Mercer University – Atlanta Mood Disorders and Suicide Discussion

Please watch the following news story on Robin Williams and answer the questions related to the clip:

1.) In the clip, Dr. Lieberman discussed the severity of Robin William’s co-occurring depression with a substance use disorder. What would be some treatment options for someone like Robin Williams who is coping with severe depression?

2.) The link between depression (or any mental disorder) and suicide is very high. Additionally, the elderly seem to be at greatest risk for committing suicide. If you knew of someone who was feeling suicidal, what could be some steps you could take to help that person get the treatment they need?

Chapter 7
Mood Disorders and Suicide
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Outline
• Understanding and Defining Mood Disorders
• Depressive Disorders
• Bipolar Disorders
• Prevalence of Mood Disorders
• Causes of Mood Disorders
• Treatment of Mood Disorders
• Suicide
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Focus Questions
• What are the clinical features of mood disorders?
• How does the prevalence of mood disorders change
across the lifespan?
• What factors contribute to the development of mood
disorders?
• What treatments exist for mood disorders?
• What is the prevalence of suicide, and what are the risk
factors for suicide?
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An Overview of Depression and Mania
• Mood disorders = gross deviations in mood
• Composed of different types of mood “episodes”
• Periods of depressed or elevated mood lasting days
or weeks, including:
• Major depressive episodes
• Manic episodes
• Hypomanic episodes
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Major Depressive Episode
• Extremely depressed mood and/or loss of pleasure
(anhedonia)
• Lasts most of the day, nearly every day, for at least
two weeks
• At least four additional physical or cognitive symptoms:
• E.g., indecisiveness, feelings of worthlessness,
fatigue, appetite change, restlessness or feeling
slowed down, sleep disturbance
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DSM-5 Criteria: Major Depressive
Episode
A. Five (or more) of the following symptoms have been present during the same 2week period and represent a change from previous functioning; at least one of the
symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
Note: Do not include symptoms that are clearly due to a general medical condition
or mood-incongruent delusions or hallucinations.
1. Depressed mood most of the day, nearly every day, as indicated by either
subjective report (e.g., feels sad or empty) or observation made by others (e.g.,
appears tearful). Note: in children and adolescents can be irritable mood.
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the
day, nearly every day (as indicated by either subjective account or observation
made by others).
3. Significant weight loss when not dieting or weight gain (e.g., a change of more
than 5% of body weight in a month), or decrease or increase in appetite nearly
every day. Note: in children, consider failure to make expected weight gains
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DSM-5 Criteria: Major Depressive
Episode, continued
4. Insomnia or hypersomnia nearly every day
5. Psychomotor agitation or retardation nearly every day (observable by others, not
merely subjective feelings of restlessness or being slowed down)
6. Fatigue or loss of energy nearly every day
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be
delusional) nearly every day (not merely self-reproach or guilt about being sick)
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day
(either by subjective account or as observed by others)
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation
without a specific plan, or a suicide attempt or a specific plan for committing suicide
B. The symptoms cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
C. The symptoms are not due to the direct physiological effects of a substance
(e.g., a drug of abuse, a medication) or a general medical condition (e.g.,
hypothyroidism).
From American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
Washington, DC
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Manic Episode
• Elevated, expansive mood for at least one week
• Examples of symptoms:
• Inflated self-esteem, decreased need for sleep,
excessive talkativeness, flight of ideas or sense that
thoughts are racing, easy distractibility, increase in
goal-directed activity or psychomotor agitation,
excessive involvement in pleasurable but risky
behaviors
• Impairment in normal functioning
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DSM-5 Criteria: Manic Episode
A. A distinct period of abnormally and persistently elevated, expansive, or irritable
mood and abnormally and persistently increased goal-directed activity or energy,
lasting at least 1 week and present most of the day, nearly every day (or any
duration if hospitalization is necessary).
B. During the period of mood disturbance and increased energy or activity, three
(or more) of the following symptoms (four if the mood is only irritable) are present
to a significant degree and represent a noticeable change from usual behavior:
1. Inflated self-esteem or grandiosity
2. Decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
3. More talkative than usual or pressure to keep talking
4. Flight of ideas or subjective experience that thoughts are racing
5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant
external stimuli), as reported or observed
6. Increase in goal-directed activity (either socially, at work or school, or sexually)
or psychomotor agitation (e.g., purposeless non-goal-directed activity).
