Chapter 7 Mood Disorders and Suicide Amber Gilewski Tompkins Cortland Community College

Major Depressive Episode Extremely depressed mood lasting at least 2 weeks Cognitive symptoms – Feelings of worthlessness, indecisiveness Disturbed physical functioning Anhedonia – Loss of pleasure/interest in usual activities

Mania and Hypomania Symptoms -elated joy, euphoria -excessive or extraordinary activity -rapid speech *Criteria for manic episode -duration of 1 week -irritability towards the end -anxiousness and depression -if left untreated, lasts 3-6 months *Hypomanic episodes – less severe

Depressive Disorders Major Depressive Disorder Single episode – Highly unusual Recurrent episodes – More common Median # of episodes = 4 with duration of 4-5 month Mean age of onset = 25-29 years old Age appears to be decreasing

Persistent Depressive Disorder (Dysthymia) Symptoms are milder than major depression Persists for at least 2 years (1 year for children & adolescents) No more than 2 months symptom free Symptoms can persist unchanged over long periods (≥ 20 years) Late onset – Typically in the early 20s Early onset – Before age 21 Greater chronicity Poorer prognosis

“Double Depression” Major depressive episodes AND dysthymia Dysthymic disorder often develops first Associated with severe psychopathology Associated with a problematic future course

Bipolar I Disorder Alternations between full manic episodes & depressive episodes Average age on onset is 18 years Can begin in childhood Tends to be chronic Suicide is a common consequence

Bipolar II Disorder Alternations between major depressive & hypomanic episodes Average age on onset is between 19 - 22 years Can begin in childhood 10 to 13% of cases progress to full bipolar I disorder Tends to be chronic

Cyclothymic Disorder Chronic version of bipolar disorder Manic & major depressive episodes are less severe Manic or depressive mood states persist for long periods Must last for at least 2 years (1 year for children & adolescents) Average age on onset is 12 to 14 years Most are female High risk for developing bipolar I or II disorder

Prevalence of Mood Disorders 16% lifetime prevalency for Major Depression Females are twice as likely to have major depression Bipolar disorders equally affect males and females High rates amongst Native Americans Most depressed persons are anxious Not all anxious persons are depressed

Causes of Mood Disorders: Biological dimensions Family & twin studies – runs in families Mood disorders are related to low levels of serotonin Endocrine system – cortisol Sleep disturbances/circadian rhythms

Mood Disorders: Psychological Dimensions Stress is strongly related to mood disorders The relation between context of life events and mood Reciprocal-gene environment model: depressed persons putting themselves in high risk situations Beck proposed cognitive errors

Treatment of Mood Disorders: Tricyclic Medications Widely used (e.g., Tofranil, Elavil) Block reuptake of NE and serotonin Therapeutic effects can take 2-8 weeks Negative side effects are common May be lethal in excessive doses

Treatment of Mood Disorders: MAO Inhibitors Monoamine oxidase (MAO) Block Monoamine Oxidase This enzyme breaks down serotonin/norepinephrine Slightly more effective than tricyclics Must Avoid Foods Containing Tyramine Examples include beer, red wine, cheese

Treatment of Mood Disorders: SSRIs Specifically block reuptake of serotonin Fluoxetine (Prozac) is the most popular SSRI Negative side effects are common SSRIs pose no unique risk of suicide or violence www.londonstimes.us/toons/index_medical.html

Treatment of Mood Disorders: St John’s Wort Herbal solution for depression Works as well as low doses of other antidepressants Alters serotonin function Few side effects No prescription needed in the U.S. www.jadeandpearl.com/.../jp0040St,John.jpg

Treatment of Mood Disorders: Lithium Lithium Is a Common Salt Primary drug of choice for bipolar disorders Can be toxic Side Effects May Be Severe Dosage must be carefully monitored Why Lithium Works Remains Unclear

Psychological Treatments Cognitive Therapy Addresses cognitive errors in thinking Also includes behavioral components Interpersonal Psychotherapy Focuses on problematic interpersonal relationships Therapy and medication may be equally effective

The Nature of Suicide: Facts and Statistics 11th Leading Cause of Death in the United States Overwhelmingly a White and Native American Phenomenon Suicide Rates Are Increasing, Particularly in the Young and Elderly Gender Differences Males complete suicide more often than females Females attempt suicide more often than males

Suicide: Risk Factors, Prevention, & Treatment Suicide in the Family Low Serotonin Levels Preexisting Psychological Disorder Alcohol Use and Abuse Past Suicidal Behavior Experience of a Shameful/Humiliating Stressor Predicting suicide: difficult, but ask appropriate questions Prevention measures -Suicide contract: may help prevent suicide -Curriculum based programs: education & prevention Treatments for those at risk: problem solving, CBT, coping, etc.