Chapter 10 – Summary
Mood disorders involve disabling disturbances in emotion. DSM-IV-TR lists major
depression and bipolar disorder as the two principal kinds of mood disorders.
In major, or unipolar, depression, a person experiences profound sadness as well as
related problems such as sleep and appetite disturbances and loss of energy and selfesteem.
Bipolar I disorder may include depression but also is characterized by mania. With
mania, mood is elevated or irritable, and the person becomes extremely active, talkative,
and distractible. The person with bipolar I disorder may have episodes of mania alone,
episodes of mania and depression, or mixed episodes, in which both manic and
depressive symptoms occur together.
DSM-IV-TR also lists cyclothymia and dysthymia as the two chronic mood disorders in
which symptoms are not considered sufficient to warrant a diagnosis of major depression
or bipolar disorder. In cyclothymia, the person has frequent periods of depressed mood
and hypomania, a change in behavior and mood that is less extreme than full-blown
mania. In dysthymia, the person is chronically depressed.
Psychological theories of depression have been couched in psychoanalytic, cognitive, and
interpersonal terms. Psychoanalytic formulations stress a fixation in the oral stage that
leads to a high level of dependency and an unconscious identification with a lost loved
one whose desertion of the individual has resulted in anger turned inward. Beck's
cognitive theory ascribes causal significance to negative schemas and cognitive biases
and distortions. According to helplessness/hopelessness theory, early experiences in
inescapable, hurtful situations instill a sense of hopelessness that can evolve into
depression. Such individuals are likely to attribute failures to their own general and
persistent inadequacies and faults. Interpersonal theory focuses on the problems
depressed people have in relating to others and the negative responses they elicit from
others.
Psychological theories applied to the depressive phase of bipolar disorder are similar to
those proposed for unipolar depression. The manic phase is considered a defense against
a debilitating psychological state, such as low self-esteem.
Biological theories suggest that there may be an inherited predisposition for mood
disorders, particularly for bipolar disorder. Early neurochemical theories related
depression to low levels of serotonin and bipolar disorder to varying levels of
norepinephrine (high in mania and low in depression). Recent research has focused on
the postsynaptic receptors rather than on the amount of the various transmitters.
Overactivity of the hypothalamic-pituitary-adrenal axis is also found among depressive
patients indicating that the endocrine system may also influence mood disorders.
Several psychological therapies are effective for depression. Psychoanalytic treatment
tries to give the patient insight into childhood loss and feelings of inadequacy and selfblame. The aim of Beck's cognitive therapy is to uncover negative and illogical patterns
of thinking and to teach more realistic ways of viewing events, the self, and adversity.
Interpersonal therapy, which focuses on the depressed patient's social interactions, can
also be effective. Psychological therapies show promise in treating bipolar patients as
well.
Biological treatments are often used in conjunction with psychological treatment and can
be effective. Electroconvulsive shock and several antidepressant drugs, such as
tricyclics, selective serotonin reuptake inhibitors, and MAO inhibitors, have proved
successful in lifting depression. Also, some patients may avoid the excesses of manic
and depressive periods through careful administration of lithium carbonate.
DSM-IV-TR diagnoses of mood disorders in children use the adult criteria but allow for
age-specific features, such as irritability and aggressive behavior, instead of or in addition
to a depressed mood.
Self-annihilatory tendencies are not restricted to those who are depressed. Although no
single theory is likely to account for the wide variety of motives and situations behind
suicide, a good deal of information can be applied to help prevent it. Most perspectives
on suicide regard it as an act of desperation to end an existence that the person feels is
unendurable.
Most large communities have suicide prevention centers, and at one time or another, most
therapists have had to deal with patients in suicidal crisis. Suicidal persons need to have
their fears and concerns understood but not judged. Clinicians must gradually and
patiently point out to them that there are alternatives to self-destruction.