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DSM-5 Criteria: Manic Episode,
continued
7. Excessive involvement in activities that have a high potential for painful
consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions,
or foolish business investments)
C. The mood disturbance is sufficiently severe to cause marked impairment in
social or occupational functioning or to necessitate hospitalization to prevent harm
to self or others, or there are psychotic features.
D. The episode is not attributable to the physiological effects of a substance (e.g., a
drug of abuse, a medication, other treatment) or to another general medical
condition.
Note: A full manic episode that emerges during antidepressant treatment (e.g.,
medication, electroconvulsive therapy) but persists at a fully syndromal level
beyond the physiological effect of that treatment is sufficient evidence of a manic
episode and, therefore, a bipolar I diagnosis.
From American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
Washington, DC.
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Types of Mood Episodes
• Hypomanic episode
• Shorter, less severe version of manic episodes
• Last at least four days
• Have fewer and milder symptoms
• Associated with less impairment than a manic
episode (e.g., less risky behavior)
• May not be problematic in and of itself, but usually
occurs in the context of a more problematic mood
disorder
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Types of Mood Episodes, continued
• “Mixed features” = term for a mood episode with some
elements reflecting the opposite valence of mood
• Example: Depressive episode with some manic
features
• Example: Manic episode with some
depressed/anxious features
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The Structure of Mood Disorders
• Unipolar mood disorder: Only one extreme of mood is
experienced
• E.g., only depression or only mania
• Depression alone is much more common than mania
alone
• Bipolar mood disorder: Both depressed and elevated
moods are experienced
• E.g., some depressive episodes and some manic or
hypomanic episodes
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DSM-5 (Unipolar) Depressive Disorders
• Major depressive disorder
• Persistent depressive disorder
• New to DSM-5:
• Premenstrual dysphoric disorder
• Disruptive mood dysregulation disorder
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Major Depressive Disorder:
An Overview
• Clinical features
• One or more major depressive episodes separated by
periods of remission
• Single episode – highly unusual
• Recurrent episodes – more common
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DSM-5 Criteria: Major Depressive
Disorder
A. At least one major depressive episode (DSM-5 Table 7.1 Criteria A–C).
B. The occurrence of the major depressive episode is not better explained by
schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional
disorder, or other specified and unspecified schizophrenia spectrum and other
psychotic disorders.
C. There has never been a manic episode or hypomanic episode. Note: This
exclusion does not apply if all of the manic-like or hypomanic-like episodes are
substance induced or are attributable to the direct physiological effects of another
medical condition.
Specify the clinical status and/or features of the current or most recent major
depressive episode:
Single episode or recurrent episode; Mild, moderate, severe; With anxious distress;
With mixed features; With melancholic features; With atypical features; With moodcongruent psychotic features; With mood-incongruent psychotic features; With
catatonia; With peripartum onset; With seasonal pattern (recurrent episode only); In
partial remission, in full remission
From American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
Washington, DC.
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Persistent Depressive Disorder: An
Overview
• At least two years of depressive symptoms
• Depressed mood most of the day on more than 50%
of days
• No more than 2 months symptom free
• Symptoms can persist unchanged over long periods
(≥ 20 years)
• May include periods of more severe major depressive
symptoms
• Major depressive symptoms may be intermittent
or last for the majority or entirety of the time
period
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Persistent Depressive Disorder: An
Overview, continued
• Types of PDD
• Mild depressive symptoms without any major
depressive episodes (“with pure dysthymic
syndrome”)
• Mild depressive symptoms with additional major
depressive episodes occurring intermittently
(previously called “double depression”)
• Major depressive episode lasting 2+ years (“with
persistent major depressive episode”
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DSM-5 Criteria: Major Depressive
Disorder (Dysthymia)
A. Depressed mood for most of the day, for more days than not,
as indicated by either subjective account or observation by
others, for at least 2 years. Note: In children and adolescents,
mood can be irritable and duration must be at least 1 year.
B. Presence, while depressed, of two (or more) of the following:
1. Poor appetite or overeating
2. Insomnia or hypersomnia
3. Low energy or fatigue
4. Low self-esteem
5. Poor concentration or difficulty making decisions
6. Feelings of hopelessness
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DSM-5 Criteria: Major Depressive
Disorder (Dysthymia), continued
C. During the 2-year period (1 year for children or adolescents)
of the disturbance, the person has never been without the
symptoms in criteria A and B for more than 2 months at a time.
D. Criteria for major depressive disorder may be continuously
present for 2 years.
E. There has never been a manic episode or a hypomanic
episode, and criteria have never been met for cyclothymic
disorder.
F. The disturbance is not better explained by a persistent
schizoaffective disorder, schizophrenia, delusional disorder, or
other specified or unspecified schizophrenia spectrum and other
psychotic disorder.
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DSM-5 Criteria: Major Depressive
Disorder (Dysthymia), part 3
G. The symptoms are not attributable to the physiological effects
of a substance (e.g., a drug of abuse, a medication) or another
medical condition (e.g., hypothyroidism).
H. The symptoms cause clinically significant distress or
impairment in social, occupational, or other important areas of
functioning.
Specify if:
Current severity: Mild, moderate, severe; With anxious distress;
With mixed features; With melancholic features; With atypical
features; With mood-congruent psychotic features; With moodincongruent psychotic features; With peripartum onset; Early
onset: If onset is before age 21 years;
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DSM-5 Criteria: Major Depressive
Disorder (Dysthymia), part 4
Late onset: if onset is at age 21 years or older; specify (for most recent 2 years
of dysthymic disorder):
With pure dysthymic syndrome: if full criteria for a major depressive episode
have not been met in at least the preceding 2 years.
With persistent major depressive episode: if full criteria for a major depressive
episode have been met throughout the preceding 2-year period.
With intermittent major depressive episodes, with current episode: if full criteria
for a major depressive episode are currently met, but there have been periods
of at least 8 weeks in at least the preceding 2 years with symptoms below the
threshold for a full major depressive episode.
With intermittent major depressive episodes, without current episode: if full
criteria for a major depressive episode are not currently met, but there has
been one or more major depressive episodes in at least the preceding 2 years.
In full remission, in partial remission
From American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
Washington, DC.
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Possible Course of Depressive
Disorders
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Diagnostic Specifiers for Depressive
Disorders
• Specifier: Additional diagnostic label used by clinicians to
convey extra information about symptoms
• Specifiers are not mandatory; only assigned if
appropriate
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Diagnostic Specifiers for Depressive
Disorders, continued
• Psychotic features specifier
• Major depressive episodes which also include some
psychotic features
• Hallucinations: Sensory experience in the
absence of sensory input
• Delusions: Strongly held inaccurate beliefs
• Anxious distress specifier
• Depression is accompanied by several significant
symptoms of anxiety
• Predicts poorer outcome
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Diagnostic Specifiers for Depressive
Disorders, part 3
• Mixed features specifier
• Depressive episodes which also include several
manic symptoms
• Melancholic features specifier
• Major depressive episode accompanied by additional
severe symptoms such as early morning awakenings,
lack of reactivity to positive stimuli
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Diagnostic Specifiers for Depressive
Disorders, part 4
• Catatonic features specifier:
• Extremely rare muscular symptoms such as
remaining in a still stupor, “waxy” limbs that remain in
place when manipulated, repetitive or purposeless
movement
• Atypical features specifier:
• Presence of several symptoms less common in
depression, including oversleeping and overeating
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Diagnostic Specifiers for Depressive
Disorders, part 5
• Peripartum onset specifier:
• Depression occurring around the time of giving birth
• Seasonal pattern specifier: Depression occurring
primarily in certain seasons (usually winter)
• Sometimes called seasonal affective disorder.
