1. MOOD DISORDERS LECTURE OUTLINE
Historical perspective
Types of symptoms and diagnostic issues
Unipolar disorders
Bipolar disorders
Etiology
Treatments

2. Historical perspective
MOOD DISORDERS
Historical perspective
Galen – bodily fluids and temperament
black bile and melancholia
Endogenous vs. reactive depression
Neurotic vs. psychotic depression

3. 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

4. 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

5. Diagnostic issues – Types of symptoms
MOOD DISORDERS
Diagnostic issues – Types of symptoms
mood and emotion
cognitions
behaviour and motivation
physical
the experience of depression

6. Unipolar disorders – Major 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

7. Unipolar disorders – Major depression
MOOD DISORDERS
Unipolar disorders – Major depression
estimates suggest about 5% of Canadians 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 70-80% chance of having another episode

8. Unipolar disorders – Major depression
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

9. Unipolar disorders – Dysthymia
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

10. Bipolar disorders – Mania
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

11. Bipolar disorders – Bipolar I and II
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, % of population
age of onset in 20s
Rapid cycling depression/mania – 4 or more episodes per year

12. Bipolar disorders – Cyclothymia
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

13. Bipolar disorders – Seasonal Affective Disorder (SAD)
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

14. Bipolar disorders – Seasonal Affective Disorder (SAD)
MOOD DISORDERS
Bipolar disorders – Seasonal Affective Disorder (SAD)
hormone melatonin
photoherapy

15. Etiology – Psychological models
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

16. Etiology – Psychological models
MOOD DISORDERS
Etiology – Psychological models
Cognitive – Beck – negative cognitive triad
negative schemata
cognitive distortions – selective abstraction, arbitrary inference, overgeneralization, magnification and minimization

17. Etiology – Psychological models
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

18. Etiology – Biological models
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

19. Etiology – Biological models
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

20. Etiology – Biological models
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

21. Treatment – Psychological models
MOOD DISORDERS
Treatment – Psychological models
Depression often improves without treatment
Cognitive therapy
Behavioural strategies
Interpersonal therapy

22. Treatment – Biological models
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

23. 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

24. 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

25. 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