Mood Disorders PDF

Mood Disorders Sydney B. Miller Ph.D., C. Psych. Ryan Persram Yue Zhao PSYC 340 https://www.youtube.com/watch?v=qap-E8oqSnk https://www.youtube.com/watch?v=rPWAhFp1TaA  Mood Disorders Depressive Disorders Major Depressive Disorder Dysthymic Disorder Bipolar Disorders Bipolar I D...

Mood Disorders Sydney B. Miller Ph.D., C. Psych. Ryan Persram Yue Zhao PSYC 340 https://www.youtube.com/watch?v=qap-E8oqSnk https://www.youtube.com/watch?v=rPWAhFp1TaA  Mood Disorders Depressive Disorders Major Depressive Disorder Dysthymic Disorder Bipolar Disorders Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder Major Depressive Disorder Unipolar Depression Lifetime prevalence: up to 21% in women 13% in men Typical age of onset: 20s, but can occur at any time  Mood Symptoms of Depression Persistent sad, depressed mood Loss of interest or pleasure in previously enjoyable activities DSM criteria specify that person must have 1 of above plus 4 additional symptoms for at least 2 weeks  Physical Symptoms of Depression Sleep disturbance too much or too little loss of energy, fatigue appetite disturbance/weight change loss of appetite or increase in appetite changes in activity level psychomotor retardation or agitation  Cognitive Symptoms of Depression difficulty concentrating, thinking difficulty making decisions feelings of worthlessness, Feeling guilty or hopeless recurrent thoughts of death or suicide  Course of Depression if untreated, average duration of first episode is 6-9 months often recur  Dysthymic Disorder Less severe, but more chronic depression Depressed mood Two of the following symptoms poor appetite or overeating insomnia or hypersomnia low energy or fatigue low self-esteem poor concentration or difficulty making decisions feelings of hopelessness  Dysthymic Disorder Duration ◼ Symptoms must have lasted for at least 2 years ◼ Never without symptoms for longer than 2 months  Double-Depression dysthymic disorder with episodes of major depression prognosis more negative  Etiology Behavioral theory of depression Cognitive-behavioral theories of depression Aaron Beck’s cognitive-behavioral theory Hopelessness theory Neurotransmitter Models “Men are disturbed not by events, but by the views which they take of them.” --- Epictetus  BEHAVIORAL THEORY OF DEPRESSION Depression is learned Charles Ferster’s View: depression is a result of a lack of positive reinforcement for the depressive's actions Peter Lewinsohn’s View: depression is caused by a combination of stressors in a person's environment and a lack of personal skills (Wetzel, 1984) BEHAVIORAL THEORY OF DEPRESSION Criticisms: Did not pay much attention to people’s thoughts, perceptions, and evaluation. Focused only on people’s external and directly observable behavior.  Cognitive-Behavioral Theory How the concept of cognition plays an important role in determining the behavioral pattern of a person.  Cognitive-Behavioral View of Depression Depression results from maladaptive, faulty, or irrational cognitions taking the form of distorted thoughts and judgments Focus on the ways in which people respond to negative experiences involving loss, failure, and disappointment. (Ingram, Miranda, & Segal, 1998) BECK’S COGNITIVE-BEHAVIORAL THEORY Negative thoughts, generated by dysfunctional beliefs are the primary cause of depression. Depressive triad (dysfunctional beliefs) The self (e.g.,“I’m a useless person”) The world (e.g.,“It is impossible to have a good day”) The future (e.g.,“Things will never get better”) (Papalia, D. E., & Old, S. W.., 1988)  BECK’S COGNITIVE-BEHAVIORAL THEORY The Cognitive Model Core belief “I’m incompetent” Intermediate belief “If I don’t’ understand something perfectly, then I’m dumb” Situation Automatic thoughts Reactions Reading a book “This is too hard. I’ll never understand this” Emotional Sadness Behavioral Close the book Physiological Heaviness in abdomen  Research Evidence Halvorsen, Wang, Eisemann, Waterloo (2009) Participants: Clinically depressed, previously depressed, & never depressed Measures: dysfunctional attitudes, maladaptive schemas 9-year follow-up: diagnostic status, depressive severity, & course of depression Results: Early maladaptive schemas significantly predicted concurrent depression severity, and depression severity and episodes for major depression 9 years later.  