Class Activity

• For each of the following words, write a sentence that describes an experience you had that is associated with that respective word…

• Train• Ice• House• Meeting• Machine• Road• Rain• Tunnel

Class Activity

• For each experience you wrote down, rate whether the experience was pleasant or unpleasant

• After you have rated all experiences, tally the total number of pleasant and unpleasant experiences

Class Activity

• How have you felt today?– Happy? Sad? Somewhat depressed?– The number of pleasant vs. unpleasant

experiences you recalled should be related to your mood today.

– When we are depressed, we remember more unpleasant than pleasant events.

Mood Disorders - Emotional disturbances that interfere with normal life functioning (Axis 1)

Depressive disorders

Bipolar disorders

Major Depressive Disorder

Single

Recurrent

Dysthymia

Bipolar II – no mania

Bipolar I

Major Depressive Episode (building block)

A. During the same 2-week period, five or more of the following symptoms including either 1 or 2 have been present (must be a change in functioning)1. Depressed mood most of the day, nearly everyday2. Diminished interest or pleasure in all, or almost all,

activities3. Significant changes in appetite and/or weight4. Significant changes in sleep patterns5. Psychomotor retardation or agitation6. Fatigue or loss of energy7. Feelings of worthlessness or inappropriate guilt8. Diminished ability to concentrate or make decisions9. Recurrent thoughts or death or suicide

Manic Episode (building block)A. Distinct period of abnormally and persistently

elevated, expansive, or irritable mood, lasting at least 1 week

B. During the mood disturbance, 3 or more of the following symptoms have persisted (4 or more if the mood is only irritable)1. Inflated self-esteem or grandiosity

2. Decreased need for sleep

3. More talkative than usual, or pressure to keep talking

4. Racing thoughts (“flight of ideas”)

5. Distractibility

6. Increase in goal-directed activity

7. Excessive involvement in pleasurable activities that have the potential for negative consequences

Hypomanic Episode(building block)

A. Distinct period of persistently elevated, expansive, or irritable mood lasting at least 4 days

B. During the mood disturbance, 3 (or more) of the following symptoms have been present (4 or more if mood is only irritable)1. Inflated self-esteem or grandiosity

2. Decreased need for sleep

3. More talkative than usual, or pressure to keep talking

4. Racing thoughts (“flight of ideas”)

5. Distractibility

6. Increase in goal-directed activity

7. Excessive involvement in pleasurable activities that have the potential for negative consequences

Mood Episodes

Depression

Mania

Hypomania

Mixed Episode

Normal Mood

Major Depressive Disorder

Major Depressive

Episode

Major Depressive

Episode

Major Depressive

Episode

Major Depressive

Episode

MDD, single episode MDD, recurrent episodes

Major Depressive Disorder: Types

• Melancholic

• Catatonic

• Seasonal Pattern

• Post-partum onset

DysthymiaA. Depressed mood most of the day, more days than

not, for at least 2 yearsB. Presence, while depressed, of 2 (or more) of the

following:1. Poor appetite or overeating2. Insomnia or hypersomnia3. Low energy or fatigue4. Low self-esteem5. Poor concentration or difficulty making decisions6. Feelings of hopelessness

C. During the 2-year period, the person has never been without the symptoms for more than 2 months at a time

Dysthymic Disorder

Dysthymic disorder lies between a blue mood and major depressive disorder. It is

a disorder characterized by daily depression lasting two years or more.

Major DepressiveDisorder

Blue Mood

DysthymicDisorder

Major Depression vs. Dysthymia

RecurrentMajor

DepressiveEpisodes

Dysthymia

Bipolar Disorder

Formerly called manic-depressive disorder. An alternation between

depression and mania signals bipolar disorder.

Multiple ideas

Hyperactive

Desire for action

Euphoria

Elation

Manic Symptoms

Slowness of thought

Tired

Inability to make decisions

Withdrawn

Gloomy

Depressive Symptoms

Bipolar Disorder

Many great writers, poets, and composers suffered from bipolar disorder.

During their manic phase creativity surged, but not during their depressed

phase.

Whitman Wolfe Clemens Hemingway

Bettm

ann/ Corbis

George C

. Beresford/ H

ulton Getty P

ictures Library

The G

ranger Collection

Earl T

heissen/ Hulton G

etty Pictures L

ibrary

Bipolar DisorderTwo Main Distinctions• Bipolar I Disorder:

– Technically, this should mean Mania/Mixed + Depression

– Actually, this means Mania/Mixed ± Depression

• Bipolar II Disorder:– Hypomania + Depression (No mania ever)

• It is distinguished from Major Depressive Disorder by the lifetime history of at last one Manic or Mixed Episode

