Mood Disorders and Suicide

Chapter 7
Mood disorders: involve severe alternations in mood which
are intense and persistent enough to be clearly maladaptive
and often lead to serious problems.

Must be clinically significant and significantly deviate from

the individual’s base line or ordinary emotional state.
The two key moods involved in mood disorders are:

Euphoric mood (mania): characterized by intense and unrealistic

feelings of excitement and euphoria.

Dysphoria: (depression): feelings of extraordinary sadness and

dejection.

Mixed features (mixed episode) characterized by symptoms of both

mania or hypomania with depressive features.
Depressive disorder: involves periods of symptoms in which
an individual experiences an unusually intense sad mood.

The disorder’s essential element is an unusually elevated sad

mood, known as dysphoria.
Major depressive disorder: a disorder in which the individual
experiences acute but time limited episodes of depressive
symptoms.

Major depressive episodes: a period in which the individual

experiences intense psychological and physical symptoms
accompanying feelings of overwhelming sadness.

Recurrent major depressive disorder with two or more episodes

within an interval of at least 2 consecutive months.
An affected person must experience the following:
Dysphoria for most of the day, nearly every day for at least 2
consecutive weeks.

Symptoms include: sleep and appetite disturbances, low

energy/fatigue, low self-esteem, difficulty concentrating or making
decisions, poor hygiene, feelings of hopelessness.

If untreated, a major depressive episode usually lasts 6 to 9 months and

often recur as some future point.
Persistent depressive disorder (dysthymia): chronic but less
severe mood disturbance in which the individual does not
experience a major depressive episode but a blue mood for a
minimum of two years (1 year for children and adolescents).

Average duration is 4 to 5 years but can last for 20 or more.

As compared to MDD, symptoms of PDD are mild to moderate but last
much longer (are chronic).
Periods of normal moods occur briefly but only last for a few days to a
few weeks with a maximum of 2 months. These intermittent normal
mood swings are the most important characteristic distinguishing
PDD from major depressive disorder.
Disruptive mood dysregulation disorder: a depressive disorder in
children who exhibit chronic and severe irritability and have frequent
temper outbursts.

Occur on average 3 or more times/week over at least 1 year and in at

least 2 settings.

Diagnosis for children between ages 6 to 18. Onset must be before

age 10.
Premenstrual dysphoric disorder (PMDD): disorder that
involves depressed mood or changes in mood, irritability,
dysphoria and anxiety during the premenstrual phase that
subside after the menstrual period begins for most of the
cycles of the preceding year.
Causal factors:
Biological: genetic influences are prevalent. 2/3 times higher among
blood relatives.

Neurochemical factors: major depression is associated with altered

neurotransmitter activity but newer research focuses more on the
complex interactions of neurotransmitters and how they affect cellular
functioning. So it’s not how much, rather it’s how they interact with
other hormonal and neurophysiological patterns.
Psychological causes: stressful life events (loss of a loved one, serious
threats to important close relationships or to one’s occupation,
economic or health problems), chronic stress, early adversity ( family
turmoil, abuse, harsh or intrusive parenting), neuroticism and learned
helplessness.

Neuroticism is the primary personality variable that serves as a

vulnerability factor for depression (and anxiety). Involves
temperamental sensitivity to negative stimuli and are prone to
experiencing a broad range of negative moods.
The learned helplessness model of depression: when perceived lack of
control is present, helplessness may result in depression.
The result: people make attributions that are central to whether they
become depressed.
3 critical dimensions:
1. Internal/external
2. Global/specific
3. Stable/unstable.

Those with a pessimistic attribution style have a vulnerability for

depression.
Bipolar disorder: mood disorder involving euphoric episodes,
intense and very disruptive experiences of heightened mood
referred to as a euphoric mood, possibly alternating with a
major depressive episode.
Two main categories of Bipolar disorder: Bipolar I and Bipolar II

Bipolar I: distinguished from major depressive disorder by at least one or

more manic episodes or mixed features for at least 1 week.

Bipolar II: person had one or major depressive episodes and at least one
mixed with clear-cut hypomanic episodes.

Hypomanic episodes: involves milder versions of mania but must last at

least 4 days. Same symptoms but less impairment and never need
hospitalization.
Cyclothymic disorder: defined as more chronic but less severe version
of bipolar disorder. (Lacks certain extreme symptoms and psychotic
features).

In the depressed phase, similar to persistent depressive disorder

(dysthymia) and the hypomanic phase involves creative and productive
physical and mental energy.
Must be at least 2 years of numerous periods with hypomanic and
depressed symptoms (1 for children and adolescents) and symptoms
must cause significant distress or impairment in functioning.
Never symptom free for more than 2 months.
Bipolar is equal in men and women.
Bipolar I: onset in adolescence or young adulthood.
Bipolar II: on average 5 years later.

Cannot be diagnosed with bipolar disorder unless exhibited at least

one manic or mixed episode.

Rapid cycling: experience at least 4 episodes in a year.

Of all the psychological disorders, bipolar disorder is the most likely to
occur in people who also have problems with substance abuse.

With both:
-earlier onset
-more frequent episodes
-greater chance for anxiety and stress related disorders
-aggressive behavior
-problems with the law
-risk of suicide
Biological causal factors: genetic influences
Neurochemical factors: excesses of norepinephrine during manic
episodes, less serotonin in both depressive and manic phases.

Abnormalities of hormonal regulatory systems: some evidence of

abnormalities of thyroid function are frequently accompanied by
changes in mood.

Psychological factors: stressful life events as in depressive disorders

Suicide: “fatal self-inflicted destructive act with explicit or inferred
intent to die”.

Suicidal continuum:
1. Suicidal ideation: thinking about ending one’s life
2. Developing a plan
3. Suicide attempt: nonfatal suicidal behavior
4. Suicide: actual ending of one’
Biopsychosocial perspective:
Biological: emphasize genetic and physiological
contributions (same as in mood disorders).
Psychological: focus on distorted cognitive
processes (hopelessness, etc.)
Sociocultural: religious beliefs, life stressors
Positive psychology: 3 aspects of resilience

1. Risk for suicide but unlikely when high in resilience

2. Bipolar dimensions of each (risk and resilience) high in one low in
another.
3. Resilience is a psychological construct: a belief you can overcome
diversity, good coping skills.
Pharmacotherapy:

Antidepressant drugs:
Monoamine oxidase inhibitors (MAOIs)
Tricyclic antidepressants
Selective serotonin reuptake inhibitors (SSRIs).
3 to 5 weeks to take effect.

Mood-stabilizing drugs: For both depressive and euphoric episodes of

bipolar disorder.
Lithium (Common medication for bipolar disorder.)
Alternative biological treatments:
Electroconvulsive therapy (ECT): Treatments induce seizures, used with
severely depressed patients who may present serious suicidal risk.

Transcranial Magnetic Stimulation (TMS): focal stimulation of the brain.

Deep Brain Stimulation: implanting an electrode in the brain and

stimulating that area with electric current.
Psychotherapy
Cognitive-behavioral therapy (CBT)
Behavioral Activation Treatment: focuses intently on getting patients to
become more active and engaged with their environment and with
interpersonal relationships.

Interpersonal Therapy (IPT): focuses on current relationship issues

and understanding and change of maladaptive interaction patterns.

Family and Marital therapy: