Psychology 2310A/B Lecture Notes - Dysthymia, Catatonia, Anhedonia

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Mood Disorders
Introduction
Depression versus Mania
DSM-IV distinguishes two general patterns:
oUnipolar – depression only periods of depression, never mania
oBipolar – both mania and depression
Unipolar Depression
“Normal” depression
o“Psychological pain” tells us there is something wrong with our life, there is a
healing process that needs to take place
oFor example: the grief process
oSimilar to physical pain, if we didn’t have pain we would be dead
DSM-IV categories:
oMajor depression
oDysthymic disorder (Dysthymia) clinically depressed for at least two years
oAdjustment disorder with depressed moodclinical depression often based on
some stressful life event (lasts shorter amount of time, approx. 6 months)
Depression is the leading cause of disability worldwide, according to WHO
oCosts more in treatment and lost productivity than anything but heart disease
oCanada – $14.4 billion per year in terms of treatment and lost productivity
DSM: Major Depressive Episode
Episodes usually lasts about 6 months to a year, then may come back later (episodic)
5 or more symptoms lasting 2+ weeks
Most of the day nearly every day
Mood symptoms (one must be present):
oDepressed mood
oLoss of interest or pleasure in activities (anhedonia) absence of positive mood
Physical symptoms:
oSignificant weight loss (common in severe cases) or gain
oInsomnia (severe cases) or hypersomnia
oPsychomotor agitation or retardation (becoming completely immobile or
catatonic)
oFatigue, loss of energy (feeling extremely tired, unmotivated)
Cognitive Symptoms:
oFeelings of worthlessness or guilt (often imagined)
oDiminished ability to think or concentrate (very distractible, everything is a big
task getting dressed)
oRecurrent thoughts of death, suicidal ideation
Symptoms must cause clinically significant distress or impairment in functioning
NB – depression is a “syndrome”
Major Depressive Disorder
Presence of Major Depressive Episode (at least one)
No history of manic or hypomanic episodes
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Subtypes: Single episode vs. recurrent
Specifiers:
oMild, moderate, severe without psychotic features, severe with psychotic features
(really clear loss of contact with reality: hallucinations and/or delusions common
for severe depression)
oAtypical – oversleep, overeat, weight gain, anxiety (more common type)
oWith Catatonic features person can become completely immobile
oWith Melancholic features severe form of depression with a particularly strong
biological aspect (more genetic heritability)
oWith Postpartum onset in a mother who has recently given birth (in the last four
weeks)
oWith Seasonal pattern seasonal affective disorder (SAD) common in the winter
(possible changes in melatonin levels causing the changes in mood with the
seasons)
How common is clinical depression?
In any given year: 1,500,000 (5% of pop) Canadians 400,000 people in Ontario
At any one time: approximately 6% of women and 3% of men
Lifetime prevalence: approximately 12% of women and 6% of men
Prevalence has increased dramatically over the past century
WHO: leading cause of disability worldwide
2:1 ratio Women: Men
Course
First episodes usually adolescence or early adulthood, but can happen at any age
Typically precipitated by a severe stressor (break-up, loss of job, divorce, etc)
Episodes typically last 6 months to 1 year
A person who has one episode of depression will, on average, go on to have 5 or 6
episodes
o1 episode: 50% risk of a second
o2 episodes: 70% risk of a third
o3+ episodes: 90% risk of more
Variable course: full versus partial remission between episodes
Associated features
Elevated risk of suicide
oApproximately 15% of people with severe depression commit suicide
Comorbidity
oAnxiety disorders (50%) eg, panic, OCD, GAD, etc
oEating disorders anorexia, bulimia, etc
oSubstance abuse way of soothing themselves
oBorderline personality disorder
Other Unipolar Depression Diagnoses
Dysthymic Disorder mild level, typically able to function
oDepressed mood most of the day, more days than not, for at least 2 years
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