Bipolar I Disorder

Major Depressive

Episode

Manicor Mixed Episode

Manic or Mixed Episode

One or more manic episode

OR Depressed and manic episodes

OR

Bipolar II Disorder

Major Depressive

Episode

Hypomanic Episode

Hypomanic Episode

One or morehypomanic episode OR Depressed and

hypomanic episodes

OR

Unipolar vs. Bipolar Disorder

Bipolar

Unipolar

Elevated Mood

Elevated Mood

Depressed Mood

Depressed Mood

Explaining Mood Disorders

Since depression is so prevalent worldwide, investigators want to develop a theory of depression that will suggest

ways to treat it. Lewinsohn et al., (1985, 1995) note that a theory of depression should explain the

following:1. Behavioral and cognitive

changes2. Common causes of depression

Theory of Depression

3. Gender differences

Theory of Depression

4. Depressive episodes self-terminate.

5. Depression is increasing, especially in the teens.

Post-partum depression

Desiree N

avarro/ Getty Im

ages

Mood Disorders

• Depression often triggered by stress• However, unlikely that stress alone

causes depression• Some people are more vulnerable to

depression – biological vulnerability; developmental vulnerability

The Etiology of Depression

Biological Perspective

Genetic Influences: Mood disorders run in families. The rate of depression is

higher in identical (50%) than fraternal twins (20%).

Linkage analysis and association studies link

possible genes and dispositions for

depression.

Jerry Irwin Photography

Neurotransmitters & Depression

Post-synapticNeuron

Pre-synapticNeuron

Norepinephrine Serotonin

A reduction of norepinephrine

and serotonin has been found in depression.

Drugs that alleviate mania

reduce norepinephrine.

The Depressed Brain

PET scans show that brain energy consumption rises and falls with manic

and depressive episodes.

Courtesy of L

ewis B

axter an Michael E

. P

helps, UC

LA

School of M

edicine

Mood Disorders

• Freud noted similarities between grief and depression

– Theorized that depression is grief (anger & sadness) turned against the self

– Actual or symbolic loss can trigger depression

– Attachment theorists have expanded the theory

– Childhood losses/separations create vulnerability to later depression

Psychological Views of Depression

Psychodynamic Views

Mood Disorders

• When people experience a decline in rewards – particularly social rewards – they can enter a downward spiral of decreasing rewards that leads to depression.

• Theoretical Problem: Does decline in rewards cause depression, or does depression cause decline in rewards?

Psychological Views of Depression

Behavioral Views

Explanatory Style

Explanatory style plays a major role in becoming depressed.

Mood Disorders

• Depression is the result of ingrained, negative thought patterns.

• Two main theories:– Beck’s “Explanatory Style”– Seligman’s “learned

helplessness”

Psychological Views of Depression

Cognitive Views

Mood Disorders

Negative Thinking• Maladaptive attitudes often

rooted in childhood– E.g.: “If I make a mistake, I’m worthless”

• These attitudes develop into entrenched schemas

• Stress triggers negative schemas

Psychological Views of Depression

Cognitive Views

Mood Disorders

Negative Thinking• Controlled by these schemas, self,

present & future perceived negatively

• Schemas lead to “automatic thoughts” that continuously confirm negative perceptions

• Schemas lead to “thinking errors”– E.g.: “Nobody cares about me”

Psychological Views of Depression

Cognitive Views

Mood Disorders

Negative Thinking• Considerable research supports

the link between depression and:– Maladaptive attitudes; negative

schemas; thinking errors; & automatic thoughts

• However, do cognitive patterns cause depression – or are they caused by it?

Psychological Views of Depression

Cognitive Views

Systems Approach

Depression Cycle

1. Negative stressful events.

2. Pessimistic explanatory style.

3. Hopeless depressed state.

4. These hamper the way the individual thinks and acts, fueling personal rejection.

Suicide

The most severe form of behavioral response to depression is suicide. Each

year some 1 million people commit suicide worldwide.

Suicide• Risk Factors:

– Best predictor = Prior attempt– Living alone, especially if divorced/separated– Retired/unemployed– Elderly– Loss of a loved one– Chronic illness– Financial troubles– Feelings of hopelessness– Impulsivity– Sexual identity difficulties

Suicide• Who attempts? Who completes?

– Women: 3-4 times more likely to attempt suicide

– Men: 3-4 times more likely to complete suicide

– Ages 18-24: Peak age for attempting suicide

– Ages 65+: Peak age for completing suicide

Suicide• Common Warning Signs

– Symptoms of depression

– Talking about death, disappearing, “ending it all”, etc., even just in passing

– Writing letters, saying last goodbyes

– Getting rid of personal effects, making a will

– Arranging for the care of pets, plants, etc.

– Extravagant spending

Suicide• Prevention

– Help the person regain ability to cope with immediate stressors

– Maintaining supportive contact with the person– Help the person realize that their distress is

impairing their judgment– Help the person realize that the distress is not

endless– Broad based programs focused on high-risk

groups– Crisis hotlines– Call 911/ER