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Chapter 7

PSYC 305 Chapter Notes - Chapter 7: Major Depressive Episode, Dysthymia, Mood Disorder

Course Code
PSYC 305
Laura Hanson

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Chapter 7: Mood Disorders and Suicide
Mood Disorders: An Overview
Two key moods: mania and depression
Some people onlya experience one or the other
Can have mixed-episodes (depression and mania at the same time) – the
person experiences rapidly alternating moods like euphoria, sadness, and
irritability all within the same episode
Types of Mood Disorders
Unipolar Depressive Disorders – the person only experiences depressive
Bipolar and Related Disorders – the person experiences both manic and
depressive episodes
Most common mood disturbance is depression
To be diagnosed with depression the person must lose interest in formerly
pleasurable activities for 2 weeks
Second mood disturbance is a manic episode – marked by elevated,
euphoric, or expansive moods
Moods must persist for at least 1 week, and must include 3 either
behavioural, mental, or physical symptoms for it to be a manic episode
Hypomanic Episode: In which a person experiences abnormally elevated,
expansive, or irritable mood for at least 4 days (and must have 3
symptoms similar to those involved in mania, but with a lesser extent)
Prevalence of Mood Disorders
Occur 15-20 x more frequently than schizophrenia
Major depressive disorder is the most common
Life time prevalence rates of major depression 17% and occurs much
more often in adult woman, but equally as often in childhood
Life time prevalence of bipolar disorder is about 1%
Unipolar Depressive Disorders
Other Forms of Depression
Nearly always the result of stress
Not all depressions can be considered mood disorders
Loss and the Grieving Process
Usually four phases to a “normal” response to the loss of a spouse or
family member: (1) numbing and disbelief, (2) yearning and searching for
the deceased, (3) disorganization and despair after accepting the loss, (4)
some reorganization as the personal begins rebuilding his/her life
Major depressive disorder should not be diagnosed for the first 2 months
following the loss

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Postpartum “Blues”
Usually occurs in mothers, but can occur in fathers too
Symptoms include changeable mood, crying easily, sadness, irritability,
often liberally intermixed with happy feelings
Can occur within 50-70% of women within 10 days after birth of child
Major depression in women occurs no more frequently in postpartum
period than would be experience in women of the same age and
socioeconomic class
Women are not necessarily at risk in the postpartum period for depression
Mixed evidence on whether or not hormones and alterations in serotonin
functions play a role in post partum blues
Dysthymic Disorder (Persistent Depressive Disorder)
Now known as persistence depressive disorder, formerly known as
dysthymic disorder
Dysthymic disorder is generally considered to be of mild to moderate
intensity, but its primary hallmark is its chronicity
To qualify for a diagnosis a person must be persistently depression for
more of the days for more days than not for at least 2 years and have 2/6
additional symptoms when depressed
Lifetime prevalence between 2.5 and 6%
Average duration is 4-5 years, can persist for 20+
Usually begins in teenage years
Major Depressive Disorder
To be diagnosed, the person must exhibit more symptoms than are
required for dysthymia and the symptoms must be more persistent and be
in a major depressive episode and never have had a manic, hypomanic,
or mixed episode
Few depressions occur without significant anxiety
High levels of comorbidity between anxiety and depression at the
diagnostic level
Depression as a Recurrent Disorder
Usually when diagnosis of major depression is made, it is specified
whether or not this is the first episode or a recurrent episode
Average duration of untreated episode is 9 months
In 10-20%, symptoms do not remit for over 2 years
Recurrence is different from relapse
Relapse is the return of symptoms within a fairly short time
signifying the depression has not yet run its course
Recurrence is a new episode of depression

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Probably of recurrence is higher with the number of prior episodes and
when the person has comorbid disorders
Previously thought that between episodes the person is symptom free,
now evidence shows there are still symptoms between episodes
Depression Throughout the Life Cycle
Depression can occur even at old age, although it is most common in late
adolescence and early adulthood
Research suggests 1-3% of school-age children meet criteria for unipolar
depressive disorder
Infants can be depressed if they are separated for long periods of time
from their attachment figure
15-20% of adolescents experience major depressive disorder at some
1 year prevalence is a lot lower in people over 65
Depression rates among older adults is higher for those living in care
facilities or nursing homes
Depression can double the risk of death in people who have had a heart
attack or stroke
Specifiers for Major Depressive Episodes
Melancholic Features
Three of the following symptoms: early morning awakening,
depression worse in the morning, marked psychomotor agitation or
retardation, loss of appetite or weight, excessive guilt, qualitatively
different depressed mood
Psychotic Features
Delusions or hallucinations, feelings of guilt and worthlessness
Atypical Features
Mood reactivity – brightens to positive events; two of the four
following symptoms: weight gain or increase in appetite,
hypersomnia, leaden paralysis (arms and legs feel heavy), being
acutely sensitive to interpersonal rejection
Catatonic Features
A range of psychomotor symptoms from motoric immobility to
extensive psychomotor activity, as well as mutism and rigidity
Seasonal Pattern
St least two or more episodes in past 2 years that have occurred at
the same time (usually fall or winter), and full remission at the same
time (usually spring). No other non-seasonal episodes in the same
2-year period
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