MOOD DISORDERS
Historical perspective
• Galen – bodily fluids and temperament
• black bile and melancholia
• Endogenous vs. reactive depression
• Neurotic vs. psychotic depression
MOOD DISORDERS
Diagnostic issues
DSM-IV lists 10 mood disorders
• Major depressive disorder
• Dysthymic disorder
• Bipolar I
• Bipolar II
• Cyclothymic disorder
• Rapid cycling depression/mania
• Seasonal affective disorder
• Mood disorder with postpartum onset
• Mood disorder due to general medical condition
• Substance-induced mood disorder
MOOD DISORDERS
Diagnostic issues
• a number of “specifiers” (e.g., severity,
chronicity) are used in diagnosis
• Two broad categories – unipolar and
bipolar
• Two important criteria in diagnosis –
duration and severity
MOOD DISORDERS
Diagnostic issues – Types of symptoms
• mood and emotion
• cognitions
• behavior and motivation
• physical
• the experience of depression
MOOD DISORDERS
Unipolar disorders – Major depression
• symptoms include feelings of sadness,
loss of interest or inability to experience
pleasure, unexplained weight loss,
difficulty sleeping, fatigue, difficulty
concentrating, feelings of worthlessness or
guilt, suicidal thoughts, agitation or
slowing down
• typically lasts 6-9 months
MOOD DISORDERS
Unipolar disorders – Major depression
• estimates suggest about 5% of Americans
suffer from depression (1-year prevalence rate);
22% lifetime prevalence for major depression
• twice as common in women – biological
differences, expression of symptoms, social
acceptability, role strain and stress
• estimates are that half of people who recover
from major depression will experience another
episode; those with 2 or more episodes have 7080% chance of having another episode
MOOD DISORDERS
Unipolar disorders – Major depression
Problem of underdiagnosis
• no obvious marker for depression
• many symptoms do not obviously point
to depression
• stigma associated with diagnosis of
depression
MOOD DISORDERS
Unipolar disorders – Dysthymia
• many of the same symptoms as major
depressive disorder, but less severe
• dysthymia persists for at least 2 years
with only brief times mood returns to
normal – chronic sadness
MOOD DISORDERS
Bipolar disorders – Mania
• flamboyance and expansiveness
• extreme or prolonged mania presumed to
be psychotic state
• less severe episodes are called
hypomanic
• some people experience mania as a
“high”
• there can be unipolar mania
MOOD DISORDERS
Bipolar disorders – Bipolar I and II
• Bipolar I – one or more manic episodes and one
or more depressive episodes
• Bipolar II – at least one hypomanic episode and
one or more episodes of major depression
• Bipolar disorders less prevalent than unipolar,
.8-1.6% of population
• age of onset in 20s
• Rapid cycling depression/mania – 4 or more
episodes per year
MOOD DISORDERS
Bipolar disorders – Cyclothymia
• long-standing pattern of alternating mood
episodes that do not meet criteria for major
depression or mania
• criteria include duration of at least 2
years with recurrent periods of mild
depression alternating with hypomania
MOOD DISORDERS
Bipolar disorders – Seasonal Affective
Disorder (SAD)
• vulnerable to changes in sunlight,
especially fall and spring
• prevalence rates of 4-6%, found more
often in northern latitudes
• many SAD symptoms opposite of those
found in major depression – increase in
appetite, weight gain, more sleep
MOOD DISORDERS
Bipolar disorders – Seasonal Affective
Disorder (SAD)
• hormone melatonin
• photoherapy
MOOD DISORDERS
Etiology – Psychological models
• Psychodynamic – fixation at oral stage
• mourning and melancholia – introjection
of lost loved one, anger turned inwards
• Depressive personality
• Attachment – Bowlby, anaclitic
depression, introjective depression
MOOD DISORDERS
Etiology – Psychological models
• Cognitive – Beck – negative cognitive
triad
• negative schemata
• cognitive distortions – selective
abstraction, arbitrary inference,
overgeneralization, magnification and
minimization
MOOD DISORDERS
Etiology – Psychological models
• Learned helplessness and causal
attributions – Seligman
• Life stress – especially loss experiences
• Interpersonal effects – marital violence,
expressed emotion (EE)
• 3 components of EE – criticism, hostility,
overinvolvement
MOOD DISORDERS
Etiology – Biological models
• Genetics – first degree relatives of people
with unipolar disorder have 30-35%
prevalence rate for depression; second
degree relatives, 12-15% prevalence rate
• Twin study (McGuffin et al., 1991) –
Concordance rates of 53% for MZ twins,
28% for DZ for unipolar disorder
MOOD DISORDERS
Etiology – Biological models
• Twin study (Bertelsen et al., 1977) –
Concordance rates of 67% for MZ twins,
20% for DZ for bipolar disorder
• Neurotransmitter deficiencies –
catecholamines (NE and serotonin)
• Monoamine hypothesis – shortage of NE,
dopamine, and serotonin
MOOD DISORDERS
Etiology – Biological models
• EEG findings – higher alpha readings in
left front region
• Sleep disturbances – decrease in slow
wave sleep and earlier onset of REM
• MRI and PET studies show increased
ventricle size and decreased activity in left
lateral prefrontal cortex
MOOD DISORDERS
Treatment – Psychological models
• Depression often improves without
treatment
• Cognitive therapy
• Behavioral strategies
• Interpersonal therapy
MOOD DISORDERS
Treatment – Biological models
• Antidepressant therapy – MAOs,
tricyclics, selective serotonin reuptake
inhibitors (SSRIs)
• Mood stabilizers – lithium carbonate for
bipolar
• Combining pharmacotherapy and
psychological therapy
• ECT – a controversial treatment
MOOD DISORDERS
SUMMARY
• Mood disorders are very common mental
disorders, yet they often go undetected
and untreated
• There are gender differences in rates of
diagnosed depression
MOOD DISORDERS
SUMMARY
• The 2 main types of mood disorder are
unipolar and bipolar
• Within these 2 categories there are wide
differences in severity and duration of
symptoms
• Biopsychosocial model appears to give
the best account of mood disorders
MOOD DISORDERS
SUMMARY
• but, not much on the social origins of
depression
• Bipolar appears to have a stronger
biological component than unipolar
disorders
• There are effective psychological and
biological treatments for the different
mood disorders