• Result of phase-delayed circadian misalignment,
meaning that the patient’s circadian rhythm is
misaligned with the environmental day-night cycle
• May be treated effectively with light therapy
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Onset and Duration of Depressive
Disorders
• Rare in childhood
• Risk increases in adolescence and young adulthood,
decreases in middle adulthood, increases again in old
age (U-shaped pattern)
• Depressive episodes are variable in length
• Usually last several months untreated, but may last
several years
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Additional Examples: Courses of
Depression
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From Grief to Depression
 In previous editions of the DSM, depression could not be
diagnosed during periods of mourning
 Now recognized that major depression may occur as
part of the grieving process
 Acute grief: Occurs immediately after loss
 Integrated grief: Eventual coming to terms with meaning
of the loss
 Complicated grief: Persistent acute grief and inability to
come to terms with loss
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Other Depressive Disorders
• Premenstrual Dysphoric Disorder
• Significant depressive symptoms occurring prior to
menses during the majority of cycles, leading to
distress or impairment
• Controversial diagnosis
• Advantage: Legitimizes the difficulties some
women face when symptoms are very severe
• Disadvantage: Pathologizes an experience many
consider to be normal
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DSM-5 Criteria: Premenstrual Dysphoric
Disorder
•
At least five symptoms must be present final week before the onset of
menses, improve days after onset, and minimal/absent in week post
menses
•
Mood swings, sensitivity, etc
•
Irritability or anger
•
Depressed mood
•
Anxiety and tension
•
Decreased interests in usual activities
•
Difficulty concentrating’
•
Lethargy
•
Change in appetite
•
Problems sleeping
•
Feeling out of control
•
Physical symptoms
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Disruptive Mood Dysregulation Disorder
• Disruptive Mood Dysregulation Disorder
• Severe temper outbursts occurring frequently, against
a backdrop of angry or irritable mood
• Diagnosed only in children 6 to 18
• Criteria for manic/hypomanic episode are not met
• Designed in part to combat overdiagnosis of bipolar
disorder in youth
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DSM-5 Criteria: Disruptive Mood
Dysregulation Disorder
•
•
•
•
•
•
Recurring temper outbursts
Outbursts inconsistent with development
3 or more times a week
Persistent irritability
Between 6 to 18 years old
Onset 10 years old
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DSM-5 Bipolar Disorders
• Bipolar I disorder
• Alternations between major depressive episodes and
manic episodes
• Bipolar II disorder
• Alternations between major depressive episodes and
hypomanic episodes
• Cyclothymic disorder
• Alternations between less severe depressive and
hypomanic periods
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DSM-5 Criteria: Bipolar II Disorder
A. Criteria have been met for at least one hypomanic episode and at
least one major depressive episode.
Criteria for a hypomanic episode are identical to those for a manic
episode (see DSM-5 Table 7.2), with the following distinctions: 1)
Minimum duration is 4 days; 2) Although the episode represents a
definite change in functioning, it is not severe enough to cause marked
social or occupational impairment or hospitalization; 3) There are no
psychotic features.
B. There has never been a manic episode.
C. The occurrence of the hypomanic episode(s) and major depressive
episode(s) is not better explained by schizoaffective disorder,
schizophrenia, schizophreniform disorder, delusional disorder, or other
specified or unspecified schizophrenia spectrum and other psychotic
disorder.
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DSM-5 Criteria: Bipolar II Disorder,
continued
D. The symptoms of depression or the unpredictability caused by frequent
alternation between periods of depression and hypomania causes clinically
significant distress or impairment in social, occupational, or other important
areas of functioning.
Specify current or most recent episode:
Hypomanic: If currently (or most recently) in a hypomanic episode
Depressed: If currently (or most recently) in a major depressive episode
Specify if: With anxious distress; With mixed features; With rapid cycling; With
mood-congruent psychotic features; With mood-incongruent psychotic features;
With catatonia; With peripartum onset; With seasonal pattern
Specify course if full criteria for a mood episode are not currently met:
In full remission, in partial remission
Specify severity if full criteria for a mood episode are currently met: Mild,
moderate, severe
From American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
Washington, DC.
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Cyclothymic Disorder:
An Overview
• Chronic version of bipolar disorder
• Alternating between periods of mild depressive
symptoms and mild hypomanic symptoms
• Episodes do not meet criteria for full major depressive
episode, full hypomanic episode, or full manic
episode
• Hypomanic or depressive mood states may persist for
long periods
• Must last for at least two years (one year for children and
adolescents)
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DSM-5 Criteria: Cyclothymic Disorder
A. For at least 2 years (at least 1 year in children and adolescents)
there have been numerous periods with hypomanic symptoms that do
not meet criteria for a hypomanic episode and numerous periods with
depressive symptoms that do not meet criteria for a major depressive
episode.
B. During the above 2-year period (1 year in children and adolescents),
the hypomanic and depressive periods have been present for at least
half the time and the individual has not been without the symptoms for
more than 2 months at a time.
C. Criteria for a major depressive, manic, or hypomanic episode have
never been met.
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DSM-5 Criteria: Cyclothymic Disorder,
continued
D. The symptoms in criterion A are not better explained by schizoaffective
disorder, schizophrenia, schizophreniform disorder, delusional disorder, or
other specified or unspecified schizophrenia spectrum and other psychotic
disorder.
E. The symptoms are not attributable to the physiological effects of a substance
(e.g., a drug of abuse, a medication) or another medical condition (e.g.,
hyperthyroidism).
F. The symptoms cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
Specify if:
With anxious distress
From American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
Washington, DC.
Copyright © 2018 Cengage Learning. All Rights Reserved.
Diagnostic Specifiers for Bipolar
Disorders
• All of the specifiers for depressive disorders may also
apply to bipolar disorders
• Additional specifer unique to bipolar disorders: Rapid
cycling specifier
• Moving quickly in and out of mania and depression
• Individual experiences at least four manic or depressive
episodes within a year
• Occurs in between 20 to 50% of cases
• Associated with greater severity
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Prevalence of Mood Disorders
• Worldwide lifetime prevalence of MDD: 16%
• 6% have experienced major depression in last
year
• Sex differences
• Females are twice as likely to have major depression
• Bipolar disorders approximately equally affect males
and females
• Women more likely to experience rapid cycling
• Women more likely to be in depressive period
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Prevalence of Mood Disorders,
continued
• Occurs less often in prepubertal children
• Rapid rise in adolescents
• Adults over 65 have about 50% less prevalence than
general population
• Bipolar same in childhood, adolescence, and adults
• Prevalence of depression seems to be similar across
subcultures
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Life Span Developmental Influences on
Mood Disorders
• 3-month-olds can show depressive symptoms
• Young children typically don’t show classic mania or
bipolar symptoms
• Mood disorder may be misdiagnosed as ADHD
• Children are being diagnosed with bipolar disorders at
increasingly high rates
• Depression in elderly between 14% and 42%
• Co-occurrence with anxiety disorders
• Less gender imbalance after 65 years of age
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Prevalence of Mood Disorders
(slide 1 of 2)
• Across Cultures
• Similar prevalence among U.S. subcultures, but
experience of symptoms may vary
• E.g., some cultures more likely to express
depression as somatic concern
• Higher prevalence among Native Americans: Four
times the rate of the general population
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Causes of Mood Disorders: Familial and
Genetic Influences
• Family studies
• Risk is higher if relative has a mood disorder
• Relatives of bipolar probands are more likely to
have unipolar depression
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Causes of Mood Disorders: Familial and
Genetic Influences, continued
• Twin studies
• Concordance rates are high in identical twins
• Two to three times more likely to present with mood
disorders than a fraternal twin of a depressed co-twin
• Severe mood disorders have a strong genetic contribution
• Heritability rates are higher for females compared to males
• Some genetic factors confer risk for both anxiety and
depression
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Causes of Mood Disorders:
Neurobiological Influences
• Neurotransmitter systems
• Serotonin and its relation to other neurotransmitters
• Serotonin regulates norepinephrine and dopamine
• Mood disorders are related to low levels of serotonin
• Permissive hypothesis: Low serotonin “permits” other
neurotransmitters to vary more widely, increasing
vulnerability to depression
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Causes of Mood Disorders:
Neurobiological Influences, continued
• The endocrine system
• Elevated cortisol
• Stress hormones decrease neurogenesis in the
hippocampus > less able to make new neurons
• Sleep disturbance
