Abnormal Psychology

Module 7: Mood Disorders

Module Learning Outcomes

Examine Mood Disorders

7.1:
Describe the characteristic symptoms and risk factors of depressive disorders
7.2: Examine bipolar and related disorders
7.3: Examine various perspectives and treatment methods for mood disorders
Symptoms and Risk Factors of Depressive Disorders
Understanding Symptoms and Risk Factors of Depressive Disorders

7.1: Describe the characteristic symptoms and risk factors of depressive disorders
7.1.1: Describe the symptoms and risk factors of major depressive disorder
7.1.2:
Describe subtypes of depression, including seasonal pattern and peripartum onset depression
7.1.3: Describe symptoms and therapies for disruptive mood dysregulation disorder
7.1.4: Explain symptoms and treatments for premenstrual dysphoric disorder
Personal Experience with MDD
Class Activity: Movie/TV Show and Mood Disorders

With a partner or in a group, discuss the following:

• Do you know of any movies, shows, or books with characters displaying unipolar or bipolar
depression?
• What symptoms of depression are portrayed in the movie/show/book and how are they
disruptive to the character’s daily life?
• What potential treatment options have been shown effective and why are those treatment(s)
recommended over others?
Major Depressive Disorder
Major depressive disorder (MDD) includes being in a
“depressed mood most of the day, nearly every day” (feeling sad,
empty, hopeless, or appearing tearful to others), and loss of
interest and pleasure in usual activities.

• MDD is believed to be a combination of genetic,

environmental, and psychological factors. Risk factors
include a family history of the condition, major life
changes, certain medications, chronic health problems, and
substance abuse.

• About 40% of the risk appears to be related to genetics.

• Major depressive disorder affected approximately 163

million people in 2017 (2% of the global population).
Major depression is about twice as common in women as in
men, although it is unclear why this is so, and whether
factors unaccounted for are contributing to this.
MDD Symptoms for Diagnosis
To receive a diagnosis of major depressive disorder, one must
experience a total of five symptoms for at least a two-week
period.
These symptoms must cause significant distress or impair
normal functioning, and they must not be caused by
substances or a medical condition. Symptoms are:
• significant weight loss (when not dieting) or weight gain
and/or significant decrease or increase in appetite
• difficulty falling asleep or sleeping too much
• fatigue or loss of energy
• feelings of worthlessness or guilt
• difficulty concentrating and indecisiveness
• thoughts of death (not just fear of dying)
Depression Subtypes
The DSM-5 lists several different subtypes of depression. They add clarification about the type
of depression and are designated as follows:

