Mood Disorders

July 24, 2012 by Dr. Tangen Leave a Comment

mood disorders

Why is everyone happier than me?

We all get “down” sometimes or feel happier than others. But that’s not a mood disoeder; it’s just normal fluctuation.

Treatment for major mood disorders is usually a combination of medication and counseling. There are several drugs available and patients should be patient in determining which ones work best for them. Finding the right combination at the right dosage is a complex but necessary process.

Here’s what is included in this lesson:

depression, mania & bipolar disorder
seasonal affective disorder
anxiety disorders
social phobias
PTSD

Read chapter 15 of Kalat’s Biological Psychology

Here’s a good description of a person’s experience with depression and bipolar II disorder: New York Times

Here are the resources you need:

cluster
slides
terms
notes
quiz
video

SLIDES

TERMS

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ADHD & OCD
alcoholism
Alprazolam
altered sleep patterns
anti-anxiety medications
antidepressant medications
antipsychotic medications
anxiety disorders
atypical antidepressants
avoidance symptoms
bad moods (irritable, angry, depressed)
Benzodiazepines
Beta-blockers
bipolar disorder
Bipolar I
Bipolar II
Borna disease
brain abnormalities
Bupropion (Wellbutrin)
Carbamazepine (anti-convulse)
childhood depression
Chlordiazepoxide
cognitive therapy
compulsions
co-occurring depression
coping strategies
cyclical changes in mood
cyclothmia = “bipolar light”
Diazepam
drug abuse
drug intoxication
early-onset (before age 30)
ECT (Electroconvulsive Therapy)
elevated mood
emotionally numb
episodes
estrogen
excessive worry
exercise
exposure-response prevention
first episode
flashbacks
fluoxetine (Prozac)
GABA
generalized anxiety disorder
hemisphere dominance
hyperarousal symptoms
hypomania
I = large swings
II = sad and guilty
infections
infectious neurotropic virus
Lamotrigine (anti-seizure)
late onset (after 45 to 50)
lithium salts (anti-manic)
major depressive disorder
mania & depression at same time
manic-depression
mixed episodes
Monoamine oxidase inhibitors (MAOI)
mood disorders
mood stabilization
obsessive-compulsive
panic disorder
Paxil
placebo
postpartum depression
promiscuity
Propranolol
Prozac & Celexa
PTSD
resilience factors
risk factors
routines & rituals
Seasonal Affective Disorder (SAD)
side effects
sleep cycle
sleep problems
SNRIs
social phobia
SSRIs
suicidal thoughts
support group
tricyclics
triggers
tumors
twin studies
unipolar vs biploar
Valproic acid (anti-seizure)
Zoloft

