MOOD DISORDERS
 Etiology
 Treatment
Dr. Eszter Barra-Johnson
Etiological factors
Biological
Neurotransmitters
 Low levels of
Serotonin
associated with
depression.
 Dopamine levels:
 High: Mania
 Low: Depression
 Norepinphrine
Depression and the Endocrine
System
 Depression has been associated with
dysfunction of the endocrine system:
 Elevated levels of the stress hormone
Cortisol
 Malfunctioning of the thyroid gland
 Dysregulation of the release of growth
hormones
Sleep & Circadian Rhythm
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Findings suggest a link between sleep and
mood disorders:
Increased duration & intensity of REM during
sleep in people suffering from depression;
Sleep deprivation leads to temporary
improvement in mood;
Seasonal Affective Disorder suggests the
involvement of circadian rhythms (Alaska,
Norway, etc.);
Extended periods of insomnia have been
linked to manic episodes in Bipolar I disorder.
Genetic Predisposition to Bipolar
Disorder
 “…10 years ago it was hoped that a
single gene for bipolar disorder might be
found, it is now clear that many genes
are involved. At least one psychiatric
illness is caused by a single gene:
Huntington's disease. But so far, nothing
else in psychiatry has proved to be that
simple” (www.psycheducation.org).
Psychological
Triggers of Mood Disorders
 Stressful events
 The context and
meaning of the event
more important than the
exact nature of event
 In Bipolar disorders
stressful events linked
with initial episodes but
not later episodes
California orange frozen on
tree in 2007
Psychological Triggers ctd
 Learned helplessness in humans linked with
attributions of a lack of control after
experiences of being in an impotent position;
 “Prisoner syndrome” – one doesn’t have to be
in jail to feel “imprisoned” or “trapped”
If environment lacks positive
reinforcement = reduction in activities
and withdrawal
Cognitive
(Thought) Processes
 Links between cognition and emotion
 Depression linked to a tendency to interpret
everyday events negatively [is the glass half
full, or half empty?]
 Beck’s cognitive triad: negative cognitions about
self, world & future.
 Errors in processing information e.g.:
 Arbitrary inference
 Early childhood [bad] experiences = negative
schema = automatic or generalized ways of
thinking = depression
Psycho-Emotive Factors
 Depression rooted in an early defect in the
attachment relationship with the caregiver.
Often the loss or threatened loss of a parent
when not explained to child = guilt, shame;
 Adult relationships unconsciously constructed in
a way that reflects this loss e.g. loss of early
attachment = dependence or avoidance in
current relationships [re-experiencing traumatic
loss].
 Any current event involving loss reactivates the
primal loss and the person regresses to the
childhood trauma = depression
Social Factors: Social Support
 High levels of social support are linked to a decreased
occurrence of mood disorders and also an increase in
the speed of recovery
 Studies with women who had experienced a serious
life stressor indicate:
 Those who had a close friend = only 10% became
depressed; while
 those who did not have a supportive relationship =
37% became depressed
 (Brown & Harris, 1978)
Bio-Psycho-Social Summary
Biological factors:
 Hormonal
 Post partum (post child-birth) risk
 Psychological
 Learned helplessness
 Help-seeking behavior / gender roles
 Environmental stressors [Bad stress, Eustress]
Social structure triggers:
 Moving (losing social support to death
and / or geographic separation)
Self-care &Coping Skills With
Stress
Nature & Spirituality
Types of Mood Disorders
 The two major types of mood disorders are depression (or
unipolar depression) and bipolar disorder.
 Depression (or unipolar depression), including subtypes:
 Major depression
 Major depression (recurrent)
 Major depression with psychotic symptoms (psychotic
depression)
 Dysthymia
 Postpartum depression
 Bipolar disorder, a mood disorder formerly known as
"manic depression" and described by alternating periods
of mania and depression (and in some cases rapid cycling,
mixed states, and psychotic symptoms). Subtypes
include:
 Bipolar I
 Bipolar II
 Cyclothymia
Major Depression
 Major depression is a serious medical illness
affecting 15 million American adults, or
approximately 5 to 8 percent of the adult
population in a given year. Unlike normal
emotional experiences of sadness, loss, or
passing mood states, major depression is
persistent and can significantly interfere with
an individual’s thoughts, behavior, mood,
activity, and physical health. Among all medical
illnesses, major depression is the leading
cause of disability in the U.S. and many other
developed countries.
Major Depression ctd.
 Major depression, also known as clinical
depression or unipolar depression, is
only one type of depressive disorders.
Other depressive disorders include
Dysthymia (chronic, less severe
depression lasting over 2yrs) and bipolar
depression (the depressed phase of
bipolar disorder) or manic depression.
Symptoms of Major Depression
 The onset of the first episode of major depression is gradual or
mild. The symptoms represent a significant change from how a
person functioned before the illness:
 persistently sad, or irritable mood
 pronounced changes in sleep, appetite, and energy
 difficulty thinking, concentrating, and remembering
 physical slowing, or agitation
 lack of interest in, or pleasure from activities that were once
enjoyed
 feelings of guilt, worthlessness, hopelessness, and emptiness
 recurrent thoughts of death or suicide
 persistent physical symptoms that do not respond to treatment,
such as headaches, digestive disorders, and chronic pain
 When several of these symptoms occur at the same time, last
longer than two weeks, and interfere with ordinary functioning,
professional treatment is needed [NAMI]
Treatment for Major Depression
 Selective serotonin reuptake inhibitors (SSRIs) act specifically on
the neurotransmitter serotonin.
 Bupropion (Wellbutrin) is a very popular antidepressant
medication classified as a norepinephrine-dopamine reuptake
inhibitor (NDRI). It acts by blocking the reuptake of dopamine and
norepinephrine.
 Mirtazapine (Remeron) works differently from the compounds
discussed above. Mirtazapine targets specific serotonin and
norepinephrine receptors in the brain, thus indirectly increasing
the activity of several brain circuits.
 Tricyclic antidepressants (TCAs)
 Monoamine oxidase inhibitors (MAOIs) are also seldom used now.
They work by inactivating enzymes in the brain which catabolize
(chew up) serotonin, norepinephrine, and dopamine from the
synapse, thus increasing the levels of these chemicals in the
brain.
Treatment for Major Depression
ctd.
 Non-antidepressant adjunctive agents. Often
psychiatrists will combine the antidepressants
mentioned above with each other (we call this a
“combination”) or with agents which are not
antidepressants themselves (we call this
“augmentation”). These latter agents can include the
atypical antipsychotic agents [aripiprazole (Abilify),
olanzapine (Zyprexa), quetiapine (Seroquel),
ziprasidone (Geodon), risperidone (Risperdal)],
buspirone (Buspar), thyroid hormone (triiodothyonine,
or “T3”), the stimulants [methylphenidate (Ritalin),
dextroaphetamine (Aderall)], dopamine receptor
agonists [pramipexole (Mirapex), ropinirole (Requipp)],
lithium, lamotrigine (Lamictal), s-adenosyl methionine
(SAMe), pindolol, and steroid hormones (testosterone,
estrogen, DHEA).
Psychotherapy for Depression
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There are several types of psychotherapy that have been shown to be
effective for depression including cognitive-behavioral therapy (CBT) and
interpersonal therapy (IPT). Research has shown that mild to moderate
depression can often be treated successfully with either of these
therapies used alone. However, severe depression appears more likely to
respond to a combination of psychotherapy and medication.
Cognitive-behavioral therapy (CBT) – helps to change the negative
thinking and unsatisfying behavior associated with depression, while
teaching people how to unlearn the behavioral patterns that contribute to
their illness.
Interpersonal therapy (IPT) – focuses on improving troubled personal
relationships and on adapting to new life roles that may have been
associated with a person’s depression.
Electroconvulsive therapy (ECT). ECT is a highly effective treatment for
severe depressive episodes. In situations where medication,
psychotherapy, and a combination of the two prove ineffective, or work
too slowly to relieve severe symptoms such as psychosis or thoughts of
suicide, ECT may be considered. ECT may also be considered for those
who for one reason or another cannot take antidepressant medications
[NAMI].
Types of Bipolar Disorders
http://www.psychnet-uk.com/dsm_iv/bipolar_disorder.htm
 Bipolar disorder is a lifelong illness. Episodes of mania
and depression eventually can occur again, if you don't
get treatment. A small percentage of people will
continue to have symptoms, even after getting
treatment.
 Bipolar I disorder involves episodes of severe mood
swings, from mania (high high) to depression (low low).
 Bipolar II disorder is a milder form, involving no or
only milder episodes of mania that alternate with
persistent depressed mood.
Types of Bipolar Disorders ctd.
 Cyclothymic disorder describes even milder mood
changes.
 With mixed bipolar disorder, there is both mania and
depression at the same time. "The person feels grandiose,
with racing thoughts, all this energy -- but is also
irritable, angry, moody, feeling bad," says Michael
Aronson, MD, a clinical psychiatrist and consultant for
WebMD. "This can be a dangerous mix."
 Rapid-cycling bipolar disorder is characterized by four
or more mood episodes that occur within a 12-month
period. Some people experience multiple episodes within
a single week, or even within a single day. Rapid cycling
tends to develop later in the course of illness. Women are
more likely than men to have rapid cycling. A rapidcycling pattern increases risk for severe depression and
suicide attempts.
Types of Bipolar Disorders ctd.
 Cyclothymic disorder describes even milder mood changes.
 With mixed bipolar disorder, there is both mania and depression
at the same time. "The person feels grandiose, with racing
thoughts, all this energy -- but is also irritable, angry, moody,
feeling bad," says Michael Aronson, MD, a clinical psychiatrist and
consultant for WebMD. "This can be a dangerous mix.“
 Rapid-cycling bipolar disorder is characterized by four or more
mood episodes that occur within a 12-month period. Some people
experience multiple episodes within a single week, or even within
a single day. Rapid cycling tends to develop later in the course of
illness. Women are more likely than men to have rapid cycling. A
rapid-cycling pattern increases risk for severe depression and
suicide attempts.
Manic Episode
 Manic episode: in the elation phase of this disorder, the
patient may show excessive, unwarranted excitement
or silliness, carrying jokes too far. They may also show
poor judgment and recklessness, and may be
argumentative. Maniacs may speak rapidly, have
unrealistic ideas, and jump from subject to subject.
They may not be able to sleep or sit still for very long.
These symptoms are predominant for a specific period
of time lasting for a few days or even a few months.
Hospitalization can often be necessary to keep the
person from harming themselves and others.
Depressive Episode
 The other side of the bipolar coin is the depressive
episode. Bipolar II (depressed without mania) patients
often sleep more than usual and are lethargic. This
contrasts with those with major depression, who
usually have trouble sleeping and are agitated. During
bipolar depressive episodes, a patient may also show
irritability and withdrawal. While depression often
occurs without mania, manic episodes rarely occur
without depression.
 Bipolar disorder is relatively uncommon, occurring in
less than 1% of the population.
Treatment for Bipolar Disorder
 No known cure, but it is treatable with meds
and therapy. However, manic depression is a
chronic and recurring disorder in spite of meds
taken. Those who have been diagnosed early
and treated early on, seem to be better able to
avoid relapse. Rapid cycling patients and people
with mixed episodes are harder to treat.
 Other treatment involves exercise, a regulated
sleep and meal plan, avoiding stress, caffeine,
alcohol and illicit drugs.
 Hospitalization is usually indicated for full
manic syndromes, since the patient's well-being
is at risk because of impaired judgment. This
includes a risk of death from exhaustion.
The End of Mood Disorders
I hope this was
useful –
Enjoy your evening!
Dr. Eszter