Chapter 16

Depression

Mood Disorders and Creativity

Two Major Categories of Mood Disorder

• Major depressive disorder (unipolar): Lengthy, uninterrupted periods of depressed mood.

• Manic depressive disorder (bipolar): Cycling between periods of elevated mood (mania) and depression.

• While sharing the common feature of depression, these are unique and separate disorders.

Major Depressive Disorder Symptoms• Depressed mood most of the time• Loss of pleasure in normally fun activities• Sleep disturbances• Eating disturbances• Lack of energy or restlessness• Difficulty concentrating• Feelings of hopelessness, worthlessness• Suicidal thoughts

Major Depressive Disorder is the “Common Cold” of Mental Disorders• As many as 12% of men and 21% of women may

experience major depressive disorder during their lifetimes.• Most patients with MDD

are women.– Prior to adolescence, boys

and girls are equally likely to experience depression.

– In adults, about 2/3 of patients with depression are female.

• Most patients experience 5–6 episodes during their lifetimes.

Bipolar Disorder• Periods of mania alternate with depression. • Mania is characterized by:

– Inflated self-esteem (grandiosity)– Reduced need for sleep– Talkativeness– Racing thoughts– Distractibility– Goal-oriented behavior– Excessive involvement in pleasurable activities

Risk FactorsGenetics: Concordance rate for mood disorders among identical and fraternal twins

Risk FactorsStress: The HPA Axis

Antidepressants• Monoamine oxidase inhibitors (nardil)

• Classic tricyclics (elavil)

• Selective reuptake inhibitors (prozac, zoloft, paxil)

• Atypical antidepressants (wellbutrin)

Therapies for Affective DisordersAcute and long-term effects of MAO-Is on synaptic function

Acuteeffects

Chroniceffects

Normal

Therapies for Affective DisordersTricyclic antidepressants

Therapies for Affective DisordersSelective serotonin reuptake inhibitors (SSRIs)

Therapies for Bipolar DisordersLithium

Theories on Affective Disordersmonoamine hypothesis

Theories on Affective Disordersglucocorticoid hypothesis

Neurochemical Bases of Mood DisordersEffect of stress and antidepressant treatment on BDNF in hippocampal cells