Mood Disorders II Unipolar Depression & Bipolar Disorder Etiology Treatment Cool Website▪ http://www.mhhe.com/socscience/psychology/faces/Unipolar Depression: Etiology & Treatment1. Biological PerspectiveTwin Studies2. Behavioral Perspective3. Cognitive-Behavioral4. Sociocultural perspectiveBiological Perspectives:- Twin studies: Concordance and heritability- Diathesis Stress Modelo negative impact of stressful events higher in a sample of women at greater genetic risk for unipolar depressionNeurochemical theory:  Decreased norepinephrine or serotonin in the limbic system  Abnormal sensitivity or number of receptors Dysregulation of the HPA axis leads to increased levels of cortisol  Ex: Cushings Syndrome Brain Imaging Studies Abnormal patterns of activation of Prefrontal cortex Increased activity in limbic system, particularly the amygdala  Overactivity of Brodmann’s Area 25  Dysregulation in circadian rhythms Melatonin-related problems▪ Seasonal Affective Disorder (SAD)▪ Mania Sleep cycle reversal Depression (REM starts sooner, is shorter, less deep sleep) Antidepressant Medications (ADM): Monoamine Oxidase Inhibitors (MAOIs) Tricyclic Antidepressants (Tricyclics)▪ Lithium as adjunctive treatment Selective Serotonin Reuptake Inhibitors (SSRIs)  Electroconvulsive Therapy (ECT): http://youtu.be/zYl13Relzbs Light Therapy : http://youtu.be/MvTHW44dTh8 A Word to the Skeptics Raises the issue of whether imbalances of the sort discussed previously exist BEFORE treatment with psychiatric medicine Also rebuts the Thorazine / deinstitutionalization link (Medicare)Behavioral Perspective Negative Life Events 3x more likely to have experienced a negative LE in the year prior to onset of depressive episode (Shrout et al., 1989) Lewinsohn’s Behavioral Theory Stressor leads to reduction in reinforcers  Person withdraws  Reinforcers further reduced  More withdrawal and depression Behavioral Therapy: Behavioral activation Improve social skillsCognitive-Behavioral Perspective: Beck’s Cognitive Theory Seligman’s Learned Helplessness Theory Nolen-Hoeksema’s Response Style Theory Beck’s Cognitive Model of Depression: Negative thoughts influence how we feel and act. Depression characterized by the cognitive triad:▪ Negative thinking about the self, the world, and the future▪  hopelessness  Depression is associated with errors in thinking or cognitive biases ▪ Overgeneralization▪ Arbitrary inferences ▪ Minimizing/Magnifying Automatic Thoughts : negative thoughts that occur automatically in response to a situation Schemas : enduring, organized representations of prior experience that guides the way people perceive and interpret environmental eventsFormation of dysfunctional schemas:Early experiences  Form errors in thinking  Form schemas  another experience  Activation of negative schemas  Negative automatic thoughts  Distress  Mood, Negative verbalization Seligman’s Learned Helplessness Depression results from the perceived absence of control over the outcome of a situation. Reformulated Learned Helplessness (Attribution-Helplessness Theory)  Believe that positive events unlikely to occur and nothing you can do to control negative events happening in the future (hopelessness) Added cognitive piece: causal attributions Example Event : You fail your Abnormal Psychology exam.  Permanence : Temporary vs. Permanent (Stable) “I had a rough day.” vs. “I’ll never get good grades.” Pervasiveness : Specific vs. Universal (Global)“This guy is unfair.” vs. “Professors are unfair.” Personalization : External vs. Internal “The test was difficult.” vs. “I’m stupid.”  Explanatory Style Optimistic Explanatory Style – External, Temporary, Specific Pessimistic Explanatory Style – Internal, Stable, Global 17% of pessimists developed depression across 2.5 years of university; 27% w/ history of depression relapsed Nolen-Hoeksema’s Response Style Theory  How you respond to depressed mood determines its severity and duration▪ Ruminative style = inward attention▪ Longer, more severely depressed moods▪ Distracting style = diverted attention▪ Shorter, less depressed moodsCognitive Treatmentshttp://youtu.be/45U1F7cDH5k Beck’s Cognitive Therapy for Depression Primary Aim : to attend to and correct (negatively) distorted thinking  Therapy utilizes:▪ Collaborative Empiricism▪ Thought Records▪ Behavioral ExperimentsSociocultural Perspective: Social Support Strong social supports decrease the likelihood of depression Interpersonal Psychotherapy  Coyne, 1975  Focused on problems in current relationships Focused on challenges in four areas:▪ Interpersonal loss (grief)▪ Role dispute▪ Role transition▪ Interpersonal deficits So…what works? Post-treatment HRSD Scores for Severely Depressed Patients (Intake HRSD > 20) Sustained Improvement for All Assigned to Treatment Mindfulness-Based Cognitive Therapy (MBCT) Teasdale et al. (2001) study Continuation therapy for recovered patients Significantly reduced risk for relapse in patients with 3 or more previous episodes of depressionBehavioral Activation (Revised) Dimidjian et al. (2006) study BA alone effective for treating depression, even severe depression Both BA and ADM outperformed CBT in this study… .. But limitations of the study included high dropout rates (50% in ADM) and an allegiance to BA Conclusions CT as efficacious as ADM even for more severely depressed outpatients CT has enduring effect (comparable to keeping patients on medications) MBCT and BA appear to be promising treatments Modest benefits of combination treatmentBipolar Disorder: Etiology & Treatments Biological Findings Genetics : strong evidence of heritability; 15 times as likely among first-degree relatives. Neurochemical: Excess norepinephrine and low serotonin during manic phase Brain imaging: Associated with increased activity in limbic system (amygdala) Biological Treatments  Pharmacotherapy▪ Lithium carbonate  Helps in 60% of cases▪ Anticonvulsants (for rapid cycling) E.g., Tegretol, Depakene▪ Electroconvulsive therapy (ECT) Used for rapid-cycling Psychological