Mood Disorders chapters 7 and 8 Psychology 3331 Emotion is a specific response to specific stimulus not prolonged like a mood Depressive Disorders one extreme just depression Bipolar Disorders two extremes very common but don t have to have both mania and depression elevated mood Major Depressive Disorder MDD must have major depressive episode without mania defining features of bipolar disorder episode has to last for minimum of 2 weeks at least 5 symptoms from cluster ppt and must have either depressed mood or lower interest pleasure as one of the symptoms anhedonic weight loss gain insomnia or hypersomnia sleeping too much psychomotor agitation trouble sitting still retardation trouble doing voluntary physical activity fatigue guilt worthless lack of concentration suicidal don t have to act on it just simply have a preoccupation some pts can be misdiagnosed though i e patients with OCD might be obsessed with death but they aren t necessarily suicidal specifiers from DSM5 seasonal peripartum presents during pregnancy or within few weeks before giving birth psychotic features mood congruent thinking about death so they hallucinate dead bodies or mood incongruent have psychotic features but not tied to MDD symptoms prevalence 9 of general pop more common median age of onset is late teens early to mid 20s early child and late onset are less common 2 1 women considered internalized disorder social or hormonal component 85 recover more relapses early more relapses later in life 40 have another episode if you have even one episode of mania your diagnosis changes from MDD to Bipolar Persistent Depressive Disorder Dysthymia no history of manic hypomanic periods depressed mood most of day for minimum of 2 yrs symptoms can t be missing for more than 2 mos two or more of appetite issues insomnia hypersomnia low energy self esteem poor concentration hopelessness typically lower severity why suicide isn t major criteria prevalence 1 Theories on Depression A Biological looking at genetics family studies show 30 of relatives of depressed patients are themselves depressed twin studies concordance rates higher rate means it is genetic serotonin transporter gene after sero fires off into synapse ascending neuron has to do reuptake of serotonin hetero or homo for short allele combined with extent of environmental maltreatment higher depression rate short high risk long lower low sero norepi are linked to depression but low levels of both are a better indicator prevalent in circuit prefrontal ctx hippo amygdala Brodmann area 25 endocrine system dysfunction is also prevalent important chronic activation of HPA axis B Psychodynamic grief and depression seem similar if a loved one dies one can regress to oral stage dependent on parents Freud s hypoth merging of own identity with loved one allows person to turn emotions symptoms into another channel inward called interjection not supported because other things can cause depression C Behavioral changes in reward punishment as you get older rewards diminish i e graduate college is a huge deal as you get older the rewards get fewer and dysthymia develops get less do less cycle repeats if person fails to find other outlet place for rewards downward spiral happens supported in research especially with social reward support D Cognitive Aaron Beck negative thinking negative patterns of thought contribute to onset maintaining the depression maladaptive attitude black and white thinking i e if I fail this exam I ll fail everything cognitive triad ever improving automatic thoughts i e friend didn t wave back they don t like me anymore likely if you feel you re worthless rumination solve it predicts depression enhances neg thinking impairs prob solving b c you re in a repetitive process drives away social support RED components of negative thinking go over and over something in your mind but don t do anything to neg view of world self and future things are bad now no hope of it learned helplessness people become depressed when they feel that they don t control the rewards punishment in their life believe they re responsible for this helplessness Dogs shuttle boxes Martin Seligman experiment dogs put into a box with partition one side was control other provided a shock first round dogs jumped over and were shocked but allowed to jump back to safe side Round 2 dogs jumped but weren t allowed to jump back over taken out of environment put back in later and were allowed to jump away but didn t just took shocks stayed there attribution helplessness theory when neg events happen attributions we make contribute to depression i e partner breaks up with you it s your fault Internal Stable and Global interpretations these are helpless interpretations neg attribution styles are characteristic and risk factor for depression E Additional Perspectives family social multicultural gender differences Premenstrual Dysphoric Disorder PMDD present for majority of menstrual cycles come before week of mensus onset resolve few days later one or more of marked affective lability rapid emotion change depressed anxiety irritability one or more of low interest in fav activities low concentration food cravings eating changes hyper insomnia bloating swelling these two above columns combine to form minimum of 5 controversial to be added into DSM5 b c these symptoms are normal we are potentially patholizing such a common issue