MOOD DISORDERS

● Moods are long-lasting but they change over time.

● When these mood disorders become so intense and prolonged, cause distress and dysfunction, then
it becomes a disorder.

➔ Mania - sobrang saya.

➔ Depressed Mood - sobrang lungkot.

MAJOR DEPRESSIVE EPISODE

- Anhedonia (disinterest on things that one has been doing with entertainment).
- Suicide ideation (no fear of dying).
- 5 or more in criteria.

MANIA and HYPOMANIA

- Feelings comparable to continuous sexual orgasm.

● Mania - 1 week.
● Hypomanic Episode - 4 days. (Mild mania).

MANIC EPISODE
- 3 or more, (4 if the mood is only irritable).
- Pwedeng mag cause ng hospitalization. Hypomanics do not.

UNIPOLAR MOOD DISORDER

- individuals who suffer from either depression or mania.
- Rarely occurs.
- UNIPOLAR DEPRESSION is the most common. (Di nagerequire ng energy)
- And one pole lang (mostly depression)
- Mania is taxing on the body and brain.
- Depression-mania continuum.

● Someone who alternates between depression and mania is said to have a bipolar mood disorder
traveling from one pole of the depression-elation continuum to the other and back again.

DEPRESSIVE DISORDERS

MAJOR DEPRESSIVE DISORDER (Severe)

- at least one major depressive disorder.
- 5 symptoms
- 2 weeks
- Misdiagnosed with schizophrenia.
- Never had manic or hypomanic episodes.
● Catatonia - naka-stop lang muscle, di nagalaw.

PERSISTENT DEPRESSIVE DISORDER (dysthymia) (milder)

- Mas mild, mas chronic
 - Personality type of mood disorders
- Hypomanic version of MDE.
- Dysthymia - milder than MDD, chronic.
- 2 years for adults. Children, 1 year.
- 2 or more criteria
- 21 years old.

DOUBLE DEPRESSION
- People who have MDD and dysthymia.
- People with dysthymia commonly develop MDD.
- Pure dysthymia is rare.

SEASONAL AFFECTIVE DISORDER (SAD)

- Episodes during certain seasons.
- 2 years; no major depressive episodes.
- Production of melatonin - a hormone secreted by the pineal gland.
- Prevalence is higher in extreme northern and southern latitudes because there is less winter
sunlight.

Onset and Duration Depressive Disorder

- Low in teens
- 19-95 - U shaped pattern
- PDD (dysthymia) lasts for 20-30 years or more.

GRIEF AND DEPRESSION

2 KINDS OF GRIEF
1. Integrated Grief
Na-accept nya ang pagkawala. No suffering na.
2. Complicated Grief
- If the person still grieves for 6 months to a year, the chance of recovery is reduced.
- 7% of bereaved individuals, a normal process becomes a disorder—prolonged grief Disorder.
(6 mos)
Denial
Anger
Bargaining
Depression
Acceptance

PROLONGED GRIEF DISORDER

- For at least 12 mos after the death of a loved one.

OTHER DEPRESSIVE DISORDERS

1. PREMENSTRUAL DYSPHORIC DISORDER (PMDD)

- At least 5 symptoms must be present in the final week before the onset of menses.
- Improves a few days after the onset of the menses.
- Becomes minimal or absent in the week if post menses.
 - Mood swings, increased disinterest (anhedonia), hypersomnia, insomnia, a marked change in
appetite, bloating, etc.
- Depression before menstruation.
- 2% - 5% - statistics (women)
- Women suffer (PMS) premenstrual symptoms that, nevertheless, are not associated with impairment
of functioning.

2. DISRUPTIVE MOOD DYSREGULATION DISORDER (DMDD)

- Bipolar-like diagnosis for children.
- Temper outburst
- Occurring, on ave, 3 or more times per week.
- Present for 12 or more months, present in three settings (school, home, peers)
- Should not be diagnosed for the first time before age 6 or after age 18.

BIPOLAR DISORDERS
- Manic episodes alternating with major depressive episodes (roller coaster ride) .

Bipolar 2 (Moderate)
- Major depressive episodes alternate with hypomanic episodes rather than full manic episodes.
- At least 1 hypomanic episode, at least 1 Major depressive episode.
- No psychotic features (or delusions or hallucinations).
- No manic episodes.
- 19-22
- Can begin in childhood

Bipolar 1 (Severe)
- Same as Bipolar 2, except individuals experience full manic episodes.
- 15-18
- Can begin in childhood

Cyclothymia (Mild)
- Milder but more chronic version of bipolar disorder.
- Chronic and lifelong.
- Numerous periods with hypomanic symptoms that do not meet the criteria for hypomanic episodes.
- Numerous periods with depressive symptoms but do not meet criteria for major depressive
episodes.
- Super mild lang sya, kumbaga, hindi na-meet criteria sa specifiers ng episodes pero may 3 or less na
occurrences nung other criteria.
- For at least 2 yrs (adults)
- 1 year (children and adolescents)
- 2 months of persisting symptoms

RAPID CYCLING SPECIFIER FOR BP1&2

- Person who experiences at least 4 manic episodes or depressive episodes within a year is
considered to have a rapid-cycling pattern.
- Walang break from mania papuntang depression or vice versa.
 - For Bipolar disorders [rare for someone to develop bipolar disorder after the age of 40, but if it
occurs, it becomes chronic].

