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Chapter 10
Mood Disorders
Ch 10
Mood Disorders
• Mood Disorders involve a disabling
disturbance in emotion
– Depression is an emotional state marked by
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Sadness or loss of pleasure
Feelings of worthlessness and guilt
Withdrawal from others
Reduced sleep, appetite, sexual desire
– Mania is an emotional state marked by
• Intense elation
• Hyperactivity, talkativeness, distractability
Ch 10.1
Diagnosis of Unipolar
Depression
• Unipolar depression diagnosis requires presence
of 5 of the following:
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Sad, depressed daily mood
Loss of interest in usual activities
Difficulties in sleeping
Poor appetite and weight loss
Loss of energy, great fatigue
Negative self-concept
Recurrent thoughts of suicide or death
Ch 10.2
Depression Issues
• Depression exists on a continuum
• Major depression is quite common
– Lifetime prevalence rates range from 5.2% to 17.1%
– Women are twice as likely to develop depression as are
men
– Higher rates in young adults and among individuals in
lower socioeconomic groups.
– Depression prevalence varies across cultures
• Prevalence of depression has been increasing
over the last 50 years
Ch 10.3
Diagnosis of Bipolar Disorder
• Bipolar disorder involves
– Alternating episodes of mania and
depression
– Increase in activity level (work, social, sexual)
– Unusual talkativeness, rapid speech
– Reduced requirements for sleep
– Inflated self-esteem
– Distractability
– Reckless spending
Ch 10.4
Chronic Mood Disorder
• Chronic Mood Disorder refers to long-term
changes in mood that are less severe than
that of unipolar or bipolar depression
– Cyclothymic disorder refers to frequent periods
of depressed mood and hypomania
– Dysthymic disorder involves chronic depression
-Recent studies suggest dysthymia may be more
debilitating over the long term than depression.
Ch 10.5
 Clinical Description
Extremely Depressed Mood
– Lasting at Least 2 Weeks
Cognitive Symptoms
Anhedonia
Vegetative Symptoms
Single or Recurrent Episode
– No Manic or Hypomanic
Episodes
 Clinical Description
2 Weeks or More
 Facts and Statistics
Mean Age of Onset is 25
Years
Length of Episode Varies
Remission is Common
Risk of Suicide
 Clinical Description
2 Years or More
 Facts and Statistics
Mean Age of Onset Early
20s; Symptoms can persist unchanged over
long periods (e.g., 20 years or more)
Onset Prior to Age 20
– Greater Chronicity
– Poor Prognosis
– Stronger Family Link
Major Depressive Episodes
are Common
 Clinical Description
Suffer From Both
– Major Depression Episodes
– Dysthymic Disorder
Dysthymic Usually Begins First
Associated With Severe
Pathology
A Problematic Future Course
 Clinical Description
Dysthymia
Dysthymia
Major
Depression
 Major Features
Experience Both
– Manic Episodes
– Major Depressive Episodes
Roller Coaster of Mood
What are Manic Episodes?
 Mania and Hypomania
 Elevated Mood
1 Week
4 Days
 Grandiosity
 Increased Activity
 Varied Impairment
 Clinical Description
Major Depressive
Episodes
Alternate With
Full Manic Episodes
 Clinical Description
Mania
Major
Depression
 Clinical Description
Major Depressive
Episodes
Alternate With
Hypomanic Episodes
 Only 10 to 13% of cases
progress to full bipolar I disorder
 Clinical Description
Hypomania
Major
Depression
 Clinical Description
Milder Depressive
Episodes
Alternate With
Hypomanic Episodes
– Average age of onset is about 12 or 14
years
– Cyclothymia tends to be chronic and
lifelong
– Most are female
– High risk for developing bipolar I or II
disorder
 Clinical Description
Hypomania
Dysthmia
 General Facts and Statistics
Bipolar I
– Onset Around 18 Years
Bipolar II
– Onset Around 22 Years
16% Commit Suicide
Cyclothymia
– Typically Chronic
 Recent Episode and Pattern
Psychotic
– Hallucinations and Delusions
– Very Rare but Serious Condition
– Poor Treatment Response
 Recent Episode and Pattern
Postpartum
– Major Depression and Mania
– Four Weeks Following Birth
– Mood Episodes of a Psychotic
Nature
– Relatively Rare
 Course and Pattern
Longitudinal
Course
Rapid-Cycling
Seasonal Pattern
– Bipolar and Recurrent Major
Depression
– Episodes During Certain
Seasons
 Facts and Statistics
7.8% Lifetime Prevalence
Females > Males
– Major Depression and
Dysthymia
Females = Males
– Bipolar Disorders
Similar in Children and Adults
Psychological Theories of
Depression
• Psychoanalytic theory views grief over object loss
as the basis for depression
• Cognitive views of depression include
– Beck’s theory of depression: the way depressed
people think is biased towards negative interpretations
– Learned helplessness: depressed people are passive
because they have been unable in the past to control
traumatic events
Ch 10.6
Depression and Positive
Emotion
• Depressed individuals:
– Display fewer positive expressions
– Report experiencing less pleasant emotion in
response to pleasant stimuli
– Physiologically less responsive to positive, but
not negative, stimuli
 Negative Cognitive Biases
 Beck’s Cognitive Triad
 Negative Schema About
Self,
World,
& Future
Cognitive Biases in Depression
• Arbitrary influence refers to a conclusion drawn in
the absence of sufficient evidence
• Selective abstraction refers to a conclusion drawn
on one of many elements in a situation
• Overgeneralization refers to an overall sweeping
conclusion drawn on a basis of a trivial event
• Magnification of trivial events
Ch 10.7
Learned Helplessness
• Learned helplessness view is that depression is a
response to a history of failing to control traumatic
life events
• The Attribution-Learned helplessness view is that
depressed people make global, stable and
internal attributions
• Hopelessness view is that depressed persons
expect that desired outcomes will not occur, their
actions will have no effect
Ch 10.8
 Stressful Life Events
 Learned Helplessness
 Attributional Style
– Internal attributions – Negative outcomes are
one’s own fault
– Stable attributions – Believing future negative
outcomes will be one’s fault
– Global attribution – Believing negative events will
disrupt many life activities
– All three domains contribute to a sense of
hopelessness
Helplessness Theories of
Depression
Ch 10.9
Mood Disorders: Social &
Cultural Dimensions
• Marriage and Interpersonal Relationships
– Marital dissatisfaction is strongly related to depression
– This link is particularly strong in males
• Gender Imbalances
– Occur across all mood disorders, except bipolar disorders
– Gender imbalance likely due to socialization (i.e., perceived
uncontrollability and more rumination in women)
• Social Support
– Extent of social support is related to depression
– Presence of social support delays onset of depression
– High expressed emotion and/or family conflict predicts relapse
– Substantial social support predicts recovery from depression but
not from mania
Interpersonal Theory of
Depression
• Interpersonal relations are altered in depression
– Depressed people have limited social support networks
– Depressed people elicit rejection from others
– Depressed people are low in social skills across a wide
variety of situations
– Depressed people seek reassurance from others, but
this reassurance is temporary
Ch 10.10
Biological Theories of Mood
Disorder
• Genetic factors for bipolar disorder are
supported by adoption, family and twin
studies
– The role of genetic factors in unipolar
depression is not as strong as bipolar disorder
• Neurochemistry studies link norepinephrine
(NE) to mania/depression and serotonin (5HT) to depression
Ch 10.11
 Biological Dimensions
Family Studies
Twin Studies
– As Severity Increases, so Does
the Genetic Connection
No Single Genetic Link
 Sleep and Circadian Rhythms
 Sleep Disturbances are
Common
 REM Sleep and Depression
 Diminished Deep Sleep
 Disruption of Circadian
Rhythms
Neurochemistry of Mood
Disorders
• Tricyclic drugs and MAO inhibitors relieve
depression and increase levels of NE and 5-HT
by blockade of reuptake
• Measurement of NE/5-HT metabolites in urine
and blood does not assess brain activity
• CSF levels of 5-HIAA (5-HT metabolite) are
related to depression
• Relief of depression takes 2 weeks or longer, but
NE and 5-HT levels may have to previous state
Ch 10.13
Integrative Model of Mood
Disorders
• 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 (i.e., negative
thinking)
– Contributes to sense of uncontrollability
– Fosters a sense of helplessness and hopelessness
• Social and Interpersonal Relationships/Support are Moderators
Therapies for Mood Disorders
• Psychoanalysis is not an effective treatment for
depression
• Beck’s cognitive-behavioral approach involves
changing thought patterns and activity levels
– Beck’s approach is an effective therapy for depression
– Behavioral activation component may be crucial
• Social skills training involves improving social
interactions so as to lift depression
Ch 10.14
Psychological Treatment of
Mood Disorders
• Cognitive Therapy
– Addresses cognitive errors in thinking
– Also includes behavioral components (“activation”)
• Behavioral Activation
– Involves helping depressed persons make increased
contact with reinforcing events
• Interpersonal Psychotherapy
– Focuses on problematic interpersonal relationships
• Outcomes with Psychological Treatments Are
Comparable to Medications
Biological Therapies for Mood
Disorders
• Electroconvulsive therapy (ECT) involves the
induction of brain seizures by the application of
electrical current to the skull
– ECT is an effective therapy for severe depression, but
its mechanism of action is unknown
• Drug therapy involves ingestion of tricyclic drugs,
MAO inhibitor drugs and selective serotonin
reuptake inhibitor (SSRI) drugs, or mood
stabilizers (e.g., Lithium, Tegretol, Depakote,
Topamax) for bipolar disorder
Ch 10.15
Treatment of Mood Disorders:
Lithium
Percentage of patients with bipolar disorder recovered after standard drug treatment or
drug treatment plus family therapy (Miklowitz et al., 2001; from Barlow/Durand, 3rd. Edition)
Psychological Treatment of Mood Disorders:
Relapse Prevention
Data from Teasdale (2000) study on patients treated with severe
depression (from Barlow/Durand, 3rd. Edition)
Suicide
• Suicide is the intentional ending of one’s own life
– Suicide is often related to depression, to drug use and
to borderline personality disorder
– Suicide is the 9th leading cause of death in the US
– There are gender differences in the methods of suicide
(men choose guns, women choose drugs)
Ch 10.16
 In the United States
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300,000 Kill Themselves
9th Leading Cause of Death
Increasing in Adolescents & Elderly
Males > Females in Killing
Themselves
 Females > Males in Attempts
Ten Commonalities of Suicide
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The common purpose of suicide is to seek a solution
The common goal of suicide is the cessation of consciousness
The common stimulus in suicide is intolerable psychological
pain
The common stressor in suicide is frustrated psychological
needs
The common emotion in suicide is hopelessness-helplessness
The common cognitive state in suicide is ambivalence
The common perceptual state in suicide is constriction
The common action in suicide is egression
The common interpersonal act in suicide is communication of
intention
The common consistency in suicide is with lifelong coping
patterns
Ch 10.17
Suicide Myths
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People who talk about suicide won’t do it
Suicide has no warning
Only people of a certain class commit suicide
All who commit suicide are depressed
Suicide is a lonely event
Suicidal people clearly want to die
Thinking about suicide is rare
Ch 10.18
The Nature of Suicide: Risk
Factors
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Suicide in the Family Increases Risk
Low Serotonin Levels Increase Risk
A Psychological Disorder Increases Risk
Alcohol Use and Abuse
Past Suicidal Behavior Increases Subsequent Risk
Experience of a Shameful/Humiliating Stressor Increases
Risk
• Hopelessness is a strong predictor of suicide (Beck et al.)
• Publicity About Suicide and Media Coverage Increase
Risk
Preventing Suicide
• Reduce the intense psychological pain and
suffering
• “Lift the blinders” (expand the constricted
view by helping the person see other
options other than the extremes of
continued suffering or nothingness)
• Encourage the person to pull back even a
little from the self-destructive act.