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NOTES

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Major Depressive Disorder
Lasts for weeks at a time
Symptoms
- Little pleasure from sex or food
- Thoughts of suicide or death
- Don’t enjoy usual activities
- Feel worthless, sad, guilty
- Lack energy & pleasure
- Pull away from friends
- Trouble concentrating
- Suicidal thoughts
- Trouble sleeping
- Helpless
- Sad
Findings
- React normally to sad images
- React normally to fearful images
- Rarely smile are happy images
- Rarely laugh at jokes
- Decreased R to likely reward
5% of US adults
Childhood depression
- Equal for boys and girls
- Beyond 14, more common in female
Range
- Long-term depression
- More common to have episodes
  - periods of normal mood
- First episode longest
- More intense first episode
- Easier to start another
Causes
- 1. Genetics
  - Early-onset (before age 30)
  - More relatives with depression
  - Bulimia, irritable bowel syndrome
  - Alcohol or marijuana abuse
  - Anxiety & migraines
  - ADHD & OCD
  - Late onset (after 45 to 50)
  - Relatives have circulatory problems
- 2. Infections
  - Viral infections in farm animals?
  - Borna disease
  - 1/3 have it
  - Infectious neurotropic virus
  - Abnormal behavior
  - Death
- 3. Estrogen
  - More women than men
  - Postpartum depression
  - 20% of mothers
  - Recover quickly
- 4. Brain Abnormalities
  - Hemisphere Dominance
  - Decreased activity in left hemisphere
  - Increased activity in right prefrontal cortex
Treatments
- Untreated
  - Recover within few months
  - Episodes
- Drugs
  - Some respond to one drug and not another
  - Takes effect minutes to hours
  - Weeks before mood elevation
Antidepressant drugs
- 1. Tricyclics
  - Prevent reuptake of serotonin+
- 2. SSRIs
  - Prevent reuptake of serotonin
  - fluoxetine (Prozac)
- 3. SNRIs
  - Block reuptake of serotonin & norepinephrine
- 4. MAOIs
  - Monoamine oxidase inhibitors
  - Block enzyme from metabolizing
- 5. Atypical antidepressants
  - bupropion (Wellbutrin)
    - inhibits reuptake of dopamine & some norepinephrine
Placebo vs drug
- Mild to moderate depression, no clear benefit
- Severe depression, drugs don’t always work
ECT (Electroconvulsive Therapy)
- Seizures with electric shock
- Every other day for two weeks
- Invented by Ladislas Meduna
  - 1930’s for schizophrenia
  - Ineffectual on schizophrenia
  - Overused in 1950’s
- Major side effect = memory loss
  - Lasts for several months
- 50% relapse within 6 months if used alone
Altered Sleep Patterns
- Sleep problems precede mood changes
- More eye movements in REM
  - Enter REM within 45 minutes
  - 80 minutes for non-depressed
- Like jet lag
- Change sleep cycle
  - Stay awake all night
  - Alternate sleep schedule
Exercise
- Regular, non-strenuous exercise
  - increase blood flow to brain
Unipolar vs Biploar
- Unipolar
  - Between depression & normal
  - Bipolar disorder
    - (also called manic-depressive)
  - between depression & mania
- Manic
  - Side effects of steroids & SSRIs
  - Drug intoxication
    - (cocaine & amphetamine)
  - Tumors
  - Mood disorder
- Presence of mania = bipolar
  - Don’t need to have been depressed
- Cyclical changes in mood
  - Even if never hit depression
  - Sleep (too much, too little)
Bipolar I
- Large swings
- Switch between
  - good moods (happy, highly active, up)
  - bad moods (irritable, angry, depressed)
- Men & women (about equal)
- Starts early: 15-25 years old
- Also called manic-depression
  - At least 1 manic episode
  - Often many depressive episodes
- Mania can last for day or months
- Unknown cause
  - More likely among relatives
- Triggers
  - Medications (antidepressants, steroids)
  - Sleeplessness
  - Drug abuse
  - Childbirth
- Manic Symptoms
  - Elevated mood; boost of energy
  - Don’t sleep much (not tired)
  - Easily distracted
  - Racing thoughts
  - Bursts of cleaning, doing
  - Talking more or faster
  - Overestimate abilities
  - Poor self control
  - Binge eating, drinking or drugs
  - Promiscuity
  - Spending
  - Temper
  - Restless activity
  - Excitement & laughter
  - Self-confidence
  - Rambling speech
  - Loss of inhibitions
Bipolar
- I = large swings
- II = sad and guilty
- Cyclothmia = “bipolar light”
Bipolar II
- Never had manic episode
- Alternate between
  - Sad and guilty
  - High energy-impulsiveness
- Milder episodes
  - Also called hypomania
  - More common in women
- More depression
- More “mixed” episodes
  - mania & depression at same time
- Women 3x more likely to also have:
  - Alcoholism
  - Anxiety disorder
- 1+ episode per year
- Genetics
  - Strong hereditary basis
  - Twin studies
  - Two genes increase probability of bipolar II
    - Same genes
      - predispose major depression
      - predispose bipolar disorder
All Types
- High risk of suicide
- Both when manic & depressed
- Manic & depressive moods can overlap
Treatment
- Drugs for mood stabilization
- Carbamazepine (anti-convulse)
- Lamotrigine (anti-seizure)
- Valproic acid (anti-seizure)
- Lithium salts (anti-manic)
  - Most effective therapy
  - Don’t know why
- Consistent sleep schedule
Seasonal Affective Disorder (SAD)
- Usually in winter
- Most common closest to poles
- Treatment
- Expose to very bright lights
  - for about an hour
  - early in morning or evening
Anxiety Disorders
- Generalized Anxiety Disorder
- Obsessive-Compulsive
- Panic Disorder
- Social Phobia
- PTSD
1. Generalize Anxiety Disorder
- Extremely worried
  - Little or no reason to worry
- Anxious about getting thru day
  - Fear things will go bad
- Develops slowly
  - Often starts as teen
- Symptoms come & go
  - Worse under stress
- Symptoms
  - Headaches
  - Trouble falling asleep
  - Excessive worry
  - Aware you’re worrying
  - Unexplained pain
  - Stomach aches
  - Difficulty swallowing
  - Tremors, twitches
- Can run in families
  - No clear genetic link
- Treated with combo of:
  - Medications
    - Anti-anxiety
    - Anti-depressants
  - Therapy
    - Thinking, breathing
2. Obsessive-Compulsive
- OCD
- Episodes
- Obsessions: upsetting thoughts
- Compulsions: stress reducers
- Development
  - Starts in childhood or teen
  - Most diagnosed by age 19
- Symptoms
  - Need to repeatedly check things
  - Repeated thoughts or images
  - Fear of dirt, gems, intruders
  - Routines & rituals
  - Spend 1+ hrs per day
  - Prefer round numbers (lucky)
  - Count lines in paragraph
  - Wash hair three times
  - Morning routine
- Runs in families
  - No direct genetic link
- Treatment
  - Cognitive therapy
  - fear without obsessive thoughts
  - Exposure-Response prevention
  - See image, change response
  - Medication
  - Anti-anxiety medications
  - Antidepressants
  - Work better than anti-anxiety
  - 2-3 months to work
3. Panic Disorder
- Frequent periods of anxiety
- Occasional attacks
- Rapid breathing
- Increased heart rate
- Sweating
- Symptoms
  - Fