CHAPTER 10 – MOOD DISORDERS:
GENERAL CHARACTERISTICS OF MOOD DISORDERS:
mood disorders: involve disabling disturbances in emotion, from the sadness of depression to
the elation and irritability of mania.
DEPRESSION – SIGNS AND SYMPTOMS:
depression: an emotional state marked by great sadness and feelings of worthlessness and
Depression in children often result ins in somatic complains. In older adults, depression is often
characterized by distractibility and complaints of memory loss.
Symptoms of depression exhibit some cross-cultural variation, probably resulting from
differences in cultural standards of acceptable behaviour.
Although it is commonly believed that people from non-western cultures emphasize somatic
symptoms of depression, while people from western cultures emphasize emotional symptoms,
studies suggest that people from various cultures tend to emphasize somatic symptoms rather
than the emotional symptoms.
psychologizers: people who emphasize the psychological aspects of depression.
Most depression, although recurrent, tends to dissipate with time. About one third of depressed
people suffer from chronic depression.
MANIA – SIGNS AND SYMPTOMS:
Mania: an emotional state or mood of intense but unfounded elation accompanied by irritability
and impractical grandiose plans.
The person in the throes of a manic episode, which last from several days to several months, is
readily recognized by his loud and incessant stream of remarks, sometimes full of puns, jokes and
FORMAL DIAGNOSTIC LISTINGS OF MOOD DISORDERS:
Diagnosis of Depression:
The formal diagnosis of a major depressive disorder MDD) requires the presence of five of
the following symptoms for at least two weeks.
sad, depressed mood, most of the day, nearly every day
loss of interest and pleasure in usual activities
difficulties in sleeping (insomnia), or a desire to sleep a great deal of time
shift in activity level, becoming either lethargic (psychomotor retardation) or agitated
poor appetite and weight loss, or increased appetite and weight gain
loss of energy, great fatigue
negative self-concept, self-reproach and self-blame, feelings of worthlessness, and guilt
complaints of evidence of difficulty in concentrating such as slowed thinking and
recurrent thoughts of death or suicide
what is controversial s whether a patient with five symptoms and a two-week duration is
distinctly different from one who has only three symptoms for 10 days.
Even with fewer than five symptoms and duration of less than two weeks, co-twins were also
likely to be diagnosed with depression and patients were likely to have recurrences. Five symptoms – increased weight, decreased weight, psychomotor retardation, indecisiveness
and suicidal thoughts – were not independently associated with the diagnosis. These findings have
implications for the possible revision of the diagnosis criteria for MDD.
MDD is one of the most prevalent of the disorders. Lifetime prevalence rates range from 5.2% to
MDD is abut two times more common in women than in men. The gender difference does not
appear in preadolescent children, but it emerges at age 14 and seems to be maintained across the
Current and lifetime prevalence rates are higher among younger than older persons.
Participants with MDD who had certain coexisting personality disorders had a significantly longer
time to remission of symptoms than did MDD patients without any personality disorder.
kindling hypothesis: the notion that nce a depression has already been experiences, it takes
relatively less stress to induce a subsequent recurrence.
What is not clear is whether the apparent reduced role of life events stress in subsequent
depressions is because depression has become autonomous and no longer requires stress (the
autonomy hypothesis) or whether the person has become sensitized to stress (the sensitivity
hypothesis) and even small amounts of stress are sufficient to induce depression.
Diagnosis of Bipolar Disorder:
Bipolar I Disorder: involving episodes of mania or mixed episodes that include symptoms of
both mania and depression.
A formal diagnosis of a manic episode requires the presence of elevated or irritable mood plus
three additional symptoms.
Some clinicians do not regard euphoria as a core symptom of mania and report that irritable
mood and even depressive features are more common.
The following symptoms must be sufficiently severe to impair social and occupational
• increase in activity level at work, socially or sexually
• unusual talkativeness; rapid speech
• flight of ideas or subjective impression that thoughts are racing
• less than the usual amount of sleep needed
• inflated self-esteem, belief that one has special talents, powers and abilities
• distractibility, attention easily diverted
• excessive involvement in pleasurable activities that are likely to have undesirable
consequences, such as reckless spending.
occurs less often than MDD, occurs equally often in men and women, like MDD, tends to recur
HETEROGENEITY WITHIN THE CATEGORIES:
Some bipolar patients experience the full range of symptoms f both mania and depression almost
everyday, termed a mixed episode. Other patients have symptoms of only mania or only
depression during a clinical episode.
Bipolar II disorder: patients have episodes of major depression accompanied by hypomania, a
change in behaviour and mood that is less extreme than full-blown mania.
Some depressed people may be diagnosed as having psychotic features if they are subject to a
delusions and hallucinations, a useful distinction among people with unipolar depression.
Depression with psychotic features is more severe than depression without delusions and
involves more social impairment and less time between episodes.
Some patients with depression may have melancholic features where people find no pleasure in
any activity and are unable to feel better.
