Chapter 5 -- Mood Disorders

I. Major Depressive Disorder (16.2% lifetime prevalence, 60% meet the criteria for anxiety disorder)
A. Characteristics include 5 symptoms for at least 2 weeks
1. Sad mood (required)
2. Loss of pleasure in daily activities (required)
3. Sleeping too much or too little
4. Psychomotor slowing or agitation
5. Weight loss or change in appetite
6. Loss of energy
7. Feelings of worthlessness or excessive guilt
8. Difficulty concentrating
9. Recurrent thoughts of death or suicide
B. Women have twice the rate of depression as men
1. Twice as many girls as boys are abused sexually
2. Women are more often exposed to chronic stressors (poverty and caretaking)
3. Females are more critical about their body image
4. Women ruminate more than men

II. Persistent Depressive Disorder (Dysthymia) (2.5% lifetime prevalence)
A. Characteristics include 3 of the following
1. Depressed mood for most of the day more than half of the time for 2 years (1 year for those below 18) (required)
2. Poor appetite or overeating
3. Sleeping too much or too little
4. Poor self-esteem
5. Low energy
6. Trouble concentrating or making decisions
7. Feelings of hopelessness

III. Premenstrual Dysphoric Disorder
A. At least 5 symptoms in the final week before menses, start to improve within a few days after onset of menses, and become minimal in the week postmenses
B. One or more of the following symptoms
1. Marked affective lability
2. Marked irritability
3. Marked depressed mood
4. Marked anxiety
C. One or more of the following symptoms
1. Decreased interest in usual activities
2. Difficulty in concentration
3. Lethargy
4. Marked change in appetite
5. Hypersomnia or insomnia
6. A sense of being overwhelmed
7. Physical symptoms such as breast tenderness, joint or muscle pain

IV. Disruptive Mood Dysregulation Disorder (2% of youth)
a. Severe recurrent temper outbursts at least 3 times per week
b. Symptoms present for at least 12 months, onset before age 12
c. Persistent negative mood between outbursts, higher risk for suicide

V. Bipolar Disorders (3.9% lifetime prevalence)
A. Characteristics include 4 of the following
1. Distinctly elevated or irritable mood nearly every day (required)
2. Increases in goal-directed activity or agitation
3. Unusual talkativeness
4. Flight of ideas or racing thoughts
5. Decreased need for sleep
6. Increased self-esteem
7. Distractibility
8. Excessive activities with undesirable consequences (reckless spending, sexual behavior, or driving)
B.Types
1. Bipolar I - symptoms for 1 week or required hospitalization
2. Bipolar II includes hypomanic episodes for at least 4 days
3. Cyclothymic Disorder (Chronic mood disturbance for 2 years with hypomanic episodes)

VI. Biological Approach
A. Biological Predisposition
1. Genetic (40% contribution for women, less for men)
2. Biochemical (diminished sensitivity of serotonin and dopamine receptors in depression, increased sensitivity to dopamine in mania)
3. Hormonal (elevated cortisol, a stress hormone)
4. Amygdala is more active, hippocampus is less active
B. Treatment
1. Tricyclic antidepressants (Elavil, Tofranil)
2. Monoamine Oxidase Inhibitors (MAOIs ) (Nardil, Parnate)
3. Selective Serotonin Reuptake Inhibitors (SSRIs) (Prozac, Zoloft)
4. Lithium, Anticonvulsants, or Antipsychotics for Bipolar Disorder
5. Exposure to light
6. Aerobic exercise
7. Electroconvulsive Therapy

VII. Behavioral Activation Approach
A. Lack of Pleasant Events (Reinforcement)
B. Occurrence of Negative Events (Punishment)
C. Increase quantity of different pleasant events
D. Increase frequency of each pleasant event

VIII. Cognitive Approach
A. Attributions (Learned Helplessness and Hopelessness Theory)
1. Internal vs. External (self vs. world caused failure or success)
2. Stable vs. Unstable (consistent vs. inconsistent)
3. Global vs. Specific (many situations vs. one situation)
B. Negative Thinking
1. Negative views of self, world, and future (cognitive triad)
2. Cognitive Distortions like dichotomous thinking
C. Rumination Theory (regretfully ponder why an event happened)
D. Cognitive Therapy
1. Monitor cognitions
2. Question the evidence
3. Find alternative rational thoughts
4. Mindful approach accepts thoughts as “I am not my thoughts”

IX. Interpersonal Approach
A. Loss or lack of relationships, role conflict, and impaired communication and social skills
B. Treatment
1. Encourage expression of feelings
2. Improve social skills and communication
3. Increase social support

X. Suicide
A. Risk Factors
1. Gender (Women make more attempts, Men more likely to die)
2. Age (Elderly have highest rates)
3. Race (Caucasians have highest rates)
4. Psychological Disorder (Depression, Bipolar Disorder, Substance Use, Schizophrenia)
5. Life Stress (Death, Divorce, Loss of Job)
B. Warning Signs
1. Verbal intent
2. A plan
3. Previous attempts
4. Available materials
5. Social Isolation
6. Terminating relationships and giving away belongings