Transcript Lecture 6
Mood Disorders Major Depressive Disorder Five or more symptoms present for two weeks or more: Disturbed Mood depressed mood anhedonia (reduced interest or pleasure) Disturbed Cognitive Functions trouble concentrating feelings of worthlessness thoughts of death / suicide Major Depressive Disorder Disturbed Physical (vegetative) Functions weight loss / gain sleep problems psychomotor disturbance lack of energy Major Depressive Disorder How long does depression last if untreated? 4 to 9 months 90% chance gone in 5 years Are men or women more likely to be depressed? women are twice as likely as men to have major depression Gender differences in depression Cultural effects: gender roles encourage mastery in males, dependence in females the way in which a person responds to the onset of a depressed mood rumination vs. distraction Depression across the lifespan: rate of depression rises dramatically in adolescence average age of onset 25 - 29 depression closely related to anxiety almost all depressed patients are also anxious Persistent Depressive Disorder (Dysthymia) Dysthymic Disorder: symptoms of major depression are milder but remain unchanged for at least two years can last 20 – 30 years – median duration of 5 years 79% with dysthymia have had a major depressive episode Double Depression: both major depressive disorder and dysthymia Seasonal Affective Disorder (SAD) depressive episode begins in the fall and ends with beginning of spring more common in northern climates Phototherapy – exposure to bright light Grief Acute Integrated Complicated Suicide 11th leading cause of death in the US more common among Caucasians than African Americans and Hispanics higher rates among the elderly than other groups. women are 3 times more likely to attempt suicide males are 4 to 5 times more likely to commit suicide Importance of Assessment Suicidal desire – Ideation Suicidal capability – Past attempts Suicidal intent - Plan Risk & Protective Factors Biological Theory and Treatment • low levels of serotonin and norepinephrine • permissive hypothesis: when serotonin levels are low, other neurotransmitters can range more widely Anti-depressants tricyclic - prevents reuptake of norepinephrine and serotonin (e.g., Imipramine, Amitriptyline) SSRI - (selective serotonin reuptake inhibitor) blocks the reuptake of serotonin (e.g., Prozac) MAO inhibitors - elevate level of norepinephrine and serotonin by blocking deactivating enzyme (e.g., Nardil) Electroconvulsive Therapy (ECT): shock is delivered to the brain transcranial magnetic stimulation: magnetic coil delivers electromagnetic pulse to the brain. Cognitive Theories and Treatment Depressive Cognitive Triad (Beck, 1967): 1) self 2) world 3) future Interpersonal Psychotherapy (IPT) Depression stems from problems in relationships. We develop cyclical maladaptive patterns (CMPs) of relating to others from our interaction with others. These patterns get played out in adult relationships including with the therapist. Therapy seeks to identify and treat these CMPs. Efficacy of Psychological Treatment of Mood Disorders CBT and IPT Outcomes Comparison with medications Bipolar and Related Disorders http://www.youtube.com/watch?v=R87GfrbXQmU Bipolar and Related Disorders Manic Episode: period of abnormally elevated mood (at least one week) inflated self-esteem decreased need for sleep extremely talkative racing thoughts distractible increase in goal-directed activity and/or pleasurable activities Types Bipolar I: At least one manic episode. Often alternate manic episodes with major depressive episodes. Bipolar II: alternate hypomanic episodes with major depressive episodes Cyclothymia: at least two years – periods of hypomania and depressive symptoms Specifiers Rapid cycling : at least four manic or depressive episodes within a year Mixed episode : criteria met for both a manic episode and major depressive episode for at least a week Medications for Bipolar Disorder lithium bicarbonate anticonvulsants (e.g.,depakote, lamictal)