Mood Disorders

• 1.Cognitive: Ruminating thoughts of
• worthlessness/hopelessness/guilt

• 2. Behaviour: Psycho-motor agitation/retardation/ eating
• fluctuations/sleep disturbance/ suicidal gestures

• 3. Physiology/sensations: sad expression/
• irritability/somatic complaints

• 4. Affect: feeling sad/lack of pleasure distinctively
• different than pre depression

1. Major Depressive Disorder (MDD)

2. Dysthymia (DD)

3. Episodic vs. Chronic Specifiers

• 1. Interaction of stressful life events & predisposition
• (stressful event may be positive)

2. Interpersonal loss/feelings of humiliation & defeat

3. Women's response style = ruminations vs distraction (more male)

1. Less contingent reinforcement - Leads to -Less activity

(low rate of bhv causes all other symptoms of dep)

2. Depressed behaviour can be reinforced

1. Genetic contribution: MDD=50%/ DD= 10%.

• 2. Short Allele of 5HTT: (serotonin) + stress above
• individual threshold triggers gene.

3. Neuroendocrine: stress response system dysfunction +hormone change

• 4. Neurological: structural/circuitry
• dysfunction/ neurotransmitter deregulation in
• -Serotonin/dopamine/norepinephrine/neuropeptides

• -Cognitive Biases, distortions & errors:
• (ie filtering/ overgeneralising/ perceived failure etc)

-Schemas/belief systems: Process information and form view based on prior experiences/schema is re-activated by similar experiences

-Schemas determine how they will cope with future problems

• - (Pervasive) Hopelessness; negative expectations of future
• events & belief of no control over negative events.

-Attribution styles- explain neg events as internal, stable & global (depressogenic attributional style) often results in perceived failure.

-Memory Bias- only remember bad events/catastrophizing

1. Disturbance in formation/maintenance/ or renewal of bonds historically & currently

2. Loss of relationship in preceding 6 mths

3. Association with global deficits in social functioning

1.Bio vulnerability/ Psych vulnerability/ Stressful life events

2. Maintenance of depression via

(a) Activation of stress hormones/change in neurotransmitters

(b) Activation of neg attributions

• (c)leads to problems in interpersonal relationships and lack
• of social support.

MDD- Lifetime Prevalence =16%/

Dysthymia - Lifetime Prevalence = 3%

• -Leading cause of diability worldwide (10% of all
• disabilities).

• 1. Early 30's
• 2. 5% increase in younger ages 18-29yrs

Duration varies

• -Most have at least 2 episodes (Mean 5-6 episodes in
• lifetime).

-Most recover from episode <6 months

*Dysthymia at least 2 years.

More women than men across cultures

• *Women's response style: more ruminations compared to men who use distraction methods more.
• *Gender roles: women learned helplessness/victim

Depressed mood and/or loss of pleasure (anhedonia) in all/most activities for at least 2 weeks + 4 symptoms (below)

1.Sleep Disturbance

2.Appetite disturbance (5% change in weight in 1mth)

3.Fatigue

4.Impaired thinking/difficulty concentrating

5.Feelings of worthlessness

6.Suicidal ideation/attempts

1.Depressed mood for most of the day, more days than not, for 2 years + 4 symptoms for MDD.

2.No break in depressed mood of more than 2 months.

3.Less severe but more chronic symptoms of MDD.

Severe form of MDD

Requires biological treatment (Med+ECT)

• Psychotic features/ Postpartum onset
• (within 4 wks. of birth).

1.Previous history of depression

2.Sensitivity to adverse events

3.Self-consciousness

4.Low self-esteem

5.20-40yrs old

6.Low coping skills

7.Low SES

8.Low threshold of evocation of self-schemata

9.Children under 7yrs

1.Learned resourcefulness

2.High frequency of pleasant events

3.Self-perceived social competence

• 4.High level of social support ( *clinical sig. to relapse
• prevention*)

Emotional Resilience

-Symptoms of dep usually present

-10:1 ratio for attempts to completion rates

(F=15-19yrs more attempts/ males higher completion rates with age)

-NSSI: Common to Borderline/Substance abuse/ ED/ MDD/DD

• *Biggest predictor of Completed suicide*
• Desire to end one's life combined with ability to enact lethal self-injury.

3rd Leading Cause of death in 15-24yr olds

15-19yrs -19% males/15.9% females

20-24 yrs -24.2% males/17.2% females.

• Medication:
• Target levels of neurotransmitters (serotonin & norepinephrine)

• -Antidepressants:
• SSRI's /NSRI's/Tricyclics/MAOI's/St John's Wart
• -2-4wks min before improvement/1-2 mths to reach optimal dose/ if dep resistant at optimal dose or melancholic episode may need ECT.

• ECT
• -Course= 3 per week for 2-7 weeks
• -Side effects severe but transient (memory loss)

1.CBT

2.Interpersonal Therapy

3.Psychodynamic (not evidence based)

4.Behavioural Activation & Exercise

5.Light Therapy (for Seasonal Affective Disorder)

• 6.Interpersonal & Social Rhythm Therapy (Focus on
• interactions b/w symptoms & social interactions)

• Psycho-education - explain role of dep, symptoms &
• responses/ ABC model- role of belief systems & schemas/ Homework & compliance.

• -Cognitions -identitfy helpful vs unhelpful cogs
• -Antecedence,belief's & consequences
• -Challenge unhelpful /underlying thoughts/ acceptance /alternative thoughts & responses.

-Emotions- Tolerance/acceptance of unpleasant emotions

• -Behaviours -Increase activity/schedule pleasant
• events/ self-reinforcement

• -Focus on identification & amelioration of patient's
• interpersonal difficulties contributing to current depression.

• -Typical problem areas; unresolved grief, interpersonal
• disputes, role of transitions, interpersonal deficits.

• -Importance for relapse prevention/ good evidence for
• efficacy.

-Encouraging patient to perform behaviors that will improve the patient’s mood and achieve the patient’s goals/ discourage behaviour that interferes with achieving goals.

-Focuses on the consequences of behavior:

Evidence based efficacy = to CBT & meds

• CBT, IPT and Tricyclic meds equally effective in approx 50-70% of cases.
• (more than placebo or brief Psychodynamic)

• -Long term efficacy better for CBT
• *30% well for CBT
• *26% well for IPT
• *19% well for Tricyclics
• *20% well in placebo

-Chronicity or no. of episodes

-High levels of emotional expressiveness

-Post-treatment severity & Cognitive style

-Dissatisfaction with major life areas

-Coexisting medical Problem *significantly higher risk

-50% relapse rate if cease medication (Stay on meds to 6-12mths once better).

• -CBT has 20% lower relapse rate after 12 wks
• treatment.

-Adaptive coping strategies & plan in place

-Booster sessions

-Pleasant activity schedule