Mood Disorders: Slides & Handouts by Karen Clay Rhines, Ph.D. Northampton Community College

Mood Disorders
Comer, Abnormal
Slides & Handouts by Karen Clay Rhines, Ph.D.
Psychology, 7e
Northampton Community College
Mood Disorders
• Sad and happy mood are normal part of life they come and go
but not effect the life but when mood changes effect normal
functioning than categorized under mood disorder.
• Two key emotions on a continuum:
– Depression
• Low, sad state in which life seems dark and its challenges overwhelming
– Mania—opposite to depression
• State of breathless euphoria or frenzied energy. They
believe that world is their for taking.
Comer, Abnormal Psychology, 7e 2

Mood Disorders
• Most people with a mood disorder experience only
depression
– This pattern is called unipolar depression
• Person has no history of mania
• Mood returns to normal when depression lifts
• Others experience periods of mania that alternate with
periods of depression
– This pattern is called bipolar disorder
• One might logically expect a third pattern – unipolar mania, in
which people suffer from mania only – but this pattern is
uncommon

Mood Disorders
• Mood disorders have always captured
people’s interest
– Millions of people have mood disorders
– Economic costs of mood disorders amount to
more than $80 billion each year
– The human suffering is incalculable

Unipolar Depression
• The term “depression” is often used to describe general
sadness or unhappiness which is response to sad event,
fatigue or unhappy thoughts.
– This loose use of the term confuses a normal mood swing
with a clinical syndrome
• Clinical depression can bring severe and long-lasting
psychological pain that may intensify over time. All type of sad
state is not depression or some time it can be beneficial in
exploring our selves.give strength.

• But clinical depression has no redeeming
characters,it can cause long and severe
psychological pain that can intensify with the
passage of time.
• Even sufferer may lose interest in carrying out
his simplest life activities.

How Common Is Unipolar Depression?
• Almost 7% of adults in the U.S. suffer from severe
unipolar depression in any given year
– As many as 5% suffer from mild forms
• The prevalence is similar in Canada, England, France,
and many other countries
• Approximately 17% of all adults experience unipolar
depression at some time in their lives
– The risk of experiencing this problem has increased
steadily since 1915

How Common Is Unipolar Depression?
• Women are at least twice as likely as men to experience
severe unipolar depression
– Lifetime prevalence: 26% of women vs. 12% of men
– Among children, the prevalence is similar among boys and girls
• These rates hold true across socioeconomic classes and ethnic
groups
• Approximately 50% recover within six weeks and 90% within a
year, some without treatment
– Most will experience another episode at some point

What Are the Symptoms of
Depression?
• Symptoms may vary from person to person
• Five main areas of functioning may be affected:
– Emotional symptoms---sad and disappointed
• Feeling “miserable,” “empty,” “humiliated”
• Experiencing little pleasure, loose sense of humor, and experience
anxiety, anger or agitation.
• Misery may lead to crying spells.
– Motivational symptoms—lacking desire to pursue activities.
• Lacking drive, initiative, spontaneity, they force themselves to talk
and work.
• Between 6% and 15% of those with severe depression commit
suicide

• It may lead toward paralysis of will.
• Person will not want to do ant thing and
always prefer to live alone.
• Become uninterested in their lives and want
to kill themselves.

What Are the Symptoms of Unipolar
Depression?
– Behavioral symptoms
• Less active, less productive, spend time on bed, alone and they
move and speak slowly, reluctent and have lack of energy.
– Cognitive symptoms
• Hold negative views of themselves such as inadequate,
undesirable , inferior, and evil.
• Blame themselves for unfortunate events, balme themselves for
every thing.
Pessimism

• Having suicidal thinking, hopeless, thought
whole world as devil.
• Confused, commit themselves as having poor
intellectual ability.
• Poor performance ,such as poor memory,
reasoning and attention.

• Physical symptoms
• Headaches, dizzy spells, general pain
• Disturb sleep and appetite
• Feel tired most of time

Diagnosing Unipolar Depression
• Criteria 1: existence of Major depressive episode
– Marked by five or more symptoms lasting two or more weeks
– Symptoms are depressed mood most of day, nearly every day, no
interest in any activity, nearly every day, weight loss or gain, increase
or decrease in appetite, insomnia or hypersomnia, fatigue or loss of
energy, feeling of worthlessness or excessive guilt, reduced ability to
think, concentrate or indecisiveness, recurrent thought of death or
suicidal attempt. Suicidal attempt, or planning to commit suicide.
In extreme cases, symptoms are psychotic, including
– Hallucinations
– Delusions

• 2. significant distress or impairment
• Major depressive disorder
• Presence of episode
• No history of mania

Diagnosing Unipolar Depression
• Two diagnoses to consider:
– Major depressive disorder
• Criteria 1 and 2 are met
– Dysthymic disorder
• Symptoms are “mild but chronic”
– Depression is longer lasting but less disabling
– Consistent symptoms for at least two years
– When dysthymic disorder leads to major depressive
disorder, the sequence is called “double depression”

Criteria of dysthymic disorder
• Depressed mood for most of the day, for more days than not,
at least for two years.
• Presence of Depression than at least two symptoms are
present, low energy or fatigue, low self esteem, poor
concentration or difficulty in making decesions , feeling
hopelessness.
• During two year period symptom absent not more than two
months.
• No history of manic or hypomanic episode.
• Significant distress or impairment.

• Major depressive episode—two or more two weeks
• Major depressive disorder---major depressive episode
without mania—than called disorder.
• If the episode changes with season its recurrent
• If cause immobility ---catatonic
• Melancholic---if not effected by any happy event
• Dysthymic disorder—longer lasting –for two years. But less
disabling pattern of unipolar disorder.----but when lead
toward major depressive disorder than called double
depression.

What Causes Unipolar Depression?
• Stress may be a trigger for depression
– People with depression experience a greater number of stressful life
events during the month just before the onset of their symptoms
– Some clinicians distinguish reactive (exogenous)—stressful event,
– When external factors are not present.depression from endogenous
depression, which seems to be a response to internal factors
– Today’s clinicians usually concentrate on recognizing both the
situational and the internal aspects of any given case

The Biological View
• Genetic factors
– Family pedigree—select proband and from family who is main focus
than study depression in his relatives.
– If depression is inherited than proband family will have higher rate of
depression.
– Twin studies showed that monozygotic (identical) twin has more
chance than dizygotic (fraternal)
– , adoption, and molecular biology gene studies suggest that some
people inherit a biological predisposition

• Researchers have found that as many as 20% of relatives of those with
depression are themselves depressed, compared with fewer than 10% of
the general population
• Twin studies demonstrate a strong genetic component:
• Concordance rates for identical (MZ) twins = 46%
• Concordance rates for fraternal (DZ) twins = 20%
• Adoption studies also have implicated a genetic factor in cases of severe
unipolar depression. But some studies demonstrated that severe
depression is basically genetic.
• Using techniques from the field of molecular biology, researchers have
found evidence that unipolar depression may be tied to specific genes

The Biological View
• Biochemical factors
– Low activity two NTs: serotonin and norepinephrine
– The accidental discovery of medicine for depression
• In the 1950s, medications for high blood pressure were found to
cause depression such as reserpine.
– Some of these medicine lowered serotonin, others lowered
norepinephrine
– The discovery of truly effective antidepressant medications, which
relieved depression by increasing either serotonin or norepinephrine,
confirmed the NT role

• Some researchers proposed low level of
serotonin is involved and some claimed low
level of norepinephrine.
• Catecholamine theory—norepinephrine
• Indoleamine theory—role of serotonin
• Depression likely involves not just serotonin nor
norepinephrine… a complex interaction is at work, and other
NTs may be involved such as
serotonin,norepinephrine,dopamine, and acetylcholine.

• Some researchers proposed that serotonin
regulate the other neurotransmitters.
therefore low activity of serotonin effects
other neurotransmitter.

