Mood Disorders - Psych 66 lec
Depressive and Bipolar Disorders
Depression: Low, sad state marked by significant levels of sadness, lack of energy, low self-worth, guilt, or related symptoms Mania: State of euphoria or frenzied activity in which people may have an exaggerated belief that the world is theirs for the taking -People with depressive disorder only experience depression *This pattern is called unipolar depression which is depression without a history of mania *Mood can return to normal when the depression lifts when there's no history of mania -Other people experience periods of mania that alternate with periods of depression *This pattern is called bipolar disorder
Bipolar II disorder
-Presence or history of major depressive episode(s) -present or history of hypomanic episode(s) -no history of a manic episode
In the past few decades, the two kind of drugs that were found to reduce symptoms of depression was joined by a third type of drug (biological view)
-Called second-generation antidepressants *most of these are labeled as selective serotonin reuptake inhibitors or SSRIs *They increase serotonin activity specifically without affecting other neurotransmitters *The effectiveness of these drugs are on par with the Tricyclics yet their sales have sky-rocketed *These medications are preferred because there are no dietary restrictions like there are with MAO inhibitors and they also have less side effects *These medications may cause undesired effects of their own which include a reduction of sexual drive and weight gain *Antidepressants don't work for everyone (failure rate may be 40% or higher)
Unipolar depression: the depressive disorders
-Depressive disorders can bring severe and long-lasting psychological pain that may intensify over time -8% of adults experience severe unipolar depression and 5% experience a mild form of depression during any given year -Approximately 20% of all adults will experience an episode of severe unipolar depression at some point in their lifetime (similar rates in many other western countries) -Rate of depression is higher amongst poor people than wealthy -This risk of experiencing this problem has increased steadily since 1915 -Typical age of onset is 19 and severe depression is 2x as often in people under 65 -Women are 2x as likely to experience episodes of unipolar depression -Approximately 85% of people w/ unipolar depression will recover within 6 months Symptoms: Emotional symptoms -Feeling "miserable" "empty" or "humiliated" -Experiencing little pleasure Motivation symptoms -Lacking drive, initiative, and spontaneity -Between 6 and 15% of those w/ severe depression die by suicide Behavioral symptoms -less active, less productive Cognitive symptoms -Hold negative views of themselves -blame themselves for unfortunate events -pessimistic Physical symptoms -headaches, dizzy spells, or general pain
Psychodynamic view of unipolar depression
-Not a lot of strong research for this model -developed by Freud and Abraham -This models links depression and grief; so when a loved one dies an unconscious process begins and the mourner may regress to the oral stage and experience introjection; introjection is the merging of his or her own identity with that of the lost person or object; this merger may be a way to for the person to undo the loss; introjection is mostly temporary, but in others, especially those with unmet needs in infancy or early childhood, they may develop depression -this depression may not only be directly caused by a loss of a loved one, but Freud argued that this loss could also be symbolic where these negative life events could equated to a loss of a loved one; this could be any negative life event like divorce, losing your job, losing your bestfriend, your pet dying -new psychoanalysts known as object relations theorists believe that depression results when people's relationships leave them feeling unsafe or insecure
Biological view of unipolar depression
-Studies of genetic factors, biochemical factors, brain circuits, and the immune system suggest unipolar depression has biological causes -genetic factors *family pedigree studies *twin studies *gene studies (molecular biology); *gene studies suggest that some people inherit a biological predisposition for unipolar depression *unipolar depression seems to run in families *as many as 30% of relatives of a person that has depression will be depressed themselves *twins studies provide strong evidence of a genetic proponent -biochemical factors that cause the disorder *low activity of serotonin and norepinephrine (early studies on high blood pressure and anti depressant drugs were found to cause depression; some lowered serotonin and others lowered norepinephrine; the discovery of truly effective antidepressant medications which relieved depression by increasing serotonin or norepinephrine confirmed the neurotransmitter role in depression; It is likely that the not one or the other neurotransmitter is the cause, but rather, a complex interaction is at work. *hormones and hpa pathway -Immune system *The immune system is the bodies network of activity and cells that fight off foreign invaders and when stressed the immune system can be dysregulated leading to declines in lymphocyte production and increases in the inflammatory crp production which is believed to produce depression *Increases in crp production can cause higher rates of migraines, IBS, chronic fatigue, arthritis, and other illnesses
Postpartum (peripartum) depression
-Symptoms may last up to a year or more *Extreme sadness, despair, tearfulness, insomnia, anxiety, intrusive thoughts, compulsions, panic attacks inability to cope, suicidal thoughts *Impact on mother-infant relationship and child well-being -Causes *Triggered by hormonal changes of childbirth *Genetic predisposition *Psychological and social change -Treatment *Self-help groups *Antidepressants, cognitive-behavioral therapy, interpersonal psychotherapy, or combination of these *treatment helps most women
