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Chapter 7
Mood Disorders & Suicide
Unipolar Depression Symptoms
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Anhedonia
Psychomotor retardation/agitation
In severe cases
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Hallucinations
Delusions
Major depression—acute
Dysthymic disorder—chronic
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Subtypes of Depression
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Depression with Melancholic Features
Depression with Psychotic Features
Depression with Catatonic Features
Depression with Atypical Features
Depression with Postpartum Onset
Depression with Seasonal Pattern (SAD)
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Symptoms of Depression

Cognitive
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Poor concentration,
indecisiveness, poor selfesteem, hopelessness, suicidal
thoughts, delusions
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Physiological and
Behavioral
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Sleep or appetite disturbances,
psychomotor problems,
catatonia, fatigue, loss of
memory
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Emotional
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Sadness, depressed mood,
anhedonia (loss of interest or
pleasure in usual activities),
irritability
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Duration
Number of
symptoms
Major Depression
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Dysthymic Disorder
Five or more
symptoms including
sadness or loss of
interest or pleasure
Three or more
symptoms including
depressed mood
At least 2 weeks in
duration
At least 2 years in
duration
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Prevalence and Prognosis
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Among adults, 18- to 29-year-olds are most likely
to have had a major depressive episode in the past
year.
Women are twice as likely to experience
depressive symptoms as men.
Depression rates vary from 3% in Japan to 16% in
the United States.
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Bipolar Disorder
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Mania combined with depression
Bipolar I
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Bipolar II
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Elevated, expansive or irritable mood >1 week
Three additional symptoms
Severe depression, but mild mania (hypomania)
that does not involve hallucinations, delusions, or
interfere with daily functioning
Cyclothymic
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Less severe but more chronic bipolar condition
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Chapter 7
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Chapter 7
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Biologic Theories of Depression
 Genetic Theory
 Genes predispose people to depression
 Neurotransmitter Theories
 Dysregulation of neurotransmitters and their
receptors
 Brain Abnormalities
 Altered brain-wave activities affect mood
 Neuroendocrine Factors
 Hormonal dysregulation
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Psychological Theories of
Depression
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Behavioral Theories
 Lewinsohn’s theory
 Learned helplessness theory
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Cognitive Theories
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Aaron Beck’s negative cognitive triad
Reformulated learned helplessness theory
Ruminative response style
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Psychological Theories of
Depression, cont.
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Interpersonal Theories
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Rejection sensitivity
Excessive reassurance seeking
Sociocultural Theories
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Cohort effects
Gender differences
Ethnicity/race differences
Cross-cultural differences
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Theories of Bipolar Disorders
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Genetic Factors- strong linkage
Brain Abnormalities
Neurotransmitter Factors
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Dysregulation of the dopamine system
Psychological Contributors
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Greater sensitivity to rewards
Increased stress
Disruptions in routines
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Biological Treatments
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Drug therapy
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Tricyclics, monoamine oxidase inhibitors, mood
stabilizers, selective serotonin reuptake inhibitors –SSRI,
selective serotonin-norepinephrine reuptake inhibitors,
norepinephrine-dopamine reuptake inhibitor,
anticonvulksant and atypical anticonvulsants
Electroconvulsive therapy (ECT)
Repetitive transcranial magnetic stimulation
(rTMS)
Vagus nerve stimulation
Deep brain stimulation
Light therapy for SAD
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Psychological Treatments for
Mood Disorders
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Behavior Therapy
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Cognitive-Behavioral Therapy
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Examines the interpersonal relationships
Interpersonal & Social Rhythm Therapy (ISRT)
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Challenge distorted thinking and help the person learn more
adaptive ways of thinking and new behavioral skills
Interpersonal Therapy
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Increase positive reinforcers and decrease aversive events by
teaching the person new skills for managing interpersonal
situations and the environment
Enhanced interpersonal therapy for bipolar disorder
Family Focused Therapy
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Reduces the interpersonal stress for bipolar disorder
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Comparison of Treatments
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Different therapies generally appear to be
equally effective for the treatment of most
people with depression
Combination of psychotherapy and drug
therapy may be more effective than either
type alone
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Suicide
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“Death from injury, poisoning, or suffocation
where there is evidence (either explicit or
implicit) that the injury was self-inflicted and
that the decedent intended to kill
himself/herself.” Centers for Disease Control
and Prevention (CDC)
Among the three leading causes of death
worldwide among people 15 to 44 years of
age. (World Health Organization [WHO],
2008)
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Gender Differences
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National Differences
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Understanding Suicide
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Durkheim’s theory
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Egoistic suicide is committed by people who feel
alienated from others
Anomic suicide is committed by those who
experience severe disorientation from society
Altruistic suicide is committed by people who
believe that taking their own life will benefit society
in some way.
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Psychological Disorders & Suicide
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Over 90% of people who commit suicide have
probably been suffering from a diagnosable mental
disorder
Depression increases the odds of a suicide attempt
by approximately 6 times and bipolar disorder
increases the odds of a suicide attempt by 7 times
Best predictor of suicidal thought and behavior is
past suicidal thought and behavior. Among
adolescents, a history of a previous suicide attempt
increases the odds of suicide by 30 times among
boys and 3 times among girls
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Personality, Cognitive & Biological
Factors
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Personality characteristic that seems best to predict
suicide is impulsivity
Cognitive variable that most consistently predicts
suicide is hopelessness
Children of parents who had attempted suicide were
6 times more likely to also attempt suicide than the
children of parents who had a mood disorder but
had not attempted suicide
Low serotonin levels are linked with suicidality even
among people who are not depressed
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Treatment & Prevention
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Community-based prevention
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Drug treatments
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Crisis intervention programs, suicide hotlines
Lithium, selective serotonin reuptake inhibitors
Psychological treatments
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Dialectical behavior therapy, psychotherapy
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