The Biological View
– Endocrine system / hormone release
• People with depression have been found to have abnormal levels
of cortisol
– Released by the adrenal glands during times of stress
• People with depression have been found to have abnormal
melatonin secretion
– “Dracula hormone” because it resealed in dark.
• Other researchers are investigating whether deficiencies of
important proteins within neurons are tied to depression

The Biological View
– Model has produced much enthusiasm but has certain
limitations:
• Relies on analogue studies: depression-like symptoms created in
lab animals
– Do these symptoms correlate with human emotions?
• Measuring brain activity has been difficult an indirect
– Current studies using modern technology are attempting to address
this issue

• Researcher often measure brain activity
indirectly for example often study activity
chemicals which are y product of NT-
metabolites which after activity within brain
enter in blood stream, urine and blood
stream.
• MRI AND CT SCANS ARE OFTEN USE.

The Biological View
• Brain anatomy and brain circuits
– Biological researchers have determined that emotional reactions of
various kinds are tied to brain circuits
• These are networks of brain structures that work together, triggering each
other into action and producing a particular kind of emotional reaction
• It appears that one circuit is tied to GAD, another to panic disorder, and
yet another to OCD
– Although research is far from complete, a circuit responsible for
unipolar depression has begun to emerge
• Likely brain areas in the circuit include the prefrontal cortex, hippocampus
and amygdala.

The Psychological Views
• Three main models:

– Psychodynamic model
• No strong research support
– Behavioral model
• Modest research support
– Cognitive views
• Considerable research support

• Psychodynamic view---Freud and Karl Abraham firstly develop
psychodynamic explanation of depression.
– Link between depression and grief—loosing loved one weeping, loss of
pleasure, appetite and withdrawal
• When a loved one dies, an unconscious process begins and the mourner
regresses to the oral stage and experiences introjection – a merging of
his/her own identity with that of the lost person
– For most people, introjection is temporary
– If grief is severe and long-lasting, depression results
– Those with oral stage issues (unmet or excessively met needs) are at
greater risk for developing depression

• Some people experience “symbolic” (or
imagined) loss-such as failure in any subject.
• Newer psychoanalysts (object relations
theorists) propose that depression results
when people’s relationships leave them
feeling unsafe and insecure. Mostly those who
are dependent.

• Psychodynamic view
– Strengths:
• Studies have offered general support for the psychodynamic idea
that depression may be triggered by a major loss (e.g., anaclitic
depression).child and mother separation.
• Research supports the theory that early losses set the stage for
later depression
• Research also suggests that people whose childhood needs were
improperly met are more likely to become depressed after
experiencing a loss

• Psychodynamic view
– Limitations:
• Early losses and inadequate parenting don’t inevitably
lead to depression and may not be typically responsible
for development of depression
• Many research findings are inconsistent
• Certain features of the model are nearly impossible to
test

• Behavioral view
– Depression results from changes in rewards and
punishments people receive in their lives
• Lewinsohn suggests that the positive rewards in life dwindle for
some people, leading them to perform fewer and fewer
constructive behaviors, and they spiral toward depression
– Research supports the relationship between the number
of rewards received and the presence or absence of
depression
• Social rewards are especially important

• Behavioral view
– Strengths:
• Researchers have compiled significant data to support this theory
– Limitations:
• Research has relied heavily on the self-reports of depressed
subjects
• Behavioral studies are largely correlational and do not establish
that decreases in rewards are the initial cause of depression

• Cognitive views
– Two main theories:
• Negative thinking
• Learned helplessness

• Cognitive views
– Negative thinking
• Beck theorizes four interrelated cognitive components combine to
produce unipolar depression:
1. Maladaptive attitudes—attitudes develop from their experiences,
parental and other people attitude.
» Self-defeating attitudes are developed during childhood. .schemes
against which the child evaluate their experiences.
» Beck suggests that upsetting situations later in life can trigger an
extended round of negative thinking

• Cognitive views—the schemes than develop

three types of thinking in later life.
2. This negative thinking typically takes three forms, called the cognitive triad:
• Individuals repeatedly interpret (1) their experiences, (2) themselves, and (3)
their futures in negative ways, leading to depression
• They view themselves as worthless,undesirable, and inadequate.