Depression with:
● Anxious Distress: a person experiences anxiety in the form of tenseness, restlessness,
lack of focus, fear, or of losing control
● Mixed Features: a person experiences some manic symptoms such as elevated moods,
increased energy, or talkativeness
● Melancholic Features: a person experiences lack of interest or pleasure in activities
● Atypical Features: a person may experience elevated moods for certain periods of time
or around particular people, or may show weight gain, increased appetite, or excessive
sleep
● Mood-congruent Psychotic Features: a person may experience delusions or
hallucinations
● Catatonia: a person may show catatonic symptoms, such as staying still or immobilized
for long periods of time
● Seasonal Pattern (formerly known as seasonal affective disorder): a person experiences
the symptoms of major depressive disorder only during a particular time of year (e.g.,
fall or winter). In everyday language, people often refer to this subtype as the winter
blues.
● Peripartum Onset: symptoms appear during pregnancy or in the weeks following birth
Persistent Depressive Disorder
Persistent depressive disorder: a person experiences
mild to moderate depressed moods for most of the day
nearly every day for at least two years, and displays at
least two of the symptoms of major depressive disorder
such as:
• decreased or increased appetite
• decreased or increased sleep (insomnia or
hypersomnia)
• fatigue or low energy
• reduced self-esteem
• decreased concentration or problems making
decisions
• feelings of hopelessness or pessimism
Disruptive Mood Dysfunction Disorder
Disruptive mood dysregulation disorder (DMDD) is a childhood
condition of extreme irritability, anger, and frequent, intense temper
outbursts.
• DMDD symptoms go beyond being a “moody” child—children
with DMDD experience severe impairment that requires clinical
attention.
• DMDD symptoms typically begin before the age of 10, but the
diagnosis is not given to children under 6 or adolescents over 18.
A child with DMDD experiences:
• irritability or angry moods for most of the day, nearly every
day
• severe temper outbursts (verbal or behavioral) at an average
of three or more times per week that are out of keeping with
the situation and the child’s developmental level
• Trouble functioning due to irritability in more than one place
(e.g., home, school, with peers)
Premenstrual Dysphoric Disorder
Premenstrual dysphoric disorder (PMDD) is a health problem that is similar to premenstrual
syndrome (PMS) but more serious. PMDD causes severe irritability, depression, or anxiety in the week
or two before your period starts. PMDD causes severe and disabling form of premenstrual syndrome
affecting 1.8–5.8% of menstruating women.
Symptoms of PMDD include:
• Lasting irritability or anger that may affect other people
• Feelings of sadness or despair, or even thoughts of suicide
• Feelings of tension or anxiety
• Panic attacks
• Mood swings or crying often
• Lack of interest in daily activities and relationships
• Trouble thinking or focusing
• Tiredness or low energy
• Food cravings or binge eating
• Trouble sleeping
• Feeling out of control
• Physical symptoms, such as cramps, bloating, breast tenderness, headaches, and joint or muscle
pain
Practice Question 1

Irma has recently lost interest in most of her regular activities. Irma has also socially withdrawn
herself from her peers and family for the last month. On most days over the past three weeks,
Irma has stayed in bed watching TV and has been sleeping for over 12 hours per night during
this period. Which of the following diagnoses would explain Irma’s symptoms?

A. Major Depressive Disorder

B. Persistent Depressive Disorder
C. Bipolar I
D. Bipolar II
Bipolar and Related Disorders
Understanding Bipolar and Related Disorders

7.2: Examine bipolar and related disorders

7.2.1: Describe the symptoms and risk factors of bipolar disorder
7.2.2: Examine the epidemiology and etiology of bipolar disorder
7.2.3: Describe cyclothymic disorder
Bipolar Disorder Symptoms and Risks
• Bipolar I Disorder (BD I), which was previously known as manic-
depression, is characterized by a single or recurrent manic episode. A
depressive episode is not necessary but commonly present for the
diagnosis of BD I.
• Bipolar II Disorder (BD II) is characterized by single (or recurrent)
hypomanic episodes and depressive episodes.
• The mood disturbances must be present for one week or longer in mania
(unless hospitalization is required) or four days or longer in hypomania.
• Concurrently, at least three of the following symptoms must be present
in the context of euphoric mood (or at least four in the context of
irritable mood):
• inflated self-esteem or grandiosity
• increased goal-directed activity or psychomotor agitation
• reduced need for sleep
• racing thoughts or flight of ideas
• distractibility
• increased talkativeness
• excessive involvement in risky behaviors
Bipolar Disorder: Etiology and Epidemiology
Etiology: Although there have been important advances in
research on the etiology, course, and treatment of BD, there
remains a need to understand the mechanisms that contribute to
episode onset and relapse.
• Genetic influences are believed to account for 73–93% of
the risk of developing the disorder.

Epidemiology: The lifetime prevalence rate of bipolar

spectrum disorders in the general U.S. population is estimated
at approximately 4.4%, with BD I constituting about 1% of this
rate.
• The co-occurrence of BD with other psychiatric disorders
is associated with poorer illness course, including higher
rates of suicidality.
Cyclothymic Disorder
Cyclothymic disorder: a mental disorder that involves numerous periods
of symptoms of depression and periods of symptoms of hypomania.
Symptoms, however, are not sufficient to be a major depressive episode
or a hypomanic episode. Symptoms must last for more than one year in
children and two years in adults.
Diagnostic criteria for the DSM-V are:
• Periods of elevated mood and depressive symptoms for at least half
the time during the last two years for adults and one year for
children and teenagers.
• Periods of stable moods last only two months at most.
• Symptoms create significant problems in one or more areas of life.
• Symptoms do not meet the criteria for bipolar disorder, major
depression, or another mental disorder.
• Symptoms are not caused by substance use or a medical condition.
Practice Question 2

Jake had been displaying manic activity for about ten days and was acting impulsively during
that time. He also hadn’t been sleeping very much and his drastic and troubling behavior was
starting to worry his parents so they took him to the hospital. At the hospital, Jake expressed that
he tended to feel down, which helped the medical staff determine his diagnosis. Which of the
following would be associated with Jake’s diagnosis?

A. Major Depressive Disorder

B. Persistent Depressive Disorder
C. Bipolar I
D. Bipolar II
Perspectives and Treatments for Mood Disorders
Perspectives and Treatment for Mood Disorders

7.3: Examine various perspectives and treatment methods for mood disorders
7.3.1: Describe and compare viewpoints from the major psychological perspectives related to mo
od disorders
7.3.2: Describe biological and genetic explanations for mood disorders
7.3.3: Compare treatment methods for major depressive disorder
7.3.4: Examine treatments for bipolar disorder
7.3.5: Discuss the relationship between mood disorders and suicidal ideation, as well as factors as
sociated with suicide
Perspectives on Mood Disorders
Cognitive Perspective: Depression is triggered by negative thoughts,
interpretations, self-evaluations, and expectations.
• These diathesis-stress models propose that depression is triggered by a
“cognitive vulnerability” (negative and maladaptive thinking) and by
precipitating stressful life events.

Sociocultural Perspective: Depression is more prevalent in women than in

men in individualist and collective cultures.
• Some have hypothesized that this is due to their inferior positions in the
culture, in which they may experience domestic violence, poverty, and
inequality that can greatly contribute to depression.

Psychodynamic Perspective: Depression is caused unresolved unconscious

conflict or repressed anger towards others.
• A person may be so plagued with inner conflict, anxiety, and guilt that
they are unable to perceive reality clearly or meet the ordinary demands
of the environment in which they live.
Perspectives on Mood Disorders (continued)
Humanistic Perspective: Involves Abraham Maslow’s emphasis on a
hierarchy of needs and motivations.
• The existential psychology of Rollo May acknowledging human
choice and the tragic aspects of human existence
• The person-centered or client-centered therapy of Carl Rogers, which
is centered on the client's capacity for self-direction and
understanding of his or her own development.

Behavioral Perspective: Depression emphasizes the role maladaptive

actions play in the onset and maintenance of depression.
• Ivan Pavlov and B. F. Skinner are often credited with the
establishment of behavioral psychology with their research on
classical conditioning and operant conditioning, respectively.
Mood Disorders: Genetic/Biological Explanations
Mood disorders have been shown to have a strong genetic and biological
basis.
Genetic:
• Relatives of those with major depressive disorder have double the risk of
developing major depressive disorder, whereas relatives of patients with
bipolar disorder have over nine times the risk.
Biological:
• People with mood disorders often have imbalances in certain
neurotransmitters, particularly norepinephrine and serotonin.
• Research has noted that depressed individuals have abnormal levels of
cortisol, a stress hormone released into the blood by the neuroendocrine
system during times of stress.
• Many people with depression show elevated cortisol levels, especially
those reporting a history of early life trauma such as the loss of a parent
or abuse during childhood.
• High levels of cortisol are a risk factor for future depression.
Treatments for Major Depressive Disorder
Selective serotonin reuptake inhibitors (SSRIs; e.g., Fluoxetine) and
serotonin and norepinephrine reuptake inhibitors (SNRIs; e.g.,
Duloxetine) are the most recently introduced antidepressant
medications.
• SSRIs, the most commonly prescribed antidepressant
medication, block the reabsorption of serotonin.
• SNRIs block the reabsorption of serotonin and norepinephrine.
• They are not, however, without their own side effects, which
include but are not limited to difficulty having orgasms,
gastrointestinal issues, and insomnia.
Other biological treatments for people with depression include
electroconvulsive therapy (ECT), transcranial magnetic stimulation
(TMS), and deep brain stimulation.
Treatments for Bipolar Disorder
Patients with BD are typically treated with
pharmacotherapy.