• Hallmark of most mood disorders
• Depressed patients have quicker and more intense
REM sleep
• Sleep deprivation may temporarily improve
depressive symptoms in bipolar patients
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Mood Disorders: Psychological
Dimensions (Stress)
• Stressful life events
• Stress is strongly related to mood disorders
• Poorer response to treatment
• Longer time before remission
• Context of life events matters
• Gene-environment correlation: People who are
vulnerable to depression might be more likely to enter
situations that will lead to stress
• The relationship between stress and bipolar is also
strong
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Diagram of Context and Meaning in Life
Stress Situations
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Psychological Dimensions: Learned
Helplessness
• The learned helplessness theory of depression
• Lack of perceived control over life events leads to
decreased attempts to improve own situation
• First demonstrated in research by Martin Seligman
• Negative cognitive styles are a risk factor for
depression
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Psychological Factors: Depressive
Attributional Style
• Internal attributions
• Negative outcomes are one’s own fault
• Stable attributions
• Believing future negative outcomes will be one’s fault
• Global attribution
• Believing negative events will disrupt many life
activities
• All three domains contribute to a sense of hopelessness
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Psychological Dimensions: Cognitive
Theory
• Negative coping styles
• Depressed persons engage in cognitive errors
• Tendency to interpret life events negatively
• Types of cognitive errors
• Arbitrary inference – overemphasize the negative
aspects of a mixed situation
• Overgeneralization – negatives apply to all situations
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Psychological Dimensions: Cognitive
Theory, continued
• Cognitive errors and the depressive cognitive triad
• Think negatively about oneself
• Think negatively about the world
• Think negatively about the future
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The Depressive Cognitive Triad
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Social and Cultural Dimensions
• Marital relations
• Marital dissatisfaction is strongly related to depression
• This relation is particularly strong in males
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Social and Cultural Dimensions,
continued
• Social support
• Extent of social support is related to depression
• Lack of social support predicts late onset depression
• Substantial social support predicts recovery from
depression
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Gender Differences in Mood Disorders
• Women account for 7 out of 10 cases of major
depressive disorder
• Recall that women also have higher rates of anxiety
disorders
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Gender Disparity in Depression
Diagnosis Worldwide
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Explanations for Gender Differences in
Mood Disorders
• Possible explanations for gender disparity
• Women socialized to have stronger perception of
uncontrollability
• Parenting style makes girls less independent
• Women more sensitive to relationship disruptions
(e.g., breakups, tension in friendships)
• Women ruminate more than men
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An Integrative Theory
• Biological and psychological vulnerabilities interact with
stressful life events to cause depression
• Biological vulnerability: e.g., overactive
neurobiological response to stress
• Psychological vulnterability: e.g., depressive cognitive
style
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Integrative Model of Mood Disorders
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Treatment of Mood Disorders:
Medication
• Antidepressants
• Selective serotonin reuptake inhibitors
• Tricyclic antidepressants
• Monoamine oxidase inhibitors
• Mixed reuptake inhibitors (e.g., serotonin/norepinephrine
reuptake inhibitors)
• Approximately equally effective
• Only 50% of patients benefit
• Only 25% achieve normal functioning
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Selective Serotonin Reuptake Inhibitors
• Called SSRIs
• Specifically block reuptake of serotonin so more
serotonin is available in the brain
• Fluoxetine (Prozac) is the most popular SSRI
• SSRIs pose some risk of suicide particularly in teenagers
• Negative side effects are common
• Some evidence that SSRI use during pregnancy lowered
risk for birth complications
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Tricyclic Antidepressants
• Include Tofranil, Elavil
• Mechanisms not well understood
• Block reuptake norepinephrine and other
neurotransmitters
• Negative side effects are common (e.g., drowsiness,
weight gain)
• Discontinuation is common
• May be lethal in excessive doses
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Mixed Reuptake Inhibitors
• Block reuptake of norepinephrine as well as serotonin
• Best known is venlafaxine (Effexor)
• Have fewer side effects than SSRIs
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Monoamine Oxidase (MAO) Inhibitors
•
•
•
•
Block monoamine oxidase