• Errors in thinking—the repeated error help in the construction of

cognitive triad.
– Negative thinking
3. Depressed people also make errors in their thinking, including:
– Arbitrary inferences—negative conclusions having little evidence.
Minimization of the positive and magnification of the negative
– Selective abstraction—focus on negative detail and ignoring
positive points.
– Over generalization; draw broad conclusion from single
– Personalization—incorrectly point themselves as cause of negative
events.

3. Depressed people experience automatic thoughts
– A steady train of unpleasant thoughts that suggest inadequacy and
hopelessness.
– These thoughts just happen as reflex arc.

• Cognitive views
– Strengths:
• There is significant research support for Beck’s model:
– High correlation between the level of depression and the
number of maladaptive attitudes
– Both the cognitive triad and errors in logic are seen in people
with depression.people most of time remember negative
events of life. Depressed people experience automatic
thoughts
– A steady train of unpleasant thoughts that suggest inadequacy
and hopelessness
– Automatic thinking has been linked to depression

Limitations:
• Research fails to show that such cognitive
patterns are the cause and core of unipolar
depression

• Cognitive views
– Learned helplessness (Seligman)
• Theory asserts that people become depressed when
they think that:
– They no longer have control over the reinforcements (rewards
and punishments) in their lives
– They themselves are responsible for this helpless state

Experiment
• With dog using appararus, hammock-
• In which the dog receives shocks periodically.
• Next day dog was placed in shuttle box.
partitioned in half from center.
• In shuttle box the dog have place to escape
but most of dog accepted the shock.

• Cognitive views
– Learned helplessness
• Theory is based on Seligman’s work with laboratory dogs
– Dogs subjected to uncontrollable shock were later placed in a shuttle
box
– Even when presented with an opportunity to escape, dogs that had
experienced uncontrollable shocks made no attempt to do so
– Seligman theorized that the dogs had “learned” to be “helpless” to
do anything to change negative situations, and drew parallels to
human depression

• Cognitive views
• There has been significant research support for this model
– Human subjects who undergo helplessness training score higher on
depression scales and demonstrate passivity in laboratory trials
– Animal subjects lose interest in sex and social activities
– In rats, uncontrollable negative events result in lower serotonin and
norepinephrine levels in the brain

• Cognitive views
• Recent versions of the theory focus on attributions
– Internal attributions that are global and stable lead to greater feelings
of helplessness and possibly depression
» Example: “It’s all my fault” [internal]. “I ruin everything I touch”
[global] “and I always will” [stable].
– If people make other kinds of attributions, this reaction is unlikely
» Example: “She had a role in this also” [external], “the way I’ve
behaved the past couple weeks blew this relationship” [specific].
“I don’t know what got into me – I don’t usually act like that”
[unstable].

• Cognitive views
• Some theorists have refined the helplessness model yet
again in recent years; they suggest that attributions are
likely to cause depression only when they further
produce a sense of hopelessness in an individual

• Cognitive views
• Strengths:
– Hundreds of studies have supported the relationship between styles
of attribution, helplessness, and depression
• Limitations:
– Laboratory helplessness does not parallel depression in every way
– Much of the research relies on animal subjects
– The attributional component of the theory raises particularly difficult
questions in terms of animal models of depression

Sociocultural Views
• Sociocultural theorists propose that unipolar

depression is greatly influenced by the social context
that surrounds people
– This belief is supported by the finding that depression is
often triggered by outside stressors
– There are two kinds of sociocultural views:
• The family-social perspective
• The multicultural perspective

The Sociocultural View
• The Family-Social Perspective

– The connection between declining social rewards
and depression (as discussed by the behaviorists)
is a two-way street
• Depressed people often display social deficits that
make other people uncomfortable and may cause them
to avoid the depressed individuals
• This leads to decreased social contact and a further
deterioration of social skills

• The Family-Social Perspective
– Consistent with these findings, depression has been tied
repeatedly to the unavailability of social support such as
that found in a happy marriage
• People who are separated or divorced display three
times the depression rate of married or widowed
persons and double the rate of people who have never
been married
• There also is a high correlation between level of marital
conflict and degree of sadness that is particularly strong
among those who are clinically depressed

