricyclics

•  MustAvoidFoodsContainingTyramine(e.g.,beer,redwine,cheese)

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SelecAveSerotoninReuptakeInhibitors(SSRI’s)

•  SpecificallyBlockReuptakeofSerotonin–  FluoxeAne(Prozac)isthemostpopularSSRI

•  SSRIsPoseNoUniqueRiskofSuicideorViolence•  NegaAveSideEffectsAreCommonbutTemporary

–  Decreasedsexualarousal/funcAoning–  “JiTeriness”

–  Sleepdisturbance

Treatment:Lithium

•  LithiumIsaCommonSalt

– Primarydrugofchoiceforbipolardisorders

•  SideEffectsMayBeSevere

– Dosagemustbecarefullymonitored

•  WhyLithiumWorksRemainsUnclear

•  CommonAlternaAve:Depakote

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ElectroconvulsiveTherapy(ECT)

•  ECTIsEffecAveforCasesofSevereDepression•  TheNatureofECT–  Involvesapplyingbriefelectricalcurrenttothebrain–  Resultsintemporaryseizures

–  Usually6to10outpaAenttreatmentsarerequired

•  SideEffectsAreFewandIncludeShort‐TermMemoryLoss

•  UncertainWhyECTworksandRelapseIsCommon

PsychosocialTreatments

•  CogniAveTherapy– AddressescogniAveerrorsinthinking– Alsoincludesbehavioralcomponents

•  InterpersonalPsychotherapy– FocusesonproblemaAcinterpersonalrelaAonships

•  OutcomeswithPsychologicalTreatmentsAreComparabletoMedicaAons

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DatafromTeasdale2000studyonpaAentstreatedwithseveredepression

SuicideFactsandStaAsAcs

•  EighthLeadingCauseofDeathintheUnitedStates•  OverwhelminglyaWhiteandNaAveAmericanPhenomenon

•  SuicideRatesAreIncreasing,ParAcularlyintheYoung•  GenderDifferences– Malesaremoresuccessfulatcomminngsuicidethanfemales

–  FemalesaTemptsuicidemoreooenthanmales

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MethodofSuicide(1990)

Female

Male

Suicide:RiskFactors

•  SuicideintheFamilyIncreasesRisk

•  LowSerotoninLevelsIncreaseRisk•  APsychologicalDisorderIncreasesRisk•  AlcoholUseandAbuse•  PastSuicidalBehaviorIncreasesSubsequentRisk•  ExperienceofaShameful/HumiliaAngStressorIncreasesRisk

•  PublicityAboutSuicideandMediaCoverageIncreaseRisk

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Suicide:WhattoDo

•  Researchshowsthatthreatsshouldbetakenseriously

•  Donotbeafraidtodiscussthetopic•  Getassistance‐don’tacceptresponsibility•  ConsiderhospitalizaAon

SummaryofMoodDisorders

•  AllMoodDisordersShare

–  GrossdeviaAonsinmood

–  Commonbiologicalandpsychologicalvulnerability

•  StressandSocialSupportSeemCriAcalinOnset,Maintenance,andTreatment

•  SuicideIsanIncreasingProblemNotUniquetoMoodDisorders

•  MedicaAonsandPsychotherapyProduceComparableResults