2621 Mood Disorders and Suicide• Moods

– Enduring states of feeling that color our psychological lives.

• Mood disorders– Are disturbances in mood that impair

functioning.

Major Depression

• Must exhibit 5 or more features and one of the features must be either depressed mood/loss of interest for most of the day.

• Major depressive disorder is based on the occurrence of one or more major depressive episodes in the absence of manic or hypomanic episodes.

Other features

• Significant weight gain or loss• insomnia/hypersomnia• agitation/slowed movement• fatigue/loss of energy• sense of worthlessness/guilt• decreased concentration• suicidal thoughts

• Affects 1 in 5 adults (17%) in the U.S. at some point in their life.

• The “common cold” of psychological problems.

Risk factors

• Age (younger more likely to develop than older)

• SES• marital status• gender (women more likely than

men)

Cont. risk factors

• sociocultural (Af-A less likely to be depressed than whites/hispanics)– multinational study shows that rates of

depression are rising. Lowest rates of depression in Taiwan; highest rates in Beirut.

– Increases in depression may be due to increasing urbanization and fragmentation of the family, exposure to war and increased incidence of violence.

• Reactive depression – Depression linked to negative events while

• Endogenous depression is born from within

• To distinguish between reactive/ endogenous, endogenous exhibits more physical symptoms (weight loss, insomnia) while reactive exhibits less physical symptoms.

Seasonal Affective Disorder• Features

– fatigue– excessive sleep– craving for carbohydrates– weight gain

• Affects women more than men

Cont. SAD features

• Most common among young adults though half of those with SAD report episodes beginning in childhood or adolescence.

• Treatment involves exposure to 2 to 3 hours of artificial light (phototherapy)

Postpartum Depression

• Postpartum blues– occurs fairly frequently and lasts a couple of

days. (normal)

• Postpartum Depression– may persist for months or even a year or more.

• Features– disturbance in appetite/sleep– low self-esteem– difficulty concentrating

Dysthymic Disorder

• Milder but chronic• Affects about 3% of the adult

population at some point in their life.• It is more common in women than in

men• A person may experience Major

Depression along with dysthymia: Double Depression.

Features

• Pessimism• self-pity• inactivity• feelings of inadequacy• low self-esteem

Bipolar Disorder

• Mood swings between mania/depression

• First episode may be either mania or depression

• Mania may last from a few weeks to several months but are shorter in duration and end more abruptly

Cont. bipolar

• Bipolar I (Mixed type): one or more manic episodes

• Bipolar II: one or more depressive episode and one hypomania (a milder form of mania) episode but never a full blown manic episode.

• Relatively uncommon affecting .4% to 1.6% for bipolar d/o and .5% for bipolar II d/o

• Affects men and women at the same rate.

Features of mania

• Sudden elevation of mood• unusually cheerful• boundless energy• pressured speech • distractible • rapid flight of ideas• inflated sense of self• show poor judgment• become argumentative

Cyclothymic Disorder

• Means Circle/spirit• individual experiences mild mood

swings for at least 2 years• hypomania is a period of elevated

mood; not as severe as manic episode

• depressed mood is not as severe as Major Depression.

Theoretical Perspectives

• Stress and Mood d/o– stressors such as

• loss of loved one• unemployment• physical illness• marital discord• poverty• pressure at work • prejudice/discrimination have been contributed to

depression

– Relationship between stress/depression may be moderated by coping styles/social support.

Psychodynamic

• Depression represents anger directed inward rather than against others.

• In bereavement where there is ambivalent feelings, this can create rage/guilt. To preserve the lost object, people introject (bring inward) their mental representations of the other person into themselves. This causes the rage/guilt to turn inward resulting in depression.

Cont. Psychodynamic

• For bipolar d/o, there is a shifting dominance over the personality by ego/superego: in depression, superego is dominant producing exaggerated notions of guilt/wrong. After a time, ego rebounds/asserts supremacy, produces feelings of elation/self-confidence = manic.

Humanistic/Existential

• Depression = no meaning• Lose self-esteem when lose

friends/family

Learning

• Focus on situational factors such as the loss of positive reinforcement.

• Depression equals too little reinforcement from environment.

• Then less activity deplete opportunity/less reinforcement encourages withdrawal. Depression may also become a reinforcer.

Cognitive

• Beck’s cognitive triad equals negative beliefs about self, environment, future.

• Typical cognitive distortions:– all or nothing – emotional reasoning– overgeneralization – should statement– mental filter – labeling/mislabeling– disqualifying the positive – personalization– jumping to conclusions– magnification/minimization

Cognitive-specificity hypothesis• Depressive thoughts center on

loss, self-depreciation, pessimism.• Anxiety centers on physical

danger, threats.

Learned Helplessness

• A combination of behavioral/cognitive: situational factors foster attitudes that lead to depression. Shock dogs/attributional style– internal/external– global/specific– stable/unstable

Biological

• Genetic – Stronger for bipolar than unipolar– Uncertain what is inherited.

• Biochemical– Neurotransmitters involved

• deficiencies in norepinephrine = depression• excess in norepinephrine = mania• serotonine, acetylcholine deficiencies• thyroid hormones

Treatment

• Psychodynamic– Helps people understand their

ambivalent feelings toward the lost object.

Cont. Treatment

• Humanistic/Existential– Become aware of authentic feelings– need self-actualization– living according to one’s own

values/choices

Cont. Treatment

• Behavioral– Depression is learned/ therefore

unlearn it.

• Cognitive– Identify distorted, self-defeating

thoughts/substitute more rational thoughts.

Cont. Treatment

• Biological– antidepressants– tricyclics– monoamine oxidase inhibitors (MAO

inhibitors)– serotonin-reuptake inhibitors (SSRI)

Side Effects of tricyclics, MAO Inhibitors• Dry mouth• constipation,• blurred vision• confusion• delirium

Side Effects of Serotonin

• Upset stomach• headaches• agitation• insomnia• sexual problems

Lithium side-effects

• Potential toxic effects• impair memory• slow people down

Electro-convulsive therapy

• Used to treat major depression when antidepressants don’t work.

• Don’t know why it works.• Controversy over memory loss as

side effect.

Suicide

• Who?– More Whites than Af-A– More women attempt; more men

succeed– Elderly more likely than teens.

Cont. suicide

• Why?– People think there is a narrow range

of options available. Connected to stress.

Cont. Suicide

• Theoretical– Psychodynamic

• anger turned murderous or motivated by death instinct- a tendency to return to tension-free state before birth.

– Humanistic/existentials• Suicide is a perception that life is

meaningless/ hopeless.

– Sociocultural: alienation in today’s society

Cont. Suicide

• Learning– Reinforcement of previous attempts/

effects of stress

• Cognitive: positive outcome expectancies

• Social-learning - modeling• Biological - genetic

Predicting Suicide

• Hopelessness• Sudden sorting of affairs• Sudden peace/calm interpreted as

hope.