This enzyme breaks down serotonin/norepinephrine
As effective as tricyclics, with fewer side effects
Dangerous in combination with certain foods
• Beer, red wine, cheese cannot be consumed; patients
dislike dietary restrictions
• Also dangerous in combination with cold medicine
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Treatment of Mood Disorders: Lithium
• Lithium carbonate = a common salt
• Treatment of choice for bipolar disorder
• Considered a mood stabilizer because it treats
depressive and manic symptoms
• Toxic in large amounts
• Dose must be carefully monitored
• Effective for 50% of patients
• Why lithium works is partially understood
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Treatment of Mood Disorders:
Electroconvulsive Therapy (ECT)
• Effective for medication-resistant depression
• The nature of ECT
• Brief electrical current applied to the brain
• Results in temporary seizures
• Usually 6 to 10 outpatient treatments are required
• Side effects:
• Short-term memory loss which is usually restored
• Some patients suffer long-term memory loss
• Mechanism is unclear
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Treatment of Mood Disorders:
Transcranial Magnetic Stimulation
• Uses magnets to generate a precise localized
electromagnetic pulse
• Few side effects; occasional headaches
• Less effective than ECT for medication-resistant
depression
• May be combined with medication
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Psychosocial Treatments for Depression
• Cognitive-behavioral therapy
• Addresses cognitive errors in thinking
• Also includes behavioral components including behavioral
activation (scheduling valued activities)
• Interpersonal psychotherapy
• Focus: Improving problematic relationships
• Prevention
• Preemptive psychosocial care for people at risk
• Has longer-lasting effectiveness than medication
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Preventing Relapse
• Research on relapse prevention is relatively less
common
• Psychosocial and pharmacological treatments are both
used
• Psychosocial interventions generally more effective at
preventing relapse
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Psychosocial Treatments for Bipolar
Disorders
• Medication (usually Lithium) is still first line of defense
• Psychotherapy helpful in managing the problems (e.g.,
interpersonal, occupational) that accompany bipolar
disorder
• Family therapy can be helpful
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Suicide: Facts and Statistics
• Eleventh leading cause of death in USA
• Underreported; actual rate may be 2 to 3 times higher
• Most common among white and native Americans
• Particularly prevalent in young adults
• Third leading cause of death among teenagers
• Second leading cause of death in college students
• 12% of college students consider suicide in a given year
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Suicide: Facts and Statistics, continued
• Gender differences
• Males complete more suicides than females
• Females attempt suicide more often than males
• Disparity is due to males using more lethal methods
• Exception: Suicide more common among women in China
• May reflect cultural acceptability; suicide is seen as an
honorable solution to problems
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The Nature of Suicide:
Risk Factors
• Risk factors
• Suicide in the family
• Low serotonin levels
• Preexisting psychological disorder
• Alcohol use and abuse
• Stressful life event, especially humiliation
• Past suicidal behavior
• Plan and access to lethal methods
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Vulnerability for Suicidal Behavior
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Suicide Contagion
• Some research indicates that a person is more likely to
commit suicide after hearing about someone else
committing suicide
• Media accounts may worsen the problem by
• Sensationalizing/romanticizing suicide
• Describing lethal methods of committing suicide
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Suicide Prevention
• In professional mental health
• Clinician does risk assessment (ideation, plans, intent,
means, etc.)
• Clinician and patient develop safety plan (e.g., who to call,
strategies for coping with suicidal thoughts)
• In some cases, sign no-suicide contract
• Preventative programs for at-risk groups
• CBT can reduce suicide risk
• Important: removing access to lethal methods
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Suicide Prevention, continued
• If you think someone is at risk, talk to them and ensure
they’re getting needed support
• Talking to someone about suicide is not likely to place
them at greater risk or “plant the idea”
• In contrast, the risk of not providing support to someone in
need is huge
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Phone Numbers for Help
SUICIDE SUPPORT LINE:
1-800-273-TALK
(1-800-273-8255)
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Summary of Mood Disorders
• All mood disorders share:
• Gross deviations in mood
• Common biological and psychological vulnerability
• Occur in children, adults, and the elderly
• Onset, maintenance, and treatment are affected by:
• Stressful life events
• Social support
• Differential response to medication
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