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

2. 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

3. 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

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

5. 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

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

7. 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

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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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.

17. 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

18. 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

19. 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

20. 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.