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Mood disorders Mood disorders: A category of mental disorders in which significant and chronic disruption in mood is the predominant symptom, causing impaired cognitive, behavioral and physical functioning. For more information, (www.nimh.nih.gov) Types of mood disorders: • Major depression o Dysthymic disorder (low-grade depression) • Bipolar disorder o Cyclothmyic disorder (low-grade bipolar) • Season Affective Disorder (SAD)

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Major Depression The diagnosis of major depression is when the person displays most of the symptoms for 2 weeks or longer. In many cases, there doesn’t appear to be any external reason for the persistent feelings of depression. In other cases, the downward emotional spiral can be triggered by a stressful or negative event.

normal depression

abnormal depression

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Symptoms of Major Depression (see figure 14.3) Emotional • Feelings of sadness, hopelessness, helplessness, guilt, emptiness or worthlessness. • Feeling emotionally disconnected from others. • Turning away from others. • Loss in ability to experience pleasure Behavioral • Dejected facial expressions • Smiles less often • Slowed movements, speech and gestures • Tearfulness or spontaneous episodes of crying • Loss of interest or pleasure in usual activities including eating and sex • Withdrawal from social activities Cognitive • Difficulty thinking, concentrating or remembering • Global negativity and pessimism • Suicidal thoughts or preoccupation with death Physical • Changes in appetite resulting in significant weight loss or gain • Insomnia, early morning awakening or oversleeping • Vague but chronic aches and pains • Diminished sexual interest • Global feelings of anxiety • Restlessness, fidgety activity

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How common/uncommon are mood disorders? • According to the World Health Organization (WHO), depression is the world's fourth most devastating illness. • 13-14 million Americans are affected by mood disorders each year. (What is the population of Oregon?) • About 17.1% of Americans are likely to suffer at least one episode of depression in their lifetime, and only 1/3 will receive treatment. • For 20-35% of patients with major depression, recurrence of episodes is chronic and may last 2 years or longer. • According to the American Psychiatric Association, 1 year after a diagnosis of their initial depression, o 40% of patients are without symptoms o 20% are still depressed, but not enough to warrant a diagnosis of major depression and o 40% are still suffering from depression

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• Some people suffer only one major depressive episode, but 50-60% will have recurrences of major depression. Risk of recurrences is greatest for females and individuals with an onset of depression before age 15. o Before the age of 11, girls and boys have the same rates of depression. o Between the ages 11-15, depression in girls rises. o By age 18, girls have twice the depression rate as boys. Women are twice as likely as men to be diagnosed with major depression.
If you are a woman, there is a 1 in 4 chance that you will experience major depression in your lifetime.
If you are a man, there is a 1 in 8 chance you will experience major depression in your lifetime. o About 10% of those with major depression attempt suicide. o Up to 15% of people who suffer from depression or bipolar disorder commit suicide each year.

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• Gender and major depression: Cross cultural studies indicate that women are more likely to suffer from major depression than men (across different cultures, there are individual variations in this ratio) AND they are more likely to be affected by negative consequences of depression. Early onset of major depression adversely affects educational attainment and earning power of women, but not men. It is suggested that this is because women serve more roles than men in society—mother, wife, lover, friend, daughter, etc., and put the needs of others ahead of her own. • When you combine the cost of treating depression, worker absenteeism, reduced productivity at work, and loss of lifetime earning from depression, the cost is estimated at $44 billion dollars a year in the United States. Risk factors for major depression: • People in the 15-24 and 35-44 age brackets are at a higher risk • If you have little education or income, a homemaker, divorced, widowed or separated.

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Example of a mood disorder A writer has periods where she produces so much work that her friends are amazed. She’s on an emotional high during her productive periods, and can get by with only a couple of hours of sleep each day. But she has other periods when she can’t seem to write anything; she can’t concentrate; in fact, she often can’t even get out of bed for days at a time. During these times, nothing interests her, even things she usually loves to do. Likely disorder: bipolar disorder (mood disorder) Characteristics of bipolar disorder: • One or more manic episodes characterized by euphoria, high energy, grandiose ideas, flight of ideas, inappropriate self-confidence, and decreased need for sleep. • Usually, one or more episodes of major depression • May alternate rapidly between symptoms of mania or major depression. Prevalence of bipolar disorder: • About 2 million Americans suffer from bipolar disorder. • Unlike major depression, there is no gender disparity.

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Bipolar Disorder (formerly known as manic depression)

Bipolar disorder is a mood disorder in which manic episodes alternate with periods of depression, usually with relatively normal periods in between. Manic episode: A period of excessive euphoria, inflated self-esteem, wild optimism, and hyperactivity. It is often accompanied by delusions of grandeur, drug abuse, and sexual promiscuity. Hostility can occur when the bipolar’s behavior is blocked by others. It is believed that Vincent Van Gogh had a bipolar disorder. In one two month period, he produced 60 paintings—some were his best works. Between these periods of mania of almost non-stop work, he experienced deep despair in which he did no work at all. • Bipolar is less common than major depression, affecting about 2 million Americans per year. • There are no gender differences in likelihood of being afflicted by bipolar disorder. The lifetime risk of developing bipolar disorder is about 1%. • Bipolar tends to appear in late adolescence or early childhood. The average person with bipolar disorder has four episodes of mania or depression during the first 10 years of their illness.

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• Manic and depressive episodes can range from a few days to a couple of months. • About 90% of those with the disorder have recurrences, and about 50% experience another episode within a year of recovering from the previous episode. • 70-80% of the patients return to a state of emotional stability, but mild cognitive deficits such as difficulties in planning, persist in many patients following a manic episode. • More than 50% of people with bipolar disorder abuse drugs or alcohol during their illness (though not all that abuse alcohol are bipolar) • On the average, people with bipolar disorder see 3 to 4 doctors and spend more than eight years seeking treatment before a correct diagnosis. • On average, without treatment, manic episodes last a few months, while depression lasts more than six months. • The more mood episodes a person experiences, the harder it is to treat subsequent episodes • Treatment: Drugs such as lithium and divalproex and psychotherapy has been helpful in treating bipolar.

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Explaining mood disorders • A small thimble-size patch of brain tissue in the lower prefontal cortex (about 2-3 inches behind the bridge of the nose) is 40-50% smaller in people with major depression. In addition, the people high in the personality trait neuroticism may be predisposed to depression and suicidal thoughts • Genetics: If one twin has major depression, there is a 50% chance the other twin will have major depression where as fraternal twins have a 7% chance. If a person’s has a mood disorder, the immediate relatives are three times as likely as the general population to have a mood disorder. • Neurotransmitters: Increasing the availability of norepinephrine and serotonin helps lifts the symptoms of depression. Lithium appears to help regulate the glutamate neurotransmitter. Psychological disorder Obsessivecompulsive Depression

Serotonin norepinephrine Deficit Deficit

Deficit

• Stress: Major depression is often triggered by traumatic and stressful events, especially those who have a family history of mood disorders.