MOOD DISORDERS
Depression
•    depression 2nd in frequency of 1st and 2nd psychiatric admissions
•    what’s first?
•    schizophrenia

Depression: Prevalence
•    higher if separated or divorced
•    women have higher rates
•    in about 50% of the cases, the first episode is also the last

Bipolar
•    rapid-cycling has the poorest prognosis

Bipolar vs. Major Depression:
•    Bipolar less common
•    Bipolar has equal frequency in men and women
•    Bipolar is more prevalent among high SES
•    Marriage/relationships have no effect on bipolar
–    less likely to be depressed if in relationship
•    Bipolar has history of hyperactivity in childhood
–    depressed have hx of low self-esteem, obsessive thinking, dependency
•    Bipolar depressive episodes more likely to involve psychomotor retardation, excess sleep
•    Course differs
–    bipolar episodes are briefer and more frequent
•    Bipolar disorder more likely to run in families

Depression:  Etiology
•    often clear precipitating events for a first episode of major depressive disorder
•    but not for later episodes (diathesis-stress)

Age of onset issues:
•    If parent’s age of onset was under 20, lifetime risk in child twice that if parent’s age of onset were over 30
•    If parent’s age of onset occurred after 40, relatives are at no greater risk than the general population

Behavioral perspective:
•    Extinction
•    depression as function of:
–     inadequate or insufficient reinforcers
–    # and range of stimuli that are reinforcing to that person
–    availability of such reinforcers in the environment
–    person’s skill in obtaining reinforcement

Aversive Social Behavior
•    depressives elicit negative reactions from others
•    patients with critical spouses more likely to relapse within 9 months

Behavioral treatment
•    Increasing Reinforcement and Social Skills
•    Relearning of pleasure - homework
•    Teaching social skills

Cognitive perspective:
•    Teach “learned optimism”
•     “immunization” against depression, in at risk children
•    unlearn pessimistic thinking

Seligman study:
•    Participants:
•     10-12 years old
•    from varied populations
•    suffering from mild depression
•    or have parents who are in regular conflict
•    both risk factors shown to foster later depression

Results
•    Follow-up is looking good
•    20% of tx group became more depressed
•    as compared to 44% of control group

Hopelessness - Abramson
•    lack of control
•    condition will persist or recur
•    Hopelessness is the best single predictor of suicide
•    even better than depression

Negative Schema
•    cognitive triad (self, world, future) - Beck
•    Reattribution training
•     Some studies find cognitive therapy better than drugs for depression
•    most conclude that combination is best

Etiology of Mood Disorders

Biological perspective
Genetics
•    1st degree relatives 1.5-3 times greater risk
•    10 times greater for bipolar
•    Suicide runs in families
Twins
•    Bipolar MZ 72%, DZ 14%
•    Unipolar MZ 40%, DZ 11%
Adoption studies
•    bipolar adoptees
•    31% prevalence in biological parents of mood disorders
•    as compared to 2% in the biological parents of normal adoptees
Chromosome 11
•    bipolar disorder in Amish families
Hormones
•    Dexamethasone Suppression Test
•    dexamethasone suppresses cortisol in normal people
•    for at least 24 hours
•    endogenously depressed excrete high levels of cortisol
•    no drug effect while depressed
“non-suppressors”
•    tend to not respond to psychotherapy or placebos
•    if nonsuppression continues after depressive episode predicts relapse

Neurotransmitters
 Theory:
•    increased levels of norepinephrine produce mania
•    decreased levels produce depression
•    Serotonin decreased in depression
So,
•    Decreased serotonin creates predisposition to mood disorders
•    given serotonin deficiency, too high NE causes mania, too low causes depression
Suicide
•     CSF of suicide attempters
•    particularly violent attempts
•    show abnormally low serotonin activity
•    link to impulsive, aggressive behavior

Is depression psychobiologically adaptive?
•    Depressed people more vigilant
•    more accurate in perception of reality?

Medications
MAO inhibitors
•    Parnate
•    Nardil
•    first antidepressants
•    MAO enzyme degrades NE and serotonin
adverse side effects
•    particularly when combined with “fermented” food (cheese, wine, beer)
Tricyclics
•    Elavil
•    Sinequan
•    called such due to 3-ringed molecular structure
•    block reabsorption of NE and Serotonin
side effects
•    drowsiness
•    blurred vision
•    constipation
•    dry mouth
•    but milder and no TD
•    take 2-4 weeks to take effect
Selective Serotonin Reuptake Inhibitors (SSRIs)
•    Prozac
•    Paxil
•    Zoloft
•    block Serotonin reuptake
side effects
•    headache
•    upset stomach
•    anxiety