Hopelessness Theory Depression is caused by negative causal attributions (Abramson, et al., 1989) Depressogenic attributional styles Internal (e.g., “Failing the exam proves that I’m a loser”) Stable (e.g., “I’ll never graduate because I’ve failed the exam”) Global (e.g., “Bad things always happen to me”) Research evidence: Inconsistent findings in children MODIFIED Hopelessness Theory The Weakest Link Hypothesis (Abela & Sarin, 2002) Vulnerability to depression is determined by the most depressogenic attributional style.  Research Evidence Research Evidence (Abela & Sarin, 2002) Participants: Grade 7 students Measures: depressive symptoms & depressogenic attributional styles 10 weeks later: depressive symptoms & negative events. Results: “Weakest links" interacted with negative events to predict increases in depression symptoms.  Take Home Message There is empirical support for the role of cognitive factors as a form of vulnerability to depression. It is possible that some theories can explain only certain aspects of depression. It may be necessary to integrate existing models in order to attain a comprehensive model of depression.  Which Neurotransmitters RYAN PERSRAM are Implicated in PSYC 700 OCTOBER 26, 2015 Depression?  Outline Definitions Neurotransmitters Major Neurotransmitters Implicated in MDD Norepinephrine Serotonin Dopamine Current Issues Future Directions Conclusion  Neurotransmitters Defined: Chemical substances that “physiologically influence the electrochemical states of nearby cells” (Snyder & Ferris, 2000) Located throughout the brain Hyper- and hypo-activity can result in a variety of behavioural changes Neurotransmitters and MDD Unique origins regarding discovery of neurotransmitter relationship Traditionally, Theory drives treatment Discovery of neurotransmitter alterations a result of the opposite effect In the 1950s, two classes of drugs found to treat symptoms of depression (Nestler et al., 2002; Nutt, 2008; Ruhé et al., 2007) : Tricyclic antidepressants (TCA) Monoamine oxidase inhibitors (MAOI)  Monoamine Hypothesis MDD may be explained as a result of monoamine neurotransmitter deficiencies (Ruhé et al., 2007) Links with at least 3 main neurotransmitters Norepinephrine Serotonin Dopamine Most effects located in the midbrain and brain stem (Hasler, 2010) The Catecholamine Hypothesis Arose from monoamine theories Hypothesis : Depression associated with decreases in catecholamines, particularly norepinephrine (Schildkraut, 1965) Conversely, elation associated with excess of amines  Norepinephrine (NE) Also known as noradrenaline (Mulinari, 2012) Integral function of the stress response system (Goddard et al., 2010) Regulates arousal Adaptation to environmental and internal stressors Decreased levels of NE associated with MDD Moret and Briley (2011), Ruhé et al. (2007): Rapid reappearance of depressive symptoms after drastic reduction of NE  Serotonin (5-HT) Implicated shortly after catecholamines (Mulinari, 2012) Serotonin hypothesis Decrease in 5-HT causally related in developing depression (Coppen, 1967; Cowen, 2008; Fakhoury, 2015) Associated with an individual’s anxiety, obsessions, compulsions Highest concentrations in hypothalamus (Coppen, 1967) Serotonin and MDD (Drevets et al., (1999, 2007)  Dopamine Associated with feelings of (Dunlop & Nemeroff, 2007; Klein, 1974; Nutt et al., 2006): Interest Pleasure Attention/Concentration Motivation Meyer et al. (2001) Reduced dopamine uptake > MDD Hasler et al. (2009) Experimentally reduced dopamine transmission → feelings of anhedonia, deficits in reward processing  Current Issues Implications of other neurotransmitters Ex: Glutamate hypothesis of depression (Sanacora et al., 2012) What are the unique contributions of each neurotransmitter? Nutt (2008): possible to establish symptoms on a spectrum of (a) negative affect, and (b) loss of positive affect Methodological considerations Samples vary Results in inconsistencies with findings Diagnosis  Future Directions Gender effects Given higher prevalence rates for women, how do neurotransmitter levels contribute to this? Tease apart: Individual/unique contributions of neurotransmitters Interactions with stress and environment Cultural factors Are there underlying factors within a culture that contribute to neurotransmitter hypoactivity?  Conclusion Modeling MDD exclusively on neurotransmitter dysregulation simplistic However, it provides a basis through which researchers can study and provide further neurobiological evidence associated with MDD Additional work obviously needed, but current literature is a step in the right direction