• Lithium is the first-line treatment choice. This is

because SSRIs and SNRIs have the potential to
induce mania or hypomania in patients with BD.

• Mood stabilizers such as lithium act on several

neurotransmitter systems in the brain through
complex mechanisms, including reduction of
excitatory (dopamine and glutamate)
neurotransmission, and increasing of inhibitory
(GABA) neurotransmission.
Mood Disorders and Suicidal Ideation
Suicide, defined by the CDC as “death caused by self-directed injurious
behavior with any intent to die as the result of the behavior,” represents, in
a sense, an outcome of several things going wrong all at the same time.
Not only must the person be biologically or psychologically vulnerable,
but they must also have the means to perform the suicidal act.
They must also lack the necessary protective factors (e.g., social support
from friends and family, religion, coping skills, and problem-solving
skills) that provide comfort and enable one to cope during times of crisis
or great psychological pain
• Suicidal risk is especially high among people with substance abuse
problems. Individuals with alcohol dependence are at 10 times
greater risk for suicide than the general population.
• The risk of suicidal behavior is especially high among those who
have made a prior suicide attempt.
• Among those who attempt suicide, 16% make another attempt within
a year and over 21% make another attempt within four years.
Practice Question 3

Jess has recently been diagnosed with PDD and she was discussing medications that may be
effective in treating her depression. Jess was wondering which medications had the least amount
of side effects in treating persistent depression. Which of the following psychotropic drug
categories would show limited side effects versus the others?

A. MAOI
B. Anti-psychotic
C. Lithium
D. SSRIs
Individual Stories: MDD and PDD
John: John has been extremely active for all of his life. Recently, he had surgery to correct issues in his shoulder and was
unable to move much other than getting out of his recliner for short periods of time. John began to feel depressed, as he was
unable to do mostly anything for himself. John began sleeping much longer and even had issues with motivation to do anything
but sleep and go to the bathroom. John went to the doctor after two weeks of this and was diagnosed with MDD. John was
treated with antidepressant medication and therapy and felt better within a few months.

Bill: Bill has been depressed mildly to moderately for over 20 years and treated with antidepressants. He has recently felt even
more depressed and even angry at times since his divorce and spending less time with his son. Bill went to his doctor and they
diagnosed him as having PDD and decided to change medications, as he was on the same one at the highest dosage for over ten
years. Bill felt much better within a couple months and his motivation improved dramatically.

Lisa: Lisa recently lost three close relatives including her father. She was having a tough time dealing with these deaths and
ended up losing interest in most of the things that she had liked in life; she also slept a lot. After a month of this, Lisa realized
she needed help. Lisa went to the doctor and they diagnosed her with MDD and treated her with antidepressants and therapy.
Lisa decided not to go to therapy, but the medication treatment did improve her condition over a few months.
Individual Stories: Bipolar Depression

Roger: Roger was diagnosed with Bipolar I when he was 17. Roger would take his medications
sometimes, but not on a regular basis. Roger would miss the manic episodes and as a result,
would go off his meds sometimes for a few weeks or a month. This was until Roger, during one
of his manic episodes, decided to impulsively withdraw all the money he had in savings and
checking accounts and take it to a casino to win big. Roger did not do well and lost all his money
within a few short hours. Roger then determined during his depressed state that he needed help
and had to take his medication. Since that time, Roger has taken his medication on a daily basis
and has even set up a routine to help him self-regulate.