Patients with melancholic features had more co-morbidity i.e. with anxiety, more frequent
episodes, and more impairment, suggesting it may be more severe type of depression. Both manic and depressive episodes may be characterized as having catatonic features, such as
motor immobility or excessive, purposeless activity. Both may also occur within four weeks
childbirth; in this case PTSD (Postpartum).
Both bipolar and unipolar disorders can be sub-diagnosed as seasonal if there is a regular
relationship between an episode and a particular time of the year.
The most prevalent explanation is that it is linked to a decrease in the number of daylight hours;
seasonal affective disorder (SAD).
A Study found that one in five people in an Inuit community were depressed.
Icelanders go without light for many months in the winter, yet as a group, they have surprisingly
low levels of SAD, 1.2%. Might have lower rate because they have adapted genetically to reduce
sunlight and are somehow protected against SAD.
CHRONIC MOOD DISORDERS:
Cyclothymic disorder: the person has frequent periods of depressed mood and hypomania,
which may be mixed with, may alternate with, or may be separated by periods of normal mood
lasting as long as two months.
during depression, they feel inadequate; during hypomania, their self-esteem is inflated. They
withdraw from people, then seek them out in an uninhibited fashion. They sleep too much and then
The person with dysthymic disorder is chronically depressed – more than half the time for at
least two years.
insomnia or sleeping too much; feelings of inadequacy; ineffectiveness, and lack of energy;
pessimism; an inability to concentrate and to think clearly; and a desire to avoid the company of
others. Women are 2-3 times more likely than men.
Many people with it have episodes of major depression, as well, a condition known as double
PSYCHOLOGICAL THEORIES OF MOOD DISORDERS:
PSYCHOANALYTIC THEORY OF DEPRESSION:
Freud; during the oral period, a child’s needs may be insufficiently or oversufficiently gratified,
causing the person to become fixated in this stage. With this arrest in psychosexual maturation,
the person may develop a tendency to be excessively dependent on other people for the
maintenance of self-esteem.
Freud hypothesized that after the loss of a loved one, the mourner first interjects, or
incorporates, the lost person’ he identifies with the lost one, perhaps in a fruitless attempt to undo
the loss. Because we unconsciously harbour negative feelings toward those we love, the mourner
then becomes the object of his own hate and anger.
The period of introjections is followed by a period of mourning work, separates himself from the
person who has died or has died or disappointed him and loosens the bonds imposed by
introjections. But the mourning work can go astray and develop into an ongoing process of self-
abuse, self-blame and depression in overly dependent individuals.
COGNITIVE THEORIES OF DEPRESSION:
Beck’s Theory of Depression:
depressed individuals feel as they do because their thinking is biased toward negative
The negative schemata acquired by depressed persons are activated whenever they encounter
new situations that resemble in some way, perhaps only remotely, the conditions in which the
schemata were learned.
An ineptness schema can make depressed individuals expect to tail most of the time, a self-
blame schema burdens them with responsibility for all misfortunes and a negative self-evaluation
schema constantly reminds them of their worthlessness. Negative schemata, together with cognitive biases or distortions, maintain what Beck called the
negative triad: negative views of the self, the world, and the future.
The following describes the principal cognitive biases:
• arbitrary inference: a conclusion drawn in the absence of sufficient evidence or of any
evidence at all.
• Selective abstraction: a conclusion drawn on the basis of only one of man elements in a
• Overgeneralization: an overall sweeping conclusion drawn on the basis of a single, perhaps
• Magnification and minimization: exaggerations in evaluating performance.
IN Beck’s theory, our emotional reactions are a function of how we construe our world. The
interpretations of depressed individuals do not mesh well with the way most people view the world,
and they become victims of their own illogical self-judgements.
Depressed people endorse more negative words and fewer positive as self-descriptive. Second,
they have a cognitive bias; they gave greater recall of adjectives with depressive content,
especially if the adjectives were rated as self-descriptive.
depressed people take longer to colour-name words that varied in their content; neutral,
depression-oriented words, suggesting that these themes were more cognitively accessible for
A deployment of attention task to show that dysphoric and clinically depressed individuals do not
seem to selectively attend to negative or positive material but that non-depressed individuals have
a protective bias that involves diverting their attention away from negative stimuli and focusing
instead on positive stimuli.
Beck and others have found that depression and certain kinds of thinking are correlated, but a
specific causal relationship cannot be determined from such data; depression could cause negative
thoughts, or negative thoughts could cause depression.
The data do not equivocally support the idea that negative thinking causes depression.
• An individual’s passivity and sense of being unable to act and control his or her own life is
acquired through unpleasant experiences and traumas that the individual tried
unsuccessfully to control
• Seligman’s dogs acquired a sense of helplessness when confronted with uncontrollable
Attribution and Learned Helplessness:
• Depressive paradox: depressed people hold themselves responsible for their failures. But
if they see themselves as helpless, how can they blame themselves?
• Attribution: the explanation a person has for his behaviour.
• The attributional revision of the helplessness theory postulates that they way in which a
person cognitively explains failure will determine its subsequent effects:
o Global attributions: “I never do anything right”; increase the generality of the effects
o Attributions to stable factors: “I never test well” make them long term.
o Attributions to internal characteristics: “I am stupid” are more likely to diminish self
esteem, particularly if the personal fault is also global and persistent.
