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Lecture 3

Lecture Notes Week 3 - Mood Disorders.docx

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PSYC 235
Christopher Bowie

The Mood Disorders Major Depressive Disorder (MDD) Biploar I Disorder Bipolar II Disorder Dysthymia Cyclothymia Unipolar vs. Bipolar Mood Disorder  Directionality  Cyclicity  Severity  Duration  Polarity Introduction to Major Depression MD different from “normal” depressed mood:  Severity of symptoms  Number of symptoms  Duration of disturbance in functioning Depression vs. Moodiness  There is an arbitrary line for diagnosis The Burden of Depression  Point Prevalence = 5% (1.35 million in Canada)  Lifetime Prevalence = 10-15%  Average age of onset = early 20s  Sex Ratio = 2:1  Social cost - $14.4 billion in Canada / $475 million in Ontario  70% of suicides are diagnosed with Depression o Depression increases suicide risk 4-folf Untreated depression  Lower graduation rates  Below average grades  Lower occupational status  Physical health problems  Relationship problems  Substance abuse Defining Major Depression Depressed Mood / Loss of interest-Pleasure + 3-4 other symptoms = MAJOR DEPRESSIVE DISORDER Symptoms of Major Depression 1. Depressed mood  Must meet at 2. Loss of interest in activities and/or people least one of these 3. Marked insomnia or hypersomnia 4. Low energy 5. Appetite disturbance 6. Psychomotor retardation or agitation (lack of productive activity) 7. Feelings of worthlessness or guilt 8. Poor concentration or indecision 9. Thoughts of death and/or suicide A total of 5 or more of 9 Major Depression Defined  Symptoms must last at least 2 weeks (average = 6 months)  Symptoms must cause clinically significant distress or impairment  50-90% experience recurrent episodes Impairment Symptoms significantly interfere with normal functioning:  At work/school: absenteeism, poor evaluation, conflict  In relationships: no interest in activities, withdrawal/isolation, increase in conflict Depression is associated with:  Substance use and abuse  Delinquency  School dropout  Early pregnancy  Poor social functioning  Occupational impairment  Career dissatisfaction  Low psychological well-being  Health difficulties  Suicidal behaviours Episodic vs. Chronic Depression Chronic Depression:  More severe symptoms  More comorbitity  Higher levels of stress  Poorer social support  Poorer response to treatment  Greater family history of affective disorders  **No difference within chronic groups Dysthymia Persistently depressed mood that continues for at least 2 years (can’t have gone without symptoms for >2 months) + 2 additional symptoms  Poor appetite or overeating  Insomnia or hypersomnia  Low energy or fatigue  Low self-esteem  Poor concentration or indecision  Hopelessness Subtypes  Late onset > age 20  Early onset < age 20, greater chronicity, poorer prognosis Genetics of Mood Disorders st  Family Studies: 1 degree relatives 2-5X more likely to develop unipolar depression; 7-15X more likely to develop bipolar disorder  Twin Studies: concordance rates for unipolar depression of 40-59% for MZ twins, 20-30% for DZ twins; for bipolar disorder: 65% MZ, 14% DZ Neuroendocrinology and Depression ****Hypothalamic Pituitary-Adrenal Axis  Role in the Diathesis-Stress model of Depression o Excess reactivity of neural and endocrine stress response systems o Acute or prolonged stress, and possibly the cognitive attributions, interact with this vulnerability Stress and Mood Disorders  Depression associated with higher cortisol reactivity to stress  Depression associated with smaller volume of the hippocampus  STRESS KILLS BRAIN CELLS Life Stress and Depression  Depressed individuals 3x more likely to have experienced a severely stressful life event prior to onset  75% of depressed individuals suffered at least one severe loss event in 3- 6 months prior to onset  Chil
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