Chapter 7 Chapter 7 Mood Disorders and Mood Disorders and

SuicideSuicide

Amber GilewskiAmber Gilewski

Tompkins Cortland Community CollegeTompkins Cortland Community College

Major Depressive EpisodeMajor Depressive Episode

Extremely depressed mood lasting at least 2 weeks

Cognitive symptoms – Feelings of worthlessness, indecisiveness

Disturbed physical functioning Anhedonia – Loss of pleasure/interest in

usual activities

Mania and HypomaniaMania and Hypomania SymptomsSymptoms

-elated joy, euphoria-elated joy, euphoria

-excessive or extraordinary activity-excessive or extraordinary activity

-rapid speech-rapid speech

*Criteria for manic episode*Criteria for manic episode

-duration of 1 week-duration of 1 week

-irritability towards the end-irritability towards the end

-anxiousness and depression-anxiousness and depression

-if left untreated, lasts 3-6 months-if left untreated, lasts 3-6 months

**Hypomanic episodesHypomanic episodes – less severe – less severe

Depressive DisordersDepressive Disorders

Major Depressive DisorderMajor Depressive Disorder

• Single episode – Highly unusual

• Recurrent episodes – More common

• Median # of episodes = 4 with duration of 4-5 month

• Mean age of onset = 25-29 years old

• Age appears to be decreasing

Persistent Depressive DisorderPersistent Depressive Disorder(Dysthymia)(Dysthymia)

Symptoms are milder than major depression

Persists for at least 2 years (1 year for children & adolescents)

No more than 2 months symptom free

Symptoms can persist unchanged over long periods (≥ 20 years)

Late onset – Typically in the early 20s

Early onset – Before age 21

• Greater chronicity

• Poorer prognosis

““Double DepressionDouble Depression””

Major depressive episodes AND dysthymia

Dysthymic disorder often develops first

Associated with severe psychopathology

Associated with a problematic future course

Bipolar I DisorderBipolar I Disorder

Alternations between full manic episodes & depressive episodes

Average age on onset is 18 years

Can begin in childhood

Tends to be chronic

Suicide is a common consequence

Bipolar II DisorderBipolar II Disorder

Alternations between major depressive & hypomanic episodes

Average age on onset is between 19 - 22 years

Can begin in childhood 10 to 13% of cases progress to full bipolar I

disorder Tends to be chronic

Cyclothymic DisorderCyclothymic Disorder Chronic version of bipolar disorderChronic version of bipolar disorder

Manic & major depressive episodes are less severeManic & major depressive episodes are less severe

Manic or depressive mood states persist for long Manic or depressive mood states persist for long periods periods

Must last for at least 2 years (1 year for children & Must last for at least 2 years (1 year for children & adolescents)adolescents)

Average age on onset is 12 to 14 yearsAverage age on onset is 12 to 14 years

Most are femaleMost are female

High risk for developing bipolar I or II disorderHigh risk for developing bipolar I or II disorder

Prevalence of Mood DisordersPrevalence of Mood Disorders

16% lifetime prevalency for Major Depression16% lifetime prevalency for Major Depression

Females are twice as likely to have major depressionFemales are twice as likely to have major depression

Bipolar disorders equally affect males and femalesBipolar disorders equally affect males and females

High rates amongst Native AmericansHigh rates amongst Native Americans

Most depressed persons are anxiousMost depressed persons are anxious

Not all anxious persons are depressedNot all anxious persons are depressed

Causes of Mood Disorders: Causes of Mood Disorders: Biological dimensionsBiological dimensions

Family & twin studies – runs in familiesFamily & twin studies – runs in families

Mood disorders are related to low levels of Mood disorders are related to low levels of serotoninserotonin

Endocrine system – cortisolEndocrine system – cortisol

Sleep disturbances/circadian rhythmsSleep disturbances/circadian rhythms

Mood Disorders: Mood Disorders: Psychological Dimensions Psychological Dimensions

