Caraga State University

Butuan City
2nd Sem., AY 2021-2022

Psych 110 - Abnormal Psychology

Facilitator: Ruth E. Sanchez

7.2 Mood Disorders and Suicide Part 2

Treatment of Mood Disorders

Biological Treatments
Psychological Treatments
Interpersonal and Social Rhythm Therapy and Family-Focused Therapy
Suicide
Defining and Measureing Suicide
Understanding Suicide
Treatment and Prevention

TREATMENT OF MOOD DISORDERS

Many forms of treatment are now available for sufferers of mood disorders.

BIOLOGICAL TREATMENTS FOR MOOD DISORDERS

 Most of the biological treatments for depression and bipolar disorder are drug treatments.
 In addition to being treated with drugs, some people with mood disorders are treated with
electroconvulsive therapy (ECT).
 Three new treatments for mood disorders - repetitive transcranial magnetic stimulation (rTMS),
vagus nerve stimulation, and deep brain stimulation-hold out hope for many people. People with
seasonal affective disorder (SAD) can benefit from a simple therapy: exposure to bright lights.
 Drug Treatments for Depression
o Recent theories suggest that these drugs have slow-emerging effects on intracellular processes
in the neurotransmitter systems discussed earlier and on the action of genes that regulate
neurotransmission, the limbic system, and the stress response
o All the different antidepressant drugs currently available reduce depression in about 50 to 60
percent of people who take them
o These medications appear to work better for treating severe and persistent depression than
for treating mild-to-moderate depression.
o People with bipolar disorder often take antidepressants continually to prevent a relapse of
depression.
o Selective Serotonin Reuptake Inhibitors (SSRIs)
 The selective serotonin reuptake inhibitors, or SSRis, are widely used to treat
depressive symptoms.
 SSRis are not more effective in the treatment of depression than the other available
antidepressants, but they have fewer difficult-to-tolerate side effects
  Finally, they have positive effects on a wide range of symptoms that co-occur with
depression, including anxiety, eating disorders, and impulsiveness.
 The SSRis do have side effects, however, and 5 to 10 percent of people have to
discontinue their use because of these side effects
 SSRis are associated with a smaller increase in suicidal thought and behavior among
adults than among children, and among the elderly SSRis are associated with a
reduction in suicidal thought and behavior
o Selective Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
 The selective serotoninnorepinephrine reuptake inhibitors (SNRis) were designed to
affect levels of norepinephrine as well as serotonin.
 Perhaps because these drugs influence both neurotransmitters, they show a slight
advantage over the selective serotonin reuptake inhibitors in preventing a relapse of
depression
 The dual action of these drugs also may account for their slightly broader array of side
effects compared to the SSRis
o Bupropion: A Norepinephrine-Dopamine Reuptake Inhibitor
 Bupropion affects the norepinephrine and dopamine systems and thus is known as a
norepinephrine-dopamine reuptake inhibitor.
 It may be especially useful in treating people suffering from psychomotor retardation,
anhedonia, hypersomnia, cognitive slowing, inattention, and craving
o Tricyclic Antidepressants
 Although the tricyclic antidepressants were some of the first drugs shown to
consistently relieve depression, they are used less frequently these days than the
other drugs
 This is due in large part to their numerous side effects, many of which are
anticholinergic effects, so-called because they are related to levels of the
neurotransmitter acetylcholine.
o Monoamine Oxidase Inhibitors
 Another older class of drugs that is no longer used frequently to treat depression is the
monoamine oxidase inhibitors (MAOis).
 MAO is an enzyme that causes the breakdown of the monoamine neurotransmitters in
the synapse.
 MAOis decrease the action of MAO and thereby increase the levels of these
neurotransmitters in the synapses.
 The MAOis are as effective as the tricyclic antidepressants, but their side effects are
potentially quite dangerous
 The MAOis also can cause liver damage, weight gain, severe lowering of blood
pressure, and several of the same side effects caused by the tricyclic antidepressants.

