Major Depressive Disorder and Bipolar Disorder Module 42 Major Depressive Disorder and Bipolar Disorder Josef F. Steufer/Getty Images

Major Depressive Disorder and Bipolar Disorder 42-1: HOW DO MAJOR DEPRESSIVE DISORDER AND BIPOLAR DISORDER DIFFER? Major depressive disorder is a prolonged state of hopeless depression Bipolar disorder (formerly called “manic-depressive disorder”) alternates between depression and overexcited hyperactivity Symptoms for these disorders may have a seasonal pattern Depression protects us from dangerous thoughts and feelings, letting us slow down Reassessing life may redirect our energy in promising ways, and even mild sadness can be helpful sometimes Depression can be seriously maladaptive and disabling

Major Depressive Disorder and Bipolar Disorder Major Depressive Disorder Major depressive disorder: A disorder in which a person experiences two or more weeks with five or more symptoms, at least one of which must be: Depressed mood or Loss of interest or pleasure These symptoms present themselves in the absence of drugs or another medical condition Phobias are more common, but depression is the number one reason people seek mental health services United States: 7.6% experience moderate or severe depression (CDC, 2014) Worldwide: 3.95% men and 7.2% women have a depressive episode (Global, 2015)

DIAGNOSING MAJOR DEPRESSIVE DISORDER

Major Depressive Disorder and Bipolar Disorder Bipolar Disorder Bipolar disorder: A disorder in which a person alternates between the hopelessness and lethargy of depression and the overexcited state of mania Formerly called “manic-depressive disorder” Mania: A hyperactive, wildly optimistic state in which dangerously poor judgment is common Mild mania fuels creativity Strikes more often among those who rely on emotional expression and vivid imagery Much less common than major depressive disorder, but often more dysfunctional Americans twice as likely as people elsewhere to be diagnosed with this disorder New to DSM-5: Disruptive mood dysregulation disorder

Major Depressive Disorder and Bipolar Disorder Understanding Major Depressive Disorder and Bipolar Disorder 42-2: HOW CAN THE BIOLOGICAL AND SOCIAL- COGNITIVE PERSPECTIVES HELP US UNDERSTAND MAJOR DEPRESSIVE DISORDER AND BIPOLAR DISORDER? Any theory of depression must explain at least the following six phenomena : Behaviors and Thoughts Change With Depression Negative aspects on environment consume the depressed Nearly half of people diagnosed with depression also display symptoms of another disorder (anxiety or substance abuse) Depression Is Widespread Found worldwide; causes must also be common

Understanding Major Depressive Disorder and Bipolar Disorder Women’s Risk of Major Depressive Disorder Is Nearly Double Men’s Women experience depression 1.7 times more often than men (CDC, 2014) Women’s disorders are generally more internal (depression, anxiety, inhibited sexual desire) Men’s disorders are more external (alcohol use disorder, antisocial conduct, lack of impulse control) Most Major Depressive Episodes End on Their Own Therapy often helps and tends to speed recovery, but even without most people recover Recovery more likely if first episode strikes later in life, there were few previous episodes, and there is minimal stress and a strong social support system

Understanding Major Depressive Disorder and Bipolar Disorder Stressful Events Often Precede Depression About one in four diagnosed with depression have experienced an emotional, financial, or professional trauma within the past month Moving to a new culture may also lead to depression With Each New Generation, Depression Strikes Earlier (Now Often in the Late Teens) and Affects More People, With the Highest Rates Among Young Adults in Developed Countries In North America, young adults three times more likely than their grandparents to suffer—recently or ever—from depression Some generational affect; young people now more willing to talk openly about their depression

Understanding Major Depressive Disorder and Bipolar Disorder The Biological Perspective Genes and Depression Risk for major depressive disorder and bipolar disorder increases if family member has disorder. Twin studies data estimated heritability (the extent to which individual differences are attributable to genes) of major depression at 37 percent. Linkage analysis points to “chromosome neighborhood” to help researchers tease out the genes that put people at risk of depression. Many genes work together and produce interacting small effects that increase risk for depression.

Understanding Major Depressive Disorder and Bipolar Disorder The Biological Perspective THE HERITABILITY OF VARIOUS PSYCHOLOGICAL DISORDERS Researchers used data from studies of identical and fraternal twins to estimate the heritability of bipolar disorder, schizophrenia, anorexia nervosa, major depressive disorder, and generalized anxiety disorder (Bienvenu et al., 2011).