• The Multicultural Perspective

– Two kinds of relationships have captured the
interest of multicultural theorists:
• Gender and depression
– A strong link exists between gender and depression
– Women cross-culturally are twice as likely as men to
receive a diagnosis of unipolar depression
– Women also appear to be younger, have more
frequent and longer-lasting bouts, and to respond
less successfully to treatment


– Various theories have been offered:
• The artifact theory holds that women and men are
equally prone to depression, but that clinicians often
fail to detect depression in men
• The hormone explanation holds that hormone changes
trigger depression in many women
• The life stress theory suggests that women in our
society experience more stress than men


• The body dissatisfaction theory state that females in Western
society are taught, almost from birth, to seek a low body weight
and slender body shape – goals that are unreasonable, unhealthy,
and often unattainable
• The lack-of-control theory picks up the learned helplessness
research and argues that women may be more prone to
depression because they feel less control than men over their lives


• The self-blame explanation holds that women are more likely than
men to blame their failures on lack of ability and to attribute their
successes to luck – an attribution style that has been linked
depression
• The rumination theory holds that people who ruminate (think
over) when sad – keep focusing on their feelings and repeatedly
consider the causes and consequences of their depression – are
more likely to become depressed and stay depressed longer


– Each explanation offers food for thought and has
gathered just enough supporting evidence to
make it interesting (and just enough contrary
evidence to raise question about its usefulness)


– Two kinds of relationships have captured the interest of
multicultural theorists:
• Cultural background and depression
– Depression is a worldwide phenomenon, and certain symptoms
seem to be constant across all countries, including sadness,
joylessness, anxiety, tension, lack of energy, loss of interest, and
thoughts of suicide
– Beyond such core symptoms, research suggests that the precise
picture of depression varies from country to country


– Depressed people in non-Western countries are
more likely to be troubled by physical symptoms
of depression than by cognitive ones
– As countries become more Westernized,
depression seems to take on the more cognitive
character it has in the West

– Within the United States, researchers have found few
differences in depression symptoms among members of
different ethnic or racial groups, however, sometimes
striking differences exist in specific populations living
under special circumstances
• In a study of one Native American village, lifetime risk was 37%
among women, 19% among men, and 28% overall
• These findings are thought to be the result of economic and social
pressures

Bipolar Disorders
• People with a bipolar disorder experience
both the lows of depression and the highs of
mania
– Many describe their lives as an emotional roller
coaster
– Back and forth shifts of mood.

What Are the Symptoms of Mania?
• Unlike those experiencing depression, people in a
state of mania typically experience dramatic and
inappropriate rises in mood
1. Emotional symptoms
• Active, powerful emotions in search of
outlet,euphoric,excitement.
2. Motivational symptoms
• Need for constant excitement, involvement, companionship

What Are the Symptoms of Mania?
3. Behavioral symptoms
• Very active – move quickly; talk loudly or rapidly
– Flamboyance is not uncommon
4. Cognitive symptoms
• Show poor judgment or planning
– Especially prone to poor (or no) planning
5. Physical symptoms
• High energy level – often in the presence of little or no rest, seek
new friends, and have little information that their behavior in over
whelming or dominating.

• Very active, think don't have much time, talk
rapidly and loudly, conversation filled with
jokes and try to be clever, dressing in bright
clothes,
• Spending lot of money,sleep little
• Participating in dangerous actitivites.
• Poor judgment, planning, optimistic approach,

Diagnosing Bipolar Disorders
• Manic episode
• A period of abnormally and persistently elevated, expensive ,or irritable mood
lasting at least one week.
• Persistent at least three of following.infalted self-esteem or
grandiosity, decreased need for sleep, more talkative,
decreased need for sleep, flight of ideas, increases in
activities, excessive involvement in painful activities that
further lead to pain.
• Significant distress and impairment.

Bipolar I disorder
• The presence of manic, hypomanic or major
depressive episode.
• In history there is manic episode.

Bipolar II
• The presence of hypomanic or major
depressive episode.
• If currently hypomanic than history major
depression. If in present major depression
than in history hypomanic.no manic episode.

