SS440: Unit 6Mood Disorders and Suicide

Dr. Angela WhalenKaplan University

An Overview of Mood Disorders

•Mood disorders ▫Gross deviations in mood▫Major depressive episodes▫Manic and hypomanic episodes

An Overview of Mood Disorders (continued)

•Types of DSM-IV-TR depressive disorders▫Major depressive disorder▫Dysthymic disorder▫Double depression

•Types of DSM-IV-TR bipolar disorders▫Bipolar I disorder▫Bipolar II disorder▫Cyclothymic disorder

Major Depression: An Overview •Major depressive episode: Overview and defining

features▫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

Dysthymia: An Overview

•Overview and defining features▫Symptoms are milder than major depression▫Persists for at least 2 years▫No more than 2 weeks symptom free▫Symptoms can persist unchanged over long periods (≥

20 years)

Dysthymia: An Overview (continued)

•Facts and statistics▫Late onset – typically in the early 20s▫Early onset – before age 21

Greater chronicity Poorer prognosis

Double Depression: An Overview•Overview and defining features

▫Major depressive episodes and dysthymic disorder▫Dysthymic disorder often develops first

•Facts and statistics▫Associated with severe psychopathology▫Associated with a problematic future course

Bipolar I Disorder: An Overview•Overview and defining features

▫Alternations between full manic episodes and depressive episodes

•Facts and statistics▫Average age of onset is 18 years▫Can begin in childhood▫Tends to be chronic▫Suicide is a common consequence

Bipolar II Disorder: An Overview•Overview and defining features

▫Alternations between major depressive and hypomanic episodes

•Facts and statistics▫Average age of onset is 22 years▫Can begin in childhood▫10% to 13% of cases progress to full bipolar I disorder▫Tends to be chronic

Cyclothymic Disorder: An Overview•Overview and defining features

▫Chronic version of bipolar disorder▫Manic and major depressive episodes are less severe▫Manic or depressive mood states persist for long

periods ▫Must last for at least 2 years (1 year for children and

adolescents)

Cyclothymic Disorder: An Overview (continued)

•Facts and statistics▫Average age of onset is 12 to 14 years▫Most are female▫Cyclothymia tends to be chronic and lifelong▫High risk for developing bipolar I or II disorder

Differences in the Course of Mood Disorders•Course specifiers

▫Longitudinal course Past history of mood disturbance History of recovery from depression and/or mania

▫Rapid cycling pattern Applies to bipolar I and II disorder only

▫Seasonal pattern Episodes covary with changes in the season

Mood Disorders: Additional Facts and Statistics•Worldwide lifetime prevalence

▫16% for major depression•Sex differences

▫Females are twice as likely to have major depression▫Gender imbalance disappears after age 65▫Bipolar disorders equally affect males and females

Mood Disorders: Additional Facts and Statistics (continued)

•Fundamentally similar in children and adults•Prevalence of depression seems to be similar across

subcultures•Relation between anxiety and depression – negative

affect▫Most depressed persons are anxious▫Not all anxious persons are depressed

Mood Disorders: Familial and Genetic Influences•Family studies

▫Rate is high in relatives of probands▫Relatives of bipolar probands tend to have unipolar

depression•Adoption studies – data are mixed

Mood Disorders: Familial and Genetic Influences (continued)

•Twin studies▫Concordance rates are high in identical twins▫Severe mood disorders have a strong genetic

contribution▫Heritability rates are higher for females compared to

males▫Vulnerability for unipolar or bipolar disorder

Appears to be inherited separately

Mood Disorders: Neurobiological Influences•Neurotransmitter systems

▫Serotonin and its relation to other neurotransmitters▫Mood disorders are related to low levels of serotonin▫Permissive hypothesis

•The endocrine system•Sleep disturbance

Mood Disorders: Psychological Dimensions (Stress)•Stressful life events

▫Stress is strongly related to mood disorders Poorer response to treatment Longer time before remission

▫The relation between context of life events and mood What’s good for you may not be good for others

•The learned helplessness theory of depression▫Lack of perceived control over life events

Mood Disorders: Psychological Dimensions (Cognitive Theory)

•Negative coping styles▫Depressed persons engage in cognitive errors▫Tendency to interpret life events negatively

•Types of cognitive errors▫Arbitrary inference – overemphasize the negative▫Overgeneralization – negatives apply to all situations

•Cognitive errors and the depressive cognitive triad▫Think negatively about oneself▫Think negatively about the world▫Think negatively about the future

Mood Disorders: Social and Cultural Dimensions•Marital relations

▫Marital dissatisfaction is strongly related to depression▫This relation is particularly strong in males

•Mood disorders in women▫Females over males▫Except bipolar disorders▫Gender imbalance likely due to socialization

Mood Disorders: Social and Cultural Dimensions (continued)

•Social support▫Extent of social support is related to depression▫Lack of social support predicts late onset depression▫Substantial social support predicts recovery from

depression

An Integrative Theory • Shared biological vulnerability

▫Overactive neurobiological response to stress• Exposure to stress

▫Activates hormones that affect neurotransmitter systems▫Turns on certain genes▫Affects circadian rhythms▫Activates dormant psychological vulnerabilities▫Contributes to sense of uncontrollability▫Fosters a sense of helplessness and hopelessness

• Social and interpersonal relationships/support are moderators

Treatment of Mood Disorders

•Tricyclic Medications•Monoamine Oxidase (MAO) Inhibitors•Selective Serotonergic Reuptake Inhibitors (SSRIs) •Lithium •Electroconvulsive Therapy (ECT)

Psychosocial Treatments

•Cognitive therapy▫Addresses cognitive errors in thinking▫Also includes behavioral components

• Interpersonal psychotherapy▫Focuses on problematic interpersonal relationships

The Nature of Suicide: Facts and Statistics•Eighth leading cause of death in the United States•Overwhelmingly a white and Native American

phenomenon•Suicide rates are increasing, particularly in the young

The Nature of Suicide: Facts and Statistics (continued)

•Gender differences▫Males are more successful at committing suicide than

females▫Females attempt suicide more often than males

The Nature of Suicide: Risk Factors•Suicide in the family •Low serotonin levels•Preexisting psychological disorder•Alcohol use and abuse•Past suicidal behavior•Experience of a shameful/humiliating stressor•Publicity about suicide and media coverage

Summary of Mood Disorders

•All mood disorders share▫Gross deviations in mood▫Common biological and psychological vulnerability

•Occur in children, adults, and the elderly•Onset, maintenance, and treatment are affected by

▫Stress▫Social support

Summary (continued)

•Suicide is an increasing problem ▫Not unique to mood disorders

•Medications and psychotherapy produce comparable results

•High rates of relapse