• The individual prone to depression is thought to show a depressive attributional style - a
tendency to attribute bad outcomes to personal, global and stable faults of character.
• Some forms of depression (hopelessness depression) are now regarded as caused by a state
of hopelessness, an expectation that desirable outcomes will not occur or that undesirable
ones will occur and that the person has no responses available to change this situation. • Low self-esteem and a tendency to infer that negative life events will have severe negative
• “weakest link” approach toward operationalizing vulnerability. The weakest link refers to the
idea that a person is as vulnerable to depression as his or her most depressogenic inferential
style (e.g the tendency to perceive negative events as having many disastrous
• In adults diagnosed with a current or past major depressive episode at the outset,
depressogenic weakest links predicted greater elevations in symptoms of depression
following elevations in hassles.
• An expectation of helplessness creates anxiety. When the expectation of helplessness
becomes certain, a syndrome with elements of anxiety and depression emerges.
• Finally, if the perceived probability of the future occurrence of negative events becomes
certain, depressive predictive certainty, hopelessness depression develops.
Issues in the Helplessness/Hopelessness Theories:
• Circular statements such as hopelessness depression is cause by hopelessness.
• Are the findings specific to depression? Depressive attributional style does not appear to be
specific to depression but is related to anxiety and general distress as well.
• Are attributions relevant? Do people actively attempt to explain their own behaviour to
themselves, and do the attributions they make have subsequent effects on their behaviour?
• One key assumptions of the helplessness/hopelessness theories is that the depressive
attributional style is a persistent part of the makeup of depressed people. However, some
research shows that the depressive attributional style disappears following a depressive
INTERPERSONAL THEORY OF DEPRESSION:
Depressed individuals tend to have sparse social networks, also elicit negative reactions from
Reduced social support may lessen an individual’s ability to handle negative life events,
This tendency was especially evident among people high in autonomy. Depression and martial
discord frequently co-occur.
Constant seeking of reassurance is a critical variable in depression. Even when reassured, they
are only temporarily satisfied. Their negative self-concept causes them to doubt the truth o the
feedback they have received, and their constant efforts to be reassured come to irritate others.
Social skills deficits may be a cause and consequence of depression.
PSYCHOLOGICAL THEORIES OF BIPOLAR DISORDER:
patients with bipolar depression have elevated levels of the dysfunctional attitudes described by
Beck, as well as problems in autobiographical memory and the ability to generate solutions in
problem-solving task. The manic phase of the disorder is seen as a defence against a debilitating
BIOLOGICAL THEORIES OF MOOD DISORDERS:
THE GENETIC DATA:
bipolar disorder is one of the mot heritable of disorders. Genes account for possibly 85% of
variance in whether a person becomes manic.
Evidence favouring the hypothesis that bipolar disorder results from a dominant gene on the 11
Within bipolar disorder, variation in the brain-derived neurotrophic factor (BDNF) gene appears to
predict risk for developing rapid cycling. Some people seem to be genetically predisposed to the
onset of MDD when confronted with a series of adverse life-events. Serotonin transporter gene-linked promoter region (5-HTTLPR), which is involved in modulating
serotonin levels, is a significant predictor of first major depression onset following multiple adverse
NEUROCHEMISTRY, NEUROIMAGING AND MOOD DISORDERS:
The original theory posited that low levels of norepinephrine and dopamine lead to depression
and high levels to mania. The serotonin theory suggests that serotonin, a neurotransmitter
presumed to play a role in the regulation of norepinephrine, also produces depression and mania.
However, the weight of the evidence does not completely support the notion that levels of
neurotransmitters are critical in the mood disorders.
Tricylclic drugs: i.e. imipramine, or Tofranil are group of antidepressant medications so named
because their molecular structure is characterized by three fused rings. They prevent some of the
reuptake of norepinephrine, serotonin and or dopamine by the presynaptic neuron after it has fired,
leaving more of the neurotransmitter in the synapse so that transmission of the next nerve impulse
is made easier.
Monoamine oxidase (MAO) inhibitors: I.e. Tranylcypromine or Parnate are antidepressant
drugs that keep the enzyme MAO from deactivating neurotransmitters, thus increasing the levels of
serotonin, norepinephrine and or dopamine in the synapse. This action produces the same
facilitating effect decried for tricylics, compensating for the abnormally low levels of these
neurotransmitters in depressed people.
Newer antidepressants, called selective serotonin reuptake inhibitors, i.e fluoxetine or Prozac, act
more selectivel, specifically inhibiting the reuptake of serotonin.
It now appears that the explanation of why these drugs work is not as straightforward as it
seemed at first.
Both tricyclics and MAO inhibitors take from seven to 14 days to relieve depression, but by that
time, the neurotransmitter level has already returned to its previous state.
Another approach to further evaluate the theories involved measuring metabolites of these NT,
the by-products of the breakdown of serotonin, norepinephrine, and or dopamine found in urine,
blood serum, and the cerebrospinal fluid.
The problem with such measu