• DSM-IV-TR distinguishes between two kinds of

bipolar disorder:
– Bipolar I disorder
• Full manic and major depressive episodes
– Most sufferers experience an alternation of episodes
– Some experience mixed episodes. Swings in same day.
– Bipolar II disorder
• Hypomanic episodes and major depressive episodes

• Without treatment, the mood episodes tend

to recur for people with either type of bipolar
disorder
– If people experience four or more episodes within
a one-year period, their disorder is further
classified as rapid cycling
– If their episodes vary with the seasons, their
disorder is further classified as seasonal

• Regardless of particular pattern, individuals
with bipolar disorder tend to experience
depression more than mania over the years
– In most cases, depressive episodes occur three
times as often as manic ones, and last longer

• Between 1% and 2.6% of all adults in the world suffer
from a bipolar disorder at any given time, and as
many as 4% over the course of their lives
• The disorders are equally common in women and
men and among all socioeconomic classes and ethnic
groups
– Women may experience more depressive episodes and
fewer manic episodes than men and rapid cycling is more
common in women

• Onset usually occurs between 15 and 44 years
of age
– In most cases, the manic and depressive episodes
eventually subside, only to recur at a later time
– Generally, when episodes recur, the intervening
periods of normality grow shorter and shorter

• A final diagnostic option:
– If a person experiences numerous episodes of
hypomania and mild depressive symptoms, a
diagnosis of cyclothymic disorder is appropriate
• Mild symptoms for two or more years, interrupted by
periods of normal mood
• Affects at least 0.4% of the population
• May eventually blossom into bipolar I or II disorder

What Causes Bipolar Disorders?
• Throughout the first half of the 20th century,
the search for the cause of bipolar disorders
made little progress(psychodynamic—
introjection and than denial lead to
depression)
• More recently, biological research has produced some
promising clues
– These insights have come from research into NT activity,
ion activity, brain structure, and genetic factors

• Neurotransmitters
– After finding a relationship between low
norepinephrine and unipolar depression, early
researchers expected to find a link between high
norepinephrine levels and mania(reserpine given
to manic patients which decreases norepinephrine
and reduce manic state)
• This theory is supported by some research studies; bipolar
disorders may be related to over activity of norepinephrine

– Because serotonin activity often parallels
norepinephrine activity in unipolar depression,
theorists expected that mania would also be
related to high serotonin activity
• Although no relationship with HIGH serotonin has been
found, bipolar disorder may be linked to LOW serotonin
activity, which seems contradictory…

– This apparent contradiction is addressed by the
“permissive theory” about mood disorders:
• Low serotonin may “open the door” to a mood disorder
and permit norepinephrine activity to define the
particular form the disorder will take:
– Low serotonin + Low norepinephrine = Depression
– Low serotonin + High norepinephrine = Mania

• Ion activity
– Ions, which are needed to send incoming messages to
nerve endings, may be improperly transported through the
cells of individuals with bipolar disorder
– Some theorists believe that irregularities in the transport
of these ions may cause neurons to fire too easily (mania)
or to stubbornly resist firing (depression)
• There is some research support for this theory

• Brain structure
– Brain imaging and postmortem studies have
identified a number of abnormal brain structures
in people with bipolar disorder; in particular, the
basal ganglia and cerebellum among others
• It is not clear what role such structural abnormalities
play

• Genetic factors
– Many experts believe that people inherit a biological
predisposition to develop bipolar disorders
• Family pedigree studies support this theory; when one twin or
sibling has bipolar disorder, the likelihood for the other twin or
sibling increases:
– Identical (MZ) twins = 40% likelihood
– Fraternal (DZ) twins and siblings = 5% to 10% likelihood
– General population = 1 to 2.6% likelihood

• Genetic factors
– Recently, genetic linkage studies have examined the
possibility of “faulty” genes
– Other researchers are using techniques from molecular
biology to further examine genetic patterns
– Such wide-ranging findings suggest that a number of
genetic abnormalities probably combine to help bring
about bipolar disorders

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Mood Disorders

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• Three main models:

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• Cognitive views—the schemes than develop

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• Errors in thinking—the repeated error help in the construction of

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• Sociocultural theorists propose that unipolar

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• The Family-Social Perspective

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• The Multicultural Perspective

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• The Multicultural Perspective

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• The Multicultural Perspective