Stress is strongly related to mood disorders

The relation between context of life events and mood

Reciprocal-gene environment model: depressed persons putting themselves in high risk situations

Beck proposed cognitive errors

Treatment of Mood Disorders: Treatment of Mood Disorders: Tricyclic MedicationsTricyclic Medications

Widely used (e.g., Tofranil, Elavil)

Block reuptake of NE and serotonin

Therapeutic effects can take 2-8 weeks

Negative side effects are common

May be lethal in excessive doses

Treatment of Mood Disorders: Treatment of Mood Disorders: MAO Inhibitors MAO Inhibitors

Monoamine oxidase (MAO)

Block Monoamine Oxidase

This enzyme breaks down serotonin/norepinephrine

Slightly more effective than tricyclics

Must Avoid Foods Containing Tyramine

Examples include beer, red wine, cheese

Treatment of Mood Disorders:Treatment of Mood Disorders:

SSRIsSSRIs Specifically block reuptake of Specifically block reuptake of

serotoninserotonin

Fluoxetine (Prozac) is the Fluoxetine (Prozac) is the most popular SSRImost popular SSRI

Negative side effects are Negative side effects are commoncommon

SSRIs pose no unique risk of SSRIs pose no unique risk of suicide or violencesuicide or violence

www.londonstimes.us/toons/index_medical.html

Treatment of Mood Disorders: Treatment of Mood Disorders: St JohnSt John’’s Worts Wort

Herbal solution for depression

Works as well as low doses of other antidepressants

Alters serotonin function Few side effects No prescription needed in

the U.S.www.jadeandpearl.com/.../jp0040St,John.jpg

Treatment of Mood Disorders: Treatment of Mood Disorders:

LithiumLithium Lithium Is a Common SaltLithium Is a Common Salt

Primary drug of choice for bipolar disordersPrimary drug of choice for bipolar disorders

Can be toxicCan be toxic

Side Effects May Be SevereSide Effects May Be Severe

Dosage must be carefully monitoredDosage must be carefully monitored

Why Lithium Works Remains UnclearWhy Lithium Works Remains Unclear

Psychological TreatmentsPsychological Treatments

Cognitive Therapy

Addresses cognitive errors in thinking

Also includes behavioral components

Interpersonal Psychotherapy

Focuses on problematic interpersonal relationships

Therapy and medication may be equally effective

The Nature of Suicide: The Nature of Suicide: Facts and Statistics Facts and Statistics

11th Leading Cause of Death in the United States11th Leading Cause of Death in the United States

Overwhelmingly a White and Native American Overwhelmingly a White and Native American PhenomenonPhenomenon

Suicide Rates Are Increasing, Particularly in the Young Suicide Rates Are Increasing, Particularly in the Young and Elderlyand Elderly

Gender DifferencesGender Differences

Males complete suicide more often than femalesMales complete suicide more often than females

Females attempt suicide more often than malesFemales attempt suicide more often than males

Suicide: Suicide: Risk Factors, Prevention, & TreatmentRisk Factors, Prevention, & Treatment

Suicide in the Family Suicide in the Family Low Serotonin LevelsLow Serotonin Levels Preexisting Psychological Preexisting Psychological

DisorderDisorder Alcohol Use and AbuseAlcohol Use and Abuse Past Suicidal BehaviorPast Suicidal Behavior Experience of a Experience of a

Shameful/Humiliating Shameful/Humiliating StressorStressor

Predicting suicide: Predicting suicide: difficult, but ask difficult, but ask appropriate questionsappropriate questions

Prevention measuresPrevention measures

-Suicide contract: may -Suicide contract: may help prevent suicidehelp prevent suicide

-Curriculum based -Curriculum based programs: education & programs: education & preventionprevention

Treatments for those at Treatments for those at risk: problem solving, risk: problem solving, CBT, coping, etc.CBT, coping, etc.