Understanding Major Depressive Disorder and Bipolar Disorder The Biological Perspective The Depressed Brain Brain activity slows during depression, increases during mania Left frontal lobe and adjacent reward center become more active during positive emotions Neurotransmitter norepinephrine scarce during depression; overabundant during mania Neurotransmitter serotonin scarce/inactive during depression Depression-relieving drugs increase serotonin supplies Repetitive physical exercise decreases depression by increasing serotonin

Understanding Major Depressive Disorder and Bipolar Disorder The Biological Perspective Nutritional Effects What’s good for the heart is also good for the brain and mind People who eat heart-healthy “Mediterranean diet” (heavy on vegetables, fish, and olive oil) have a comparatively low risk of depression as well as lower risk for many other ailments Excessive alcohol use correlates with depression Alcohol misuse in fact leads to depression

Understanding Major Depressive Disorder and Bipolar Disorder The Social-Cognitive Perspective Biological influences contribute to depression, but our life experiences also play a part. Thinking matters: People’s assumptions and expectations influence what they perceive. Many depressed people have low self-esteem, holding negative views of themselves, their situation, and their future. Their self-defeating beliefs and negative explanatory style often feed depression’s vicious cycle.

Understanding Major Depressive Disorder and Bipolar Disorder The Social-Cognitive Perspective Negative Thoughts and Negative Moods Interact Learned helplessness may exist with self-defeating beliefs, self-focused rumination, and self-blaming and pessimistic explanatory style. Found more often in women than men, who may tend to respond more strongly to stress Rumination: Compulsive fretting; overthinking about our problems and their causes Can divert us from thinking about other life tasks Can increase negative moods Critics note a chicken-and-egg problem in the social-cognitive explanation of depression. Which comes first, the pessimistic explanatory style or the depressed mood?

EXPLANATORY STYLE AND DEPRESSION After a negative experience, a depression-prone person may respond with a negative explanatory style.

Understanding Major Depressive Disorder and Bipolar Disorder The Social-Cognitive Perspective Depression’s vicious cycle—pieces of the depression puzzle: Stressful events are interpreted through A brooding, negative explanatory style, that Creates a hopeless, depressed state, that Hampers the way the person thinks and acts These thoughts and actions, in turn, fuel 1), and the cycle continues.

Understanding Major Depressive Disorder and Bipolar Disorder The Social-Cognitive Perspective THE VICIOUS CYCLE OF DEPRESSED THINKING Therapists recognize this cycle, and they work to help depressed people break out of it, by changing their negative thinking, turning their attention outward, and engaging them in more pleasant and competent behavior.

Understanding Major Depressive Disorder and Bipolar Disorder Suicide and Self-Injury 42-3: WHAT FACTORS INCREASE THE RISK OF SUICIDE, AND WHAT DO WE KNOW ABOUT NONSUICIDAL SELF-INJURY? Worldwide, 800,000 people annually take their own lives. At least five times higher risk for suicide with diagnosis of depression, and ironically it may especially occur when people are beginning to rebound (when they become capable of following through). Is more likely to occur when people feel disconnected from or burden to others, or when they feel defeated and trapped by an inescapable situation.

Understanding Major Depressive Disorder and Bipolar Disorder Suicide and Self-Injury Comparing the suicide rates of different groups, researchers have found: National differences Racial differences Gender differences Age differences and trends Other group differences Day of the week differences Only 1 in 25 attempts in the United States are successful

Understanding Major Depressive Disorder and Bipolar Disorder Suicide and Self-Injury How to help a family member or friend who is talking suicide? Three tips: Listen, offering sincere empathy (rather than arguments for why suicide is not the answer) Connect, by doing your best to link those at risk with a helpline or with campus health services Protect, by seeking help right away (doctor, emergency room, or 911) and removing potential tools for suicide (weapons, medications) for anyone appearing in immediate risk

Understanding Major Depressive Disorder and Bipolar Disorder Suicide and Self-Injury Nonsuicidal Self-Injury Nonsuicidal self-injury (NSSI) includes cutting, burning, hitting oneself, inserting objects under nails or skin, and self-administered tattooing. These self-injuries are painful but not fatal. People engage in NSSI to: gain relief from intense negative thoughts through the distraction of pain ask for help and gain attention relieve guilt by self-punishment get others to change their negative behavior (bullying, criticism) fit in with a peer group Typically are suicide gesturers, not suicide attempters.

RATES OF NONFATAL SELF-INJURY IN THE U.S. Self-injury rates peak higher for females than for males (CDC, 2009).