Mood Disorders

Brian J. Piper, Ph.D.

Goals

Major Depressive Disorder

Bipolar Disorder

Major Depressive Disorder

• Lifetime prevalence of 12% in men, 20% in women.

• Social or occupational impairment.

Anhedonia

• Loss of interest in previously pleasurable activities

Edvard Munch (1863-1944) Despair (1894)

DSM-IV Criteria: 5 Total

• One of the following:– Depressed Mood– Anhedonia

• Also includes:– Significant weight increase or decrease (5% of body weight in 1

month)– Insomnia or hypersomnia– Feelings of worthlessness– Diminished ability to concentrate– Recurrent thoughts of death

Exclusion: Life events & medical conditions

Anna M. Kring, Ph.D. Lecture 14, 19:38-23:08

Causes of MDD

• Genetics

• Stress Hormones

• Brain Chemistry: Monoamine Theory

• Cognitive patterns

Twin Studies

BMJ 1999; 319 : 37

Cortisol

• The Hypothalamus-Pituitary-Adrenal (HPA) axis control release of the stress hormone cortisol.

• As many as half of depressed patients show elevations in cortisol. Drugs that turn off the HPA axis are ineffective.

Belmaker & Agam (2008). New England Journal of Medicine, 358, 55-68.

Structural Changes following Elevated Cortisol?

• Rat research indicate that persistent increases in cortisol are toxic to hippocampal neurons.

• Studies examining the volume of the hippocampus in MDD were inconsistent.

• A meta-analysis showed that the left (-4.5%) and right hippocampus (-4.0%) showed reductions.

Cole et al. (2011). J of Affective Dis 134, 483-487.

Monoamine Theory

• Monoamine = 1 NH2 and include 5-HT and NE

• Reserpine (reduces monoamines) was found to cause depression.

• Several drug classes that increase 5-HT/NE are helpful for some people with MDD.

Forced Swim Test

• Animal model of “hopelessness”.• Monoamine drugs decrease immobility.

http://www.youtube.com/watch?v=Wq2dyNILb5U

Problems with Monoamine Theory

• No lack of monoamines in depressed people• “Therapeutic lag”

Norepinephrine

Learned Helplessness

• Part I: Harness– Experimental Group: learns to press lever to avoid

footshock– “Yoked” Group: footshocks but no control

Seligman, M.E.P. & Maier, S. F. (1967). J Exp Psychol 74(1), 1-9.

Martin Seligman1942-

Learned Helplessness

• Part I: Harness– Experimental Group: learns to press lever to avoid

footshock– “Yoked” Group: footshocks but no control

• Part II: Unrestrained– Experimental: avoid shocks– Yoked: do not

Social-Cognitive Perspective

The social-cognitive perspective suggests that depression arises partly from self-

defeating beliefs and negative explanatory styles.

Negative Thoughts and Moods

Explanatory style plays a major role in becoming depressed.

Depression Cycle

1. Negative stressful events.

2. Pessimistic explanatory style.

3. Hopeless depressed state.

4. These hamper the way the individual thinks and acts, fueling personal rejection.

Bipolar Disorder

Formerly called manic-depressive disorder. An alternation between depression and

mania signals bipolar disorder.

Multiple ideas

Hyperactive

Desire for action

Euphoria

Elation

Manic Symptoms

Slowness of thought

Tired

Inability to make decisions

Withdrawn

Gloomy

Depressive Symptoms

Example of Mania

• Lifetime prevalence: 1%

• 1st Minute: http://www.youtube.com/watch?v=rcl09ztmoDw

Diagnosis

• Bipolar I: – manic episode– depression not

required– not due to

recreational drugs

• Bipolar II:– Hypomanic Episode– major depressive episode– not due to recreational

drugs

Copyright restrictions may apply.

Moreno, C. et al. (2007). Arch Gen Psychiatry, 64, 1032-1039.

National trends in visits with a diagnosis of bipolar disorder as a percentage of total office-based visits by youth (aged 0-19 years) and adults (aged >= 20 years)

Bipolar Disorder

Many great writers, poets, and composers suffered from bipolar disorder.

During their manic phase creativity surged, but not during their depressed

phase.

Whitman Wolfe Clemens Hemingway

Bettm

ann/ Corbis

George C

. Beresford/ H

ulton Getty Pictures L

ibrary

The G

ranger Collection

Earl T

heissen/ Hulton G

etty Pictures L

ibrary

The Depressed Brain

PET scans show that brain energy consumption rises and falls with manic

and depressive episodes.

Courtesy of L

ewis B

axter an Michael E

. P

helps, UC

LA

School of M

edicine

Treatment

• Lithium carbonate (Li2CO3)

• John Cade, Australian psychiatrist, on giving lithium to guinea pigs:– “After a latent period of about two-hours, the animals, although fully conscious

became extremely lethargic and unresponsive to stimuli for one to two hours before once again becoming timid and active. Those who have experimented with guinea pigs know to what extent a ready startle reaction is part of their makeup. It was even more startling to find that after the injection of a solution of lithium carbonate they could be turned on their backs and that, instead of the usual frantic righting behavior, they merely lay there and gazed placidly back at him.”

Treatment

• Lithium carbonate (Li2CO3)

• John Cade, Australian psychiatrist & guinea pigs

• Many Bipolar patients find lithium helpful but

– Not all

– Kidney function

Depression & Pregnancy

• Drug treatment & pregnancy is a tough decision.

• Depression may also occur Post-partum.

Edinburgh Postnatal Depression Scale

0 to 3 points/item, 10+ is probable Postpartum Depression.

Cox, J.L., Holden, J.M., & Sagovsky, R. (1987). Detection of postnatal depression: Development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry 150, 782-786 .

Suicide

The most severe form of behavioral response to depression is suicide. Each

year some 1 million people commit suicide worldwide.

1. National differences

2. Racial differences3. Gender

differences4. Age differences5. Other differences

Suicide Statistics

MDD & Bipolar Summary

• Symptoms

• Biopsychosocial

components

At Eternity’s Gate (1890)Vincent van Gogh