This table 7.5 summarizes the classes of drugs commonly used in treating depressive disorders and the
depressive symptoms of bipolar disorders.
 Mood Stabilizers
o People with bipolar disorder may take antidepressants to relieve their depressive symptoms,
but they also usually take a mood stabilizer (lithium or an anticonvulsant medication) to
relieve or prevent symptoms of mania.
o Lithium
 Lithium may work by improving the functioning of the intracellular processes that
appear to be abnormal in the mood disorders
 People maintained on adequate doses of lithium have significantly fewer relapses of
mania and depression than people with bipolar disorder not maintained on lithium
 The side effects of lithium range from annoying to life threatening.
o Anticonvulsant and Atypical Antipsychotic Medications
 In the mid-1990s, it was discovered that a medication that helps reduce seizures,
valproate (trade name Depakote), also helped stabilize mood in people with bipolar
disorder.
 Another anti-epileptic medication, carbamazepine (trade names Tegretol, Equetro),
has been approved for use in treating bipolar disorder.
  The anti-epileptics may work by restoring the balance between the neurotransmitter
systems in the amygdala
o Electroconvulsive Therapy
 Perhaps the most controversial of the biological treatments for mood disorders is
electroconvulsive therapy (ECT).
 Neuroimaging studies show that ECT results in decreases in metabolic activity in
several regions of the brain, including the frontal cortex and the anterior cingulate,
although the mechanisms by which ECT relieves depressive symptoms are not clear
 ECT can lead to memory loss and difficulty learning new information, particularly in
the days following treatment
 Newer Methods of Brain Stimulation
o In the procedure known as repetitive transcranial magnetic stimulation (rTMS), scientists
expose patients to repeated, high-intensity magnetic pulses focused on particular brain
structures
o Another newer method that holds considerable promise in the treatment of serious
depression is vagus nerve stimulation (VNS)
 In vagus nerve stimulation, the vagus nerve is stimulated by a small electronic device,
much like a cardiac pacemaker, that is surgically implanted under the patient's skin in
the left chest wall.
o The newest and least studied procedure to date is deep brain stimulation, in which electrodes
are surgically implanted in specific areas of the brain
 Light Therapy
o Recall that seasonal affective disorder (SAD) is a form of mood disorder in which people
become depressed during the winter months, when there are the fewest hours of daylight.
o It turns out that exposing people with SAD to bright light for a few hours each day during the
winter months, known as light therapy, can significantly reduce some people's symptoms.
o One theory is that light therapy helps reduce seasonal affective disorder by resetting circadian
rhythms, natural cycles of biological activity that occur every 24 hours.
o Also, studies suggest that exposure to bright lights may directly increase serotonin levels, also
decreasing depression.

PSYCHOLOGICAL TREATMENTS FOR MOOD DISORDERS

 Behavioral Therapy
o Behavioral therapy focuses on increasing positive reinforcers and decreasing aversive
experiences in an individual's life by helping the depressed person change his or her patterns
of interaction with the environment and with other people
o Behavioral therapy is designed to be short-term, lasting about 12 weeks
o The first phase of behavioral therapy involves a functional analysis of the connections between
specific circumstances and the depressed person's symptoms.
o Once the circumstances that precipitate the client's depressive symptoms are identified,
therapists help the client change aspects of the environment that are contributing to the
depression, such as isolation.
o They teach depressed clients skills for changing their negative circumstances, particularly
negative social interactions.
 o They also help clients learn new skills, such as relaxation techniques, for managing their moods
in unpleasant situations.
 Cognitive-Behavioral Therapy
o Cognitive-behavioral therapy (CBT) represents a blending of cognitive and behavioral theories
of depression
o This therapy has two general goals.
 First, it aims to change the negative, hopeless patterns of thinking described by the
cognitive models of depression.
 Second, it aims to help people with depression solve concrete problems in their lives
and develop skills for being more effective in their world so they no longer have the
deficits in reinforcers described by behavioral theories of depression.
o The therapist and client usually will agree on a set of goals they wish to accomplish in 6 to 12
weeks.
o From the beginning of therapy, the therapist urges clients to set their own goals and make
their own decisions.
o The first step in cognitive-behavioral therapy is to help clients discover the negative automatic
thoughts they habitually have and understand the link between those thoughts and their
depression.
o The second step in cognitive-behavioral therapy is to help clients challenge their negative
thoughts.
o The third step in cognitive-behavioral therapy is to help clients recognize the deeper, basic
beliefs or assumptions they might hold that are fueling their depression
o Often people with depression are unassertive in making requests of other people or in
standing up for their rights and needs.
 This lack of assertiveness can be the result of their negative automatic thoughts.
o The therapist first will help clients recognize the thoughts behind their actions (or lack of
action).
o The therapist then may work with the clients to devise exercises or homework assignments in
which they practice new skills, such as assertiveness, between therapy sessions.
 Interpersonal Therapy
o In interpersonal therapy (IPT), therapists look for four types of problems in depressed
individuals
 First, many depressed people are grieving the loss of a loved one, perhaps not from
death but instead from the breakup of an important relationship.
 A second type of problem on which interpersonal therapy focuses is interpersonal role
disputes, which arise when people do not agree on their roles in a relationship.
 The third type of problem addressed in interpersonal therapy is role transitions, such
as the transition from college to work or from work to full-time motherhood.
 People sometimes become depressed over the role they must leave behind.
 Fourth, people with depression also turn to interpersonal therapy for help with
problems caused by deficits in interpersonal skills.
INTERPERSONAL AND SOCIAL RHYTHM THERAPY AND FAMILY-FOCUSED THERAPY