psychodynamic treatment for unipolar depression
-They believe that unipolar depression results from unconscious grief over real or imagined losses, compounded by excessive dependence on others -therapists seek to bring these issues into conscious and to work through them *free association *therapist interpretation *review of past events and feelings -Despite successful case reports researchers have found that long term psychodynamic therapy is only occasional helpful in cases of unipolar depression *there are only 2 features that limit results: 1) clients may be too passive or weary to participate in clinical discussions 2) clients may become discouraged and end treatment too early -short-term approaches have performed better than some of the traditional approaches
treatments for bipolar disorder
-Until the 2nd half of the 20th century, people w/ bipolar disorder were destined to spend their lives on this emotional rollercoaster *psychotherapist reported almost no success in treating them and antidepressants were of limited help and often trigger a mania -the treatment of choice are mood stabilizer medications; these medications are lithium and other mood stabilizers; use of lithium is an element naturally occurring as mineral salt and other mood stabilizers have dramatically changed this picture; lithium is very effective in treating bipolar disorders and mania; all manner of research has supported lithium and other stabilizers to treating manic episodes *60% of patients with mania improve on these medications *most individuals experience fewer new episodes while on the drugs *the risk of relapse can be 20x higher if the person discontinues the medication *the findings also suggest that mood stabilizers are also a prophylactic medication (they prevent symptoms from developing); mood stabilizers can help people with mood disorders overcome their depressive episodes to a lesser degree -One of the problems with mood stabilizers is that people go off the medication and aren't compliant to the treatment plan; one reason they aren't compliant is because of the side effects like weight gain, decreased sexual drive, and constipation; most people do very well on these medications; if a person goes off the meds, a week or two later, they relapse back into their disorder
Stats for bipolar
-between 1 and 2% of adults suffer through a bipolar issue and as many as 4% over the course of their lives -equally common amongst gender and amongst all socioeconomic classes and ethnic groups -women may experience more depressive and fewer manic episodes than men; rapid cycling is also more common in men -onset is usually between 15 and 44 years of age -in most cases, the manic or depressive episodes eventually subside but they reoccur at a later time; generally when episodes occur the intervening periods of normality grow shorter and shorter (the person may have normal mood for a period of time)
cognitive behavioral therapy
-combines behavioral techniques to increase pleasurable activities in the persons life and cognitive approaches to increase adaptive thinking rather than maladaptive thinking -behavioral activation is modeled after Lewinsohn which reintroduces clients to pleasurable activities and events, often using a weekly schedule, and then appropriately reinforcing depressive and non-depressive behaviors *this also helps improve social skills *behavioral activations seems to be only of limited help when it's the sole focus of treatment *when combined with cognitive strategies, behavioral treatment does seem to reduce depressive symptoms -becks cognitive therapy *beck viewed unipolar depression as resulting from a pattern of negative thinking that may be triggered by these current upsetting situations -maladaptive attitudes lead people to the cognitive triad -These biased views combined with illogical thinking produces negative thoughts -in becks cognitive therapy, this includes a number of behavioral techniques that's designed to help clients to change their cognitive processes -new wave cognitive-behavioral therapy *growing # of cognitive-behaviorists disagree with beck's proposition that individuals must fully discard their negative cognitions *acceptance and commitment therapy (ACT) is an approach that uses mindfulness training, meditation, etc. *these therapists guide clients to recognize and accept their negative cognitive as just simply streams of thought
limiations of psychodynamic model
-early losses and inadequate parenting do not inevitability lead to depression and may not be typically responsible for the development of depression -many research findings are inconsistent
Manic episode
-for at least 1 week the person displays continually abnormally, inflated, unrestrained, or irritable mood as well as continually heightened energy or activity, for most of every day -a person experiences at least 3 of the following symptoms *grandiosity or overblown self-esteem *reduced sleep need *rapidly shifting ideas or the sense that one's thoughts are moving very fast ("Flight of ideas") *attention pulled in many directions *heightened activity or agitated movements *excessive pursuit of risky and potentially problematic activities (shopping, drinking, sex)
Cognitive-behavioral model
