Mood Disorders

MS. PAULYN ANN S. MARCOS, MSc, RPm

Causes of Mood Disorders: Biological
❖ Familial and Genetic Influences ❖ Endocrine System
▪ Family Studies ▪ “Stress hypothesis”
▪ Twin Studies • Overactive HPA axis
Bipolars & Unipolar • Elevated cortisol

❖ Higher heritability for females ❖ Sleep and Circadian Rhythms

▪ REM sleep
❖ Shared genetic vulnerability • Reduced latency
▪ High familial heritability • Increased intensity
▪ Same genetic factors ▪ Sleep deprivation effects

❖ Neurotransmitter Systems
▪ Serotonin (low) — depression
▪ Dopamine (high) — mania
▪ The “permissive” hypothesis
Dopamine & Norepinephrine
Causes of Mood Disorders: Psychological
❖ Stressful life events
▪ Context & Meaning
▪ Stressful life events are strongly related to the
onset of mood disorders

❖ Stress and bipolar disorder

▪ A more positive set of stressful life events
seems to trigger mania
▪ Episode develop a “life of their own”
▪ Loss of sleep and jet lag

❖ Learned Helplessness (Seligman)

▪ Lack of perceived control

❖ Sense of hopelessness
▪ Lack of perceived control
▪ Will not regain control
▪ Pessimism
Causes of Mood Disorders: Psychological
❖ Negative Cognitive Styles
▪ Cognitive Theory of Depression (Beck)
▪ Cognitive errors in depression
• Negative interpretations
▪ Types of Cognitive Errors
• Arbitrary inference
• Overgeneralization

❖ Cognitive Theory of Depression (Beck)

▪ Negative schémas
▪ Automatic thoughts
▪ Treatment implications
Correcting the errors

❖ Cognitive Vulnerability for Depression

▪ Pessimistic explanatory style
▪ Negative cognitions
▪ Hopelessness attributions
▪ Interactions with:
Biological vulnerabilities
Stressful life events
Social and Cultural Dimensions
❖ Marriage and Interpersonal Relationships
▪ Relationship disruption precedes depression
Strongest effects for males
▪ Martial conflict vs. marital support

❖ Mood Disorders in Women

▪ Prevalence: Females > males
▪ True for all mood disorders except bipolar
▪ Gender roles
Perceptions of uncontrollability
Socialization
▪ Access to resources

❖ Social Support
▪ Related to depression
▪ Lack of support
predicts late onset depression
▪ Substantial support
predicts recovery for depression (not mania)
An Integrative Theory
❖ An integrative theory
▪ Shared biological vulnerability
▪ Psychological vulnerability
▪ Exposure to Stress
▪ Social and interpersonal relationships
Treatment of Mood Disorders
❖ Changing the chemistry of the brain
Medications, Psychological treatment

Antidepressant Medications
❖ Tricyclics (Tofranil, Elavil) Selective MAO-Is
▪ Frequently used for severe depression
▪ Block reuptake/down regulate ❖ Selective Serotonin Reuptake Inhibitors (SSRI)
Norepinephrine ▪ Fluoxetine (Prozac)
Serotonin ▪ First treatment choice
▪ 2 to 8 weeks to work ▪ Block presynaptic reuptake
▪ Many negative side effects ▪ No unique risks
▪ Lethality Suicide or violence
▪ Many negative side effects
❖ Monoamine Oxidase (MAO) Inhibitors
❖ Block MAO ❖ Mixed reuptake inhibitors
▪ Higher efficacy ▪ Blocking reuptake of norepinephrine as well as
▪ Fewer side effects serotonin
▪ Interactions
Foods
Medicines
Lithium
❖ Mood-stabilizing drug
▪ Common salt
▪ Primary treatment for bipolar disorders
▪ Unsure of mechanism of action
▪ Narrow therapeutic window
Too little—ineffective
Too much—toxic, lethal

❖ Treatment of Mood Disorders: Antimanics

Electroconvulsive Therapy and Transcranial Magnetic Stimulation

❖ Electroconvulsive Therapy (ECT) ❖ Transcranial magnetic stimulation (TMS)
▪ Brief electrical current ▪ Localized electromagnetic pulse
▪ Temporary seizures ▪ Fewer side effects
▪ 6 to 10 treatments ▪ Efficacy is likely good
▪ High efficacy ▪ More studies needed
Severe depression
▪ Few side effects
▪ Relapse is common
Psychological Treatments for Depression
❖ Cognitive Therapy ❖ CBT and IPT Outcomes
▪ Identify errors in thinking ▪ Comparable to medications
▪ Correct cognitive errors ▪ More effective than:
▪ Substitute more adaptive thoughts Placebo
▪ Correct negative cognitive schemas Brief psychodynamic treatment

❖ Behavioral therapy ▪ Management of interpersonal problems

▪ Increased positive events ▪ Increase medication compliance
▪ Exercise ▪ Interpersonal and Social Rhythm Therapy
▪ Family-focused treatment
❖ Interpersonal Psychotherapy (IPT)
▪ Address interpersonal issues in relationships ❖ Possible benefits above individual treatments
Role disputes (combined treatments)
Loss ▪ 48% benefit from meds or CBT
New relationships ▪ 73% benefit from combined
Social skill deficits

• Stage of dispute
Negotiation stage
Impasse stage
Resolution stage