Chapter 6 – Mood Disorders

I. Common feature: disturbance in mood

II. Mood episodes

A. Major Depressive Episode

B. Manic Episode

C. Hypomanic Episode

D. Mixed Episode

III. Primary mood disorders

A. Major Depression (unipolar depression)

1. one or more major depressive episodes (MDEs)

2. NO history of mania or hypomania EVER

B. Bipolar Disorder (manic depression)

1. one or more manic/mixed (Bipolar I) or hypomanic (Bipolar II) episodes

2. may or may not also have MDEs for Bipolar I

3. must have had at least one MDE for Bipolar II

C. Subtypes (specifiers) include:

1. seasonal type (seasonal affective disorder)

2. postpartum onset

3. single episode vs recurrent

4. several others (based on duration, specific sxs, etc)

IV. Other mood disorders

A. cyclothymia

B. dysthymia

V. Etiology

A. Biological factors

1. Genetics: MDD vs. Bipolar Disorder

2. Neurochemical

a. roles of serotonin (esp for dep), directly and impact on other neurotransmitters

b. others (such as norepinephrine) also implicated

3. Impact of stress on brain

B. Psychoanalytic theories

1. Depression: “Mourning and Melancholia” – internalized loss/bereavement (“anger turned inward”)

2. Mania: Mania as a defense against depression

C. Cognitive and behavioral factors

1. Lack of positive reinforcement

a. depression can also LEAD to decrease in social support and other reinforcement

2. Learned helplessness

3. Reformulated helplessness (Attributional Style Theory)

4. Beck: Negative triad à cognitive distortions

VI. Treatments

A. Biological

1. Electroconvulsive (shock) Therapy

2. Medication

a. tricyclics

b. MAOIs

c. SSRIs and SNRIs

d. Lithium and anticonvulsants

3. Light therapy

4. Trancranial magnetic stimulation and deep brain stimulation?

B. Psychological treatments

1. Beck’s cognitive therapy

a. evaluating and challenging thoughts

b. testing hypotheses

2. Behavioral Activation (Pleasant Activities Scheduling)

a. increased activities

b. decreased avoidance of triggers for depression

c. importance of exercise!

3. Interpersonal psychotherapy (IPT)

a. focus on one or more of four interpersonal areas

b. identify issue, work toward resolution (of dispute, skill deficit, etc)

4. For bipolar disorder:

a. Psychoeducation and more to increase compliance w/meds

b. Increasing awareness of incipient manic episodes

c. Interpersonal and social rhythm therapy

C. Comparative evaluation of treatments

1. Medication

a. All meds above found to be effective relative to placebo, but…

b. more true for severe than mild/moderate depression

c. Often don’t lead to remission, and don’t relieve symptoms for many

d. May have unpleasant side effects (and severe SEs for kids/teens)

e. Lithium fairly dangerous, requires monitoring

2. Medication vs Psychotherapy

a. IPT and CT about equally effective with each other and with IMI, and better than placebo

i. by some measures, but not by others

b. CT > meds long-term

c. Combo tx (meds plus CBT) *may* be superior

d. Psych tx for bipolar useful as adjunct to meds

e. Standalone psych tx for bipolar shows initial promise

VII. Other Issues in Mood Disorders

A. Noncompliance (esp for mania)

B. Suicide

C. Gender differences

1. hormones?

2. impact of gender roles

3. differential societal advantages

4. differences in coping styles

D. Age-related differences in expression