-more behavioral explanations suggest that unipolar depression results from significant changes in rewards and punishments that people perceive -Lewisohn believed that positive rewards in life dwindle for some people leading them to perform fewer and fewer constructive behaviors so that they spiral towards depression *research has supported this relationship of the # of reward received and the presents of depression -social rewards are especially important in the downward depression spiral -depressed individuals do not elicit the same positive feedback and social interactions that non-depressed individuals receive, this leads to greater feelings of depression Negative thinking -Beck theorized that 4 interrelated cognitive components combine to produce this unipolar depression: maladaptive attitudes, cognitive triad, errors in thinking, and automatic thoughts -Beck believed that these self-defeating attitudes were developed during childhood and suggested that upsetting situations later in life can trigger an extended round of negative thinking -negative thinking typically takes 3 forms called the cognitive triad (where the individuals repeatedly interpret the experiences they had in life, themselves, and their future in negative ways -the errors of thinking that depressed people make are minimizing the positive, magnifying the negative, making arbitrary inferences that have no basis in reality -automatic thinking is where someone just jumps to this one way of thinking -many studies have produced evidence and support of becks explanation and there is a high correlation between level of depression and the # of maladaptive attitudes that a person may feel -learned helplessness *this is a cognitive-behavioral interplay which asserts that people become depressed when they have no control over the reinforcements in life and they're responsible for this helpless state *based on seligmans work with laboratory dogs; when dogs have been subjected to inescapable shocks and were later placed in a shuttle box, they made no attempts to escape even though they had the opportunity to do so; he theorized that the dogs learned to be helpless (they couldn't do anything to change their negative situations); with this conclusion, he then drew parallels to human depression; -there has been research support for this model; human subjects who undergo helplessness training score higher on depression scales and demonstrate passivity in laboratory trials; animal subjects lose interest in sex and social activities which is also a common symptom of human depression; in animals these uncontrollable negative events result in lower serotonin and norepinephrine levels in the brain attribution helplessness theory *modification of learned helplessness *it suggests that experiences with uncontrollable negative events lead to an explanatory style; individuals come to attribute negative life events to internal factors and they see these negative events as global and stable; these individuals are essentially attributing these negative events to themselves; this negative attributional style leads to greater feelings of helplessness and depression *some theorists have refined this model and they suggest that attributions are likely to cause depression only when they further produce a sense of hopelessness in an individual *laboratory helplessness does parallel depression in every way; much of research relies on animal subjects; the attributional component of the theory raises questions in terms of the animal models of depression (do animals make attributions?) -while these theories are influential there's still a lot of questions that remain
Bipolar I disorder
-occurrence of a manic episode -hypomanic or major depressive episodes may precede or follow the manic
Diagnosing bipolar disorders
-people are considered to be in a full manic episode when, for at least one week, they display an abnormally high or irritable mood, increased activity or energy, and at least three other symptoms of mania *In extreme cases, symptoms are psychotic *When symptoms are less severe, the person is said to be experiencing a hypomanic episode (hypomania is not a full blown manic episode but it has characteristics of it) -Two kinds of bipolar disorder *bipolar I disorder (you have these full manic and major depressive episodes; sufferer experience an alteration of mood and some have mixed episodes which mean that they experience manic or depression in the same day) *bipolar II (the person has hypomanic episodes and major depressive episodes; their mania is not a full blown mania -without treatment these mood episodes tend to reoccur for people with either type of bipolar issue
Bipolar disorders
-people experience the lows of depression and the highs of mania -many describe their lives as a emotional roller coaster -10-15% of people with this disorder commit suicide -what are the symptoms of mania *unlike those experiencing depression, people in the state of mania experience a very dramatic and inappropriate rises of mood *5 main areas of functioning may be effected: emotional symptoms (the person may feel active; they have powerful emotions in search of an outlet; feelings of euphoria), motivational symptoms (need for constant excitement, involvement, companionship), behavioral symptoms (the person is very active, move quickly, talk loudly/rapidly, flamboyance), cognitive symptoms (individuals show poor judgments, poor planning, they make very impulsive decisions, many of these individuals may have trouble being coherent or in touch with reality), physical symptoms (they may have a high energy level often in the presence of little to no rest)
strengths of psychodynamic model
-studies have offered general support for this model that depression may be triggered by a major loss experienced by the person -research has supported this theory that early loss sets the stage for later depression -research suggests that people with childhood needs that were improperly met are more likely to become depressed after experiencing a loss of some kind
The moods of people with mood disorder ..