Interpersonal and social rhythm therapy (ISRT) is an enhancement of interpersonal therapy designed
specifically for people with bipolar disorder

 When people with bipolar disorder experience disruptions in either their daily routines or their social
environment, they sometimes experience an upsurge in symptoms.
 ISRT combines interpersonal therapy techniques with behavioral techniques to help patients maintain
regular routines of eating, sleeping, and activity, as well as stability in their personal relationships.
 By having patients self-monitor their patterns over time, therapists help patients understand how
changes in sleep patterns, circadian rhythms, and eating habits can provoke symptoms.

Family-focused therapy (FFT) is also designed to reduce interpersonal stress in people with bipolar disorder,
particularly within the context of families.

 Patients and their families are educated about bipolar disorder and trained in communication and
problem-solving skills.

COMPARISON OF TREATMENTS

 These therapies, despite their vast differences, appear to be about equally effective in treating most
people with depression
 We might expect the combination of psychotherapy and drug therapy to be more effective in treating
people with persistent depressive disorder than either type of therapy alone, and some studies
support this expectation
 Relapse rates in depression are quite high, even among people whose depressions completely
disappear with treatment.
o For this reason, many psychiatrists and psychologists argue that people with a history of
recurrent depression should be kept on a maintenance level of therapy even after their
depression is relieved
 Even when maintenance doses of psychotherapy are not available, people who have had any of the
empirically supported psychotherapies appear to be less likely to relapse than those who have had
only drug therapy.

SUICIDE

Suicide is among the three leading causes of death worldwide among people ages 15 to 44 (World Health
Organization [WHO], 2012). Around the world, more people die from suicide than from homicide. Suicide is
associated with mood disorders.

DEFINING AND MEASURING SUICIDE

The Centers for Disease Control and Prevention (CDC), one of the federal agencies in the United States that
tracks suicide rates, defines suicide as "death from injury, poisoning, or suffocation where there is evidence
(either explicit or implicit) that the injury was self-inflicted and that the decedent intended to kill
himself/herself."

 We can distinguish among completed suicides, which end in death; suicide attempts, which may or
may not end in death; and suicidal ideation or thought.
 Many deaths are ambiguous, particularly when no notes are left behind and no clues exist as to the
victim's mental state before death.
 Suicide is not just an American phenomenon, however. Internationally, an estimated 1 million people
die by suicide each year, or 1 person about every 40 second
 Gender Differences
o While two to three times more women than men attempt suicide men are four times more
likely than women to complete suicide
o Men tend to choose more lethal methods of suicide than do women, with more than half of
men who kill themselves using a firearm
 Ethnic and Cross-Cultural Differences
o In the Philippnies and for males, there was a 24.4 increase from 3.9 in 2000 to 4.8 in 2012. The
figure in the Philippines is lower than the annual global age-standardized suicide rate of 11.4
per 100,000 population. The Philippines also has the lowest suicide rate among ASEAN-
member countries.
o The suicide rate among Filipinos has gone up in the last 21 years with the majority of cases
involving young people.
 Suicide in Children and Adolescents
o The rate of suicide increases substantially in early adolescence
o Suicide may become more common in adolescence than in childhood because the rates of
several types of psychopathology tied to suicide, including depression, anxiety disorders, and
substance abuse, increase in adolescence.
o Suicide rates also may rise during the teen years because adolescents are more sophisticated
than children in their thinking and can contemplate suicide more clearly.
o Finally, adolescents simply may have readier access to the means to commit suicide (e.g.,
drugs and guns) than do children.
o The initial increase may have been linked to the increase in substance use by teenagers during
that same period, coupled with an increased availability of firearms.
 College Students
o The college years are full of academic and social pressures and challenges.
o Students who had contemplated or attempted suicide were more likely than those who had
not to have experienced depression and hopelessness, loneliness, and problems with their
parents.
o Regrettably, only 20 percent of the students who had contemplated suicide had sought any
type of counseling.
 Suicide in Older Adults
o When they attempt suicide, older people are much more likely than younger people to be
successful.
o Escape from illness and disabilities may be a particularly strong motive for suicide among men,
who are reluctant to become a burden to others
o Those with a history of depression or other psychological problems are at greatest risk for
responding to the challenges of old age with suicide
 Nonsuicidal Self-Injury
o Some people-often adolescents-repeatedly cut, burn, puncture, or otherwise significantly
injure their skin with no intent to die, a behavior known as nonsuicidal self-injury, or NSSI
 o Theories of NSSI suggest that it functions as a way of regulating emotion and/ or influencing
the social environment
o People who engage in NSSI often report that the experience of feeling the pain and seeing the
blood actually calms them and releases tension
o Self-injury also draws support and sympathy from others or may punish other

UNDERSTANDING SUICIDE

 Our ability to understand the causes of suicide is hampered by many factors.

o First, although suicide is more common than we would hope, it is still rare enough to make
studying it difficult.
o Second, in the wake of a suicide, family members and friends may selectively remember
certain information about the victim (e.g., evidence that he or she was depressed) and forget
other information.
o Third, most people who kill themselves do not leave a note.
 The notes that are left often do not provide much understanding of what led the people to take their
lives

In this section, we briefly discuss historical perspectives on suicide and then discuss research findings on the
factors contributing to suicide.

 Historical Perspectives on Suicide

o Freud argued that depressed people express anger at themselves instead of at the people they
feel have betrayed or abandoned them.
o In his classic work on suicide, sociologist Emile Durkheim (1897) focused on the mindsets
certain societal conditions can create that increase the risk for suicide. He proposed that there
are three types of suicide.
 Egoistic suicide is committed by people who feel alienated from others, empty of
social contacts, and alone in an unsupportive world
 Anomic suicide is committed by people who experience severe disorientation because
of a major change in their relationship to society
 Finally, altruistic suicide is committed by people who believe that taking their life will
benefit society
o Durkheim's theory suggests that social ties and integration into a society will help prevent
suicide if the society discourages suicide and supports individuals in overcoming negative
situations in ways other than suicide.
 Psychological Disorders and Suicide
o By far the best predictor of future suicidal thoughts and behavior is past suicidal thoughts and
behavior
o Thus, it is critically important that suicidal thoughts and behaviors be assessed and that
intervention be made, regardless of what other psychological problems they may be related to
 Stressful Life Events and Suicide
o Studies across cultures have shown that a variety of stressful life events increase the risk of
suicide
o Negative experiences not only are immediate triggers of suicidal thoughts and behavior but
also are associated with increased risk over the victim's lifespan.
 o Loss of a loved one through death, divorce, or separation is also consistently related to suicide
attempts or completions
o Another stressful event consistently linked to increased vulnerability to suicide is economic
hardship
o Loss of a job, for example, can precipitate suicidal thoughts and attempts
o Finally, a large international study found that physical illness, especially if it occurred early in
life, was a risk factor for suicidal ideation, plans, and attempts even in people who did not have
a mental disorder
 Suicide Contagion
o When a well-known member of society commits suicide, people who closely identify with that
person may see suicide as more acceptable
o When two or more suicides or attempted suicides are nonrandomly bunched together in space
or time, such as a series of suicide attempts in the same high school or a series of completed
suicides in response to the suicide of a celebrity, scientists refer to them as a suicide cluster
o Other suicide clusters occur not among close friends but among people who are linked by
media exposure to the suicide of a stranger, often a celebrity. Some theorists have labeled it
suicide contagion
 Personality and Cognitive Factors in Suicide
o The personality characteristic that seems to predict suicide best is impulsivity, the general
tendency to act on one's impulses rather than to inhibit them when it is appropriate to do so
o The cognitive variable that has most consistently predicted suicide is hopelessness - the
feeling that the future is bleak and there is no way to make it more positive
 Thomas Joiner and colleagues (2005) suggest that hopeless feelings about being a
burden on others and about never belonging with others are especially linked to
suicide.
 Biological Factors in Suicide
o Suicide runs in families
o Strong evidence of a genetic component to suicide remained when researchers controlled for
histories of psychiatric problems in the twins and their families, for recent and past negative
life events, for how close the twins were to each other socially, and for personality factors.
o People with low serotonin levels who attempt suicide are 10 times more likely to make
another suicide attempt than are people with higher serotonin levels

TREATMENT AND PREVENTION

Some intervention and prevention programs appear to reduce the risk of suicide. Intervention programs
include crisis intervention services (e.g., suicide hotlines) and dialectical behavior therapy.