Prevalence of Mood Disorder

- 16% - MDD
- 6% experienced MDD in 2005
- 3.5% - Double Depression
- 1% - Bipolar Disorder
- Less in children
- High in adolescents (they can experience MDD as often as adults)

LIFE SPAN DEVELOPMENTAL INFLUENCES ON MOOD DISORDER

- Evidence that 3 mos old babies can become depressed (although unclear) [social, biological]

● *Depression is high in adults.

● *Creative people are inclined to be depressed.
● *Artists (writers, poets) have tendencies toward “melancholia”

CAUSES
Biopsychosocial Approach

MOOD DISORDERS
Biological Dimension
*Familial and Genetic Influence
- Twin studies suggest mood disorders are heritable
- Women are more likely to develop depression. 40%
- For men, environmental events play a larger role in causing depression. 20%

*Neurotransmitter Systems
- Low levels of serotonin, but only in relation to other neurotransmitters, including norepinephrine and
dopamine.
- According to the “permissive” hypothesis, low levels of serotonin permits dopamine and
norepinephrine to fluctuate.

*Endocrine System
- STRESS HYPOTHESIS - focuses on overactivity in the hypothalamic-pituitary-adrenocortical (HPA)
axis, which produces cortisol (stress hormone)
- Cortisol levels are elevated in depressed patients.

*Sleep and Circadian Rhythm

- Aside from entering REM sleep more quickly, depressed patients experience intense REM activity.
- Stages of deep sleep (slow wave sleep) don't occur until later.
- Unusual short or long sleep durations - associated with risk of depression.

Psychological Dimension
*Stressful Life Events
- Stress causes depression or depression causes stress (cause-effect connection that go both ways)
 - Na-stress ka na meron kang depression, at na-stress ka dahil na-stress ka na meron kang depression
and so on.
- Diathesis Stress Model

*Learned Helplessness
- People become depressed when they believe they have no control over the stress in their lives.

*Negative Cognitive Style

- Depression may result from a tendency to interpret events in a negative way.
- Example - overgeneralization (Prof gave one critical remark on your paper, and you assume that you
will fail the class despite a long string of positive comments and good grades on other papers.
- They make cognitive errors in thinking negatively about themselves, the immediate world, and their
future---3 areas that together are called DEPRESSIVE COGNITIVE TRIAD

*Cognitive Vulnerability for Depression: Integration

- Depression is always associated with pessimistic explanatory and negative cognitions.
- Puro negative ang pag iisip, combined with biological vulnerabilities - create a slippery path to
depression.

Social and Cultural dimensions

- Influenced by interpersonal, especially marital dissatisfaction
- Women (most likely to be depressed) place a greater value on intimate relationships, they ruminate
about their situation and blame themselves for being depressed.
- Women are at disadvantaged in our society: they experience discrimination, poverty, sexual
harassment, and abuse than do men.
- Disorders associated with aggressiveness, overactivity, and substance abuse occur far more often in
men than in women.

TREATMENT OF MOOD DISORDERS

Biological, Psychological, and Social Approach

Medications
*Antidepressants
- SSRIs, mixed reuptake inhibitors, tricyclic antidepressants, and monoamine oxidase (MAO) inhibitors
- Approximately 50% of patients receive some benefit, with about half of the 50% coming very close
to normal functioning (remission)

*Lithium Carbonate (mood stabilizing drug)

- Used for treating Bipolar
- Dosage has to be carefully regulated to prevent toxicity (poisoning) and lowered thyroid functioning,
which might intensify the lack of energy associated with depression.

Medical Procedures
*Electroconvulsive Therapy (ECT)
- Electrically shocking (mild) the brain
- Side effects - STM loss and confusion that disappear after a week or two, although some patients
may have LTM problems
*Transcranial Magnetic Stimulation (TMS)
- Works by placing magnetic coil over the individual's head to generate a precisely localized
electromagnetic pulse

*Vagus nerve stimulation

- Implanting a pacemaker-like device that generates pulses to the vagus nerve in the neck which in
turn is thought to influence neurotransmitter production in the brainstem and limbic system (weak
results)

Psychological Treatments
*Cognitive Therapy - Beck’s Method

*Cognitive-Behavioral Analysis System of Psychotherapy

- Effective for people with dysthymia

*Interpersonal Therapy (IPT)

Prevention
*Psychoeducation (for people with depression, family and friends)

Preventing Relapse of Depression

*Maintenance Treatment
- Psychological treatment (check patients)

PSYCHOLOGICAL TREATMENT FOR BIPOLAR

● *For mania, lithium is the most effective

● *For depression, CBT. (No to antidepressants because it can trigger manic episodes)
● *Interpersonal and social rhythm therapy (IPSRT) - Psychological treatment that regulates circadian
rhythms by helping patients regulate their eating and sleep cycles and other daily schedules as well
as cope more effectively with stressful life events, particularly interpersonal relationships

SUICIDE
- 11th leading cause of death
- Males are 4 times more likely to commit suicide than females
- Males generally choose far more violent methods (guns, hanging)
- Females tend to rely on less violent methods (drug overdose)

● Suicidal Ideation - thinking

● Suicidal plans - steps on how to the dee
● Suicidal attempts - execution of plan

Causes of Suicide
*Risk Factors
- Family History
- Neurobiology (low levels of serotonin)
- Existing psychological disorders and other psychological risk factors
- Stressful life events