-tend to last a long time, especially in comparison to a normal person -they also cause impairments to daily functioning -mood disturbances are at the center of 2 groups of disorders: depressive disorders and bipolar disorders -disorders of mood as painful and disabling as they tend to be they actually respond more successfully to treatment then any forms of psychological dysfunctioning
what causes bipolar disorders
-throughout the first half the 20th century, the search for the cause had made little progress -more recently, biological research has produced some promising clues *these insights have come from research into neurotransmitter activity, ion activity, brain structure, and genetic factors -because unipolar depression is linked to low levels of norepinephrine and serotonin, researchers expected that mania would be the opposite, instead, researchers have found the bipolar disorder may be linked to high levels of norepinephrine and low levels of serotonin; low serotonin opens the door to mood disorder and permits norepinephrine activity to define what form of the disorder the person will take *Low serotonin, low norepinephrine = depression *low serotonin, high norepinephrine = mania -Some of the genetic factors that many theorists believe is that people inherit a biological predisposition to develop bipolar disorders; findings from twin studies support this theory; the rate of bipolar disorder among the adult pop. is about 1-2%
What are the biological treatments for unipolar depression
-usually antidepressant drugs -in the 1950s, 2 kinds of drugs were found to reduce symptoms of depression *monoamine oxidase inhibitors (MAO); originally used for Tuberculosis; MAO breaks down norepinephrine, serotonin, and dopamine, and so, MAO inhibitors stop this breakdown from occurring which leads to a rise of MAO activity in the brain and a reduction of depressive symptoms; About half of patients who take these medications are helped; *These medications are known as Tricyclics *These medications pose a potential danger; People who take these MAO inhibitors can experience a dangerous rise in blood pressure if they eat certain common foods like cheese -for very severe cases that don't respond to other forms of treatment, treatment may include electroconvulsive therapy or brain stimulation
what's the difference between bipolar I and II
Bipolar I has manic episodes and Bipolar II has hypomanic episodes
People may experience a major depressive episode
Major Depressive Disorder: -they can have no history of mania -could be a subtype (several) *seasonal (receiving recurrent episodes during a specific time of year *catatonic (severe disturbances in motor behavior; could be agitation or retardation) *peripartum (depression that develops during pregnancy or the month after delivery; not uncommon *melancholic major depression (pervasive loss of pleasure; total lack of responsiveness to reward or something pleasurable in your environment Persistent Depressive Disorder: *person experiences chronic, long-lasting depression for 2 years or more *when there are repeated episodes of major depression this is called persistent depressive disorder with major depressive episodes *no history of mania or hypomania *significant distress or impairment *When the chronic depression is less severe it's classified as persistent depressive disorder with dysthymic syndrome
Diagnosing Unipolar Depression
Major Depressive episode -A major depressive episode is a period of 2 or weeks marked by 5 symptoms of depression which include depressed mood, loss of interest in thing that they previously enjoyed, loss of pleasure, changes in sleep, loss of appetite, weight, could be psychomotor retardation, agitation, feelings of fatigue, decreases in concentration, feelings of hopelessness or worthlessness, feelings of guilt, thoughts about death or suicide -in extreme cases the person could become psychotic including mood related hallucinations and delusions
cyclothymic disorder
if a person experiences numerous episodes of hypomania and mild depressive symptoms then they're diagnosed with cyclothymic disorder -the individual has to have symptoms for more than 2 years to be diagnosed with this disorder -periods of hypomania and depression are often interrupted with periods of normal mood -this disorder is a milder form of bipolar I or II
