Mood Disorders – two major types bipolar disorder and unipolar depressionCriteria set for mood disorders require the presence (or absence) of mood episodes:Major Depressive EpisodeManic EpisodeHypomanic EpisodeUnipolar DepressionPeople with unipolar depression experience only depression, not mania.Take over the whole person – emotions, bodily functions, behaviors, thoughts.Anhedonia, psychomotor retardation (slowed down) – walk more slowly, gesture more slowly, talk more slowly and quietly; Have more accidents because they don’t react quickly enough. Psychomotor agitation – physically agitated, cannot sit still, may move around or fidget aimlessly.Some lose appetite, some eat more. Changes in appetite, sleep, and activity take many forms.Have trouble concentrating and making decisions; themes of worthlessness, guilt, hopelessness, and suicide.Severe cases – lose touch with reality, experiencing delusions (beliefs with not basis in reality) and hallucinations (seeing, hearing, or feeling things that are not real). Usually negative.Depression takes several forms:Major depression and dysthymic disorderMajor depression diagnosis:Person experience either depressed mood or loss of interest in usual activities, plus at least four other symptoms of depression for 2 weeks. Must be severe enough to interfere with person’s ability to function in everyday life.People who experience only one depressive episode receive a diagnosis of major depression, single episode. Two or more episodes separated by 2+ months major depression recurrentDysthymic disorderLess severe than major depression but more chronicPerson must experience depressed mood plus two of the following symptoms for at least 2 years.Poor appetite or overeatingInsomnia or hypersomniaLow energy or fatigueLow self-esteeemPoor concentrationFeelings of hopelessnessSome individuals with dysthymic disorder also experience episodes of major depression intermittently, a condition referred to as double depression.Major depression and dysthymic disorder lasting longer than 2 years = chronic depressive disorder.Major Depressive EpisodeAt least 5 of the following symptoms…Depressed moodAnhedonia – losing interest in everything in life.Appetite or weight changesSleep problemsPsychomotor changesLoss of energyFeelings of worthlessness or inappropriate guiltConcentration problemsSuicidalityMajor Depressive Disorder1. A presence of major depressive episode2. Not better accounted for by another disorder3. No history of manic, mixed or hypomanic episodeSubtypes of Major DepressionDepression with melancholic features – physiological symptoms; inability to experience pleasure, distinct depressed mood, depression regularly worse in the morning, early morning awakening, marked psychomotor retardation or agitation, significant anorexia or weight loss, excessive guilt.Depression with psychotic features – presence of depressing delusions or hallucinations.Depression with catatonic features – strange behaviors collectively known as catatonia, which can range from a complete lack of movement to excited agitation; catalepsy, excessive motor activity, severe disturbances in speech.Depression with atypical features – positive mood reactions to some events, significant weight gain or increase in appetite, hypersomnia, heavy or laden feelings in arms or legs, long-standing pattern of sensitivity to interpersonal rejection.Depression with postpartum onset – onset of major depressive episode within four weeks of delivery of child; emotional lability, crying, irritability, fatigue.Depression with seasonal pattern – Seasonal Affective Disorder – history of at least 2 years in which major depressive episodes occur during one season of the year (usually the winter) and remit when the season is over. Depressed when daylight hours are short and recover when daylight hours are long. Come without reason or cause.Depression Facts16% lifetime prevalencelong lasting, recurrentleading cause of disease burden$37 million/year in lost productivity2X more common in women than menIn the US, 18-29 year olds.Good - Once people undergo treatment for their depression, they tend to recover more quickly than they would without treatment and reduce their risk of relapse.Bad - Many people never seek care or wait years after symptoms have begun before they seek care.Age Difference in DepressionWhy rates lower in people over 60?Less willing to report symptomsDifficult to make diagnosisDepressed people don’t live past 60 years? Not trueAdaptive coping skillsLowest in people over 60. Go up among those over 85. As people age, they develop more adaptive coping skills.Less common among children than among adults.Biological Theories of DepressionGenetic FactorsFamily history studies show that first-degree relatives of people with unipolar depression are two to three times more likely to also have depression than are the first-degree relatives of people without the disorder.Higher concordance rates for monozygotic twins than for dizygotic twins, implicating genetic processes in the disorder.Depression that begins early in life has a more stronger genetic base than depression that begins in adulthood.Genetics plays a greater role in this disorder for women than for men.Serotonin Transporter GeneSerotonin is one of the neurotransmitters implicated in depression.Abnormalities in the serotonin transporter gene could lead to dysfunction in the regulation of serotonin, which in turn could affect the stability of individuals’ moods.In a study, it was found that people with abnormalities in the serotonin transporter gene were at increased risk for depression when they faced negative life events. Not all studies have replicated these findings.Neurotransmitter TheoriesThe neurotransmitters that have been implicated most often in depression are the monoamines, specifically, norepinephrine, serotonin, and to a lesser extent, dopamine.Found in large concentrations in the limbic system, a part of the brain associated with the regulation of sleep, appetite, and emotional processes.Problems in the production and regulation of serotonin and norepinephrine depression.Decreased synthesisAbnormalities in transportIncreased degradation by synaptic enzymesImpaired release or reuptakeAbnormalities with receptorA number of processes within brain cells that affect the functioning of neurotransmitters may go awry in depression.Example, serotonin and norepinephrine are
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