Chapter 7 Depressive Disorders Bipolar Disorders and Suicide 03 27 2014 Mood Disorders two major types bipolar disorder and unipolar depression Criteria set for mood disorders require the presence or absence of mood episodes o Major Depressive Episode o Manic Episode o Hypomanic Episode Unipolar Depression People 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 Have trouble concentrating and making decisions themes of worthlessness guilt forms 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 o Major depression and dysthymic disorder o Major 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 recurrent o Dysthymic disorder Less severe than major depression but more chronic Person must experience depressed mood plus two of the following symptoms for at least 2 years Poor appetite or overeating Insomnia or hypersomnia Low energy or fatigue Low self esteeem Poor concentration Feelings of hopelessness Some individuals with dysthymic disorder also experience episodes of major depression intermittently a condition referred to as double depression o Major depression and dysthymic disorder lasting longer than 2 years chronic depressive disorder Major Depressive Episode At least 5 of the following symptoms o Depressed mood o Anhedonia losing interest in everything in life o Appetite or weight changes o Sleep problems o Psychomotor changes o Loss of energy o Feelings of worthlessness or inappropriate guilt o Concentration problems o Suicidality Major Depressive Disorder 1 A presence of major depressive episode 2 Not better accounted for by another disorder 3 No history of manic mixed or hypomanic episode Subtypes of Major Depression Depression 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 Facts 16 lifetime prevalence long lasting recurrent leading cause of disease burden o 37 million year in lost productivity 2X more common in women than men In 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 Depression Why rates lower in people over 60 o Less willing to report symptoms o Difficult to make diagnosis o Depressed people don t live past 60 years Not true o Adaptive coping skills Lowest 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 Depression Genetic Factors o Family 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 o Higher concordance rates for monozygotic twins than for dizygotic twins implicating genetic processes in the disorder o Depression that begins early in life has a more stronger genetic base than depression that begins in adulthood o Genetics plays a greater role in this disorder for women than for men o Serotonin Transporter Gene Serotonin 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 o The 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 o Problems in the production and regulation of serotonin and norepinephrine depression Decreased synthesis Abnormalities in transport Neurotransmitter Theories Increased degradation by synaptic enzymes Impaired release or reuptake Abnormalities with receptor o A number of processes within brain cells that affect the functioning of neurotransmitters may go awry in depression Example serotonin and norepinephrine
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