 Prevention programs generally have focused on educating people broadly about suicide risk and the
steps to take if they are suicidal or know of someone who is suicidal.
 Because access to guns is associated with higher suicide rates, some prevention efforts focus on
removing access to guns, which might reduce the chances of a person taking his or her own life
impulsively.
 Treatment of Suicidal Persons
o A person who is gravely suicidal needs immediate care. Sometimes people require
hospitalization to prevent an imminent suicide attempt.
o They may voluntarily agree to be hospitalized. If they do not agree, they can be hospitalized
involuntarily for a short period of time (usually about 3 days)
o Community-based crisis intervention programs are available to help suicidal people deal in
the short term with their feelings and then refer them to mental health specialists for longer-
term care.
 Some crisis intervention is done over the phone, on suicide hotlines.
 Some communities have walk-in clinics or suicide prevention centers, which may be
part of a more comprehensive mental health system.
o The medication most consistently shown to reduce the risk of suicide is lithium.
o The selective serotonin reuptake inhibitors also may reduce the risk of suicide, because they
reduce depressive symptoms and possibly because they regulate levels of serotonin, which
may have an independent effect on suicidal intentions
o Psychological therapies designed to treat depression can be effective in treating suicidal
individuals.
o Dialectical behavior therapy (DBT) was developed to treat people with borderline personality
disorder, who frequently attempt suicide
 This therapy focuses on managing negative emotions and controlling impulsive
behaviors.
 It aims to increase problem-solving skills, interpersonal skills, and skill at managing
negative emotions.
o What is clearest from the literature on the treatment of suicidal people is that they are
woefully undertreated.
o Most people who are suicidal never seek treatment
o Even when their families know they are suicidal, they may not be taken for treatment because
of denial and a fear of being stigmatized.
 Suicide Prevention
o Suicide hotlines and crisis intervention centers provide help to suicidal people in times of their
greatest need, hoping to prevent a suicidal act until the suicidal feelings have passed.
o In addition, many prevention programs aim to educate entire communities about suicide.
These programs often are based in schools or colleges.
o Parents and school officials often worry that asking teenagers about thoughts of suicide might
"put the idea in their head."
 Guns and Suicide
o The most frequent use of a gun in the home is for suicide
o The mere presence of a firearm in the home appears to be a risk factor for suicide when other
risk factors are taken into account, especially when handguns are improperly secured or are
kept loaded
o Instead, the unavailability of guns seems to give people a cooling off period during which their
suicidal impulses can wane
 What to Do If a Friend Is Suicidal
o What should you do if you suspect that a friend or family member is suicidal? The Depression
and Bipolar Support Alliance (2008), a patient-run advocacy group, makes the following
suggestions in Suicide and Depressive Illness:
 Take the person seriously: Although most people who express suicidal thoughts do
not go on to attempt suicide, most people who do commit suicide have communicated
their suicidal intentions to friends or family members beforehand.
 Get help: Call the person's therapist, a suicide hotline, 911, or any other source of
professional mental health care.
 Express concern: Tell the person concretely why you think he or she is suicidal.
 Pay attention: Listen closely, maintain eye contact, and use body language to indicate
that you are attending to everything the person says.
 Ask direct questions about whether the person has a plan for suicide and, if so, what
that plan is
 Acknowledge the person's feelings in a nonjudgmental way: For example, you might
say something like "I know you are feeling really horrible right now, but I want to help
you get through this" or "I can't begin to completely understand how you feel, but I
want to help you."
 Reassure the person that things can be better: Emphasize that suicide is a permanent
solution to a temporary problem.
 Don't promise confidentiality: You need the freedom to contact mental health
professionals and tell them precisely what is going on.
 Make sure guns, old medications, and other means of self-harm are not available.
 If possible, don't leave the person alone until he or she is in the hands of
professionals.
 Take care of yourself: Interacting with a person who is suicidal can be extremely
stressful and disturbing. Talk with someone you trust about it particularly if you worry
about how you handled the situation or that you will find yourself in that situation
again.

Thank you so much for our time together!