Etiology

Various theories for the etiology of mood disorders focuses both biologic and psychodynamic theories.

Biologic Theories

 believes behavior to be as a consequence of our genetics and physiology.

a. Genetic Theories
 This study implicates the transmission of major depression in first degree relatives who are at twice
the risk for developing depression compared with general population.
o Sevenfold risk person with relatives of bipolar for developing the same disorder compared
to general population with 1 % risk.
o In all mood disorders, identical twins have 2 to 4 times higher than fraternal to develop
disorder although the rate for monozygotic twins in not 100%, so genetic alone do not
account for all mood disorder.
 It is also indicated in this study about overlapping of genetic between early-onset bipolar disorder
and early onset alcoholism.
o People with both problems have a higher rate of mixed and rapid cycling, poorer response
to lithium, slower rate of recovery, and more hospital admission.
o In this state, mania patient is more agitation than elation, better to give anticonvulsant than
lithium.

b. Neurochemical Theories
 Neurochemical influences of neurotransmitters focus on serotonin and norepinephrine as the
two major biogenic amines implicated in the mood disorder.

Serotonin role:
a. Mood
b. Activity
c. Aggressiveness and irritability
d. Cognition
e. Pain
f. Biorhythms
g. Neuroendocrine processes

Serotonin Deficit

- Precursor tryptophan or 5-hydroxyindole acetic acid found in blood or CSF occur in people with
depression.
- PET demonstrate reduce metabolism in prefrontal cortex, which promote depression
Norepinephrine (Noradrenaline) role:

- Memory
- Sleep & wake cycle
- Mood regulation

Norepinephrine (Noradrenaline) deficit:

- Depression
- Mania

Catecholamines which energizes the body during stress and inhibits kindling. This theorized that kindling
may underlie the cycling of mood disorders as well as addiction.

Dysregulation of acetylcholine and dopamine which also link to mood disorder

Neurotransmitter problem

C. Neuroendocrine influences

- hormonal fluctuation in relation to depression which can be link to different endocrine disorders in the
thyroid, adrenal, parathyroid, and pituitary glands.

- elevated glucocorticoid activity associated with stress response and evidence of increase cortisol
secretion

- postpartum hormones alterations precipitate mood disorder such as postpartum depression and
psychosis.

PSYCHODYNAMIC THEORIES

This includes superstitions and belief:

- The self- depreciation of people with depression becomes self-reproach and “anger turned
inward” related to either a real or perceived loss. Feeling abandoned by this loss people are
then angry while both loving and hating the lost object
- A person’s ego aspires to be ideal and that to be loved and worthy, must achieved this high
standard. Depression results when the person is not able to achieve these ideals all the time.
- The state of the person is like a situation in which the ego is powerless, helpless child who is
victimized by the superego, much like a powerful and sadistic parent who takes delight in
torturing their child.
- Most psychoanalytical theories of mania view manic episodes as “defense” against underlying
depression, with the Id taking over the ego and acting as an undiscipline hedonistic being (child)
- Depression is a reaction to a distressing life experience, such as event with psychic casualty.
- Children raised by rejecting or unloving parents are prone to feeling of insecurity and loneliness,
making them susceptible to depression and helplessness.
- Depression is a result of specific cognitive distortions in susceptible people. Early experiences
distorted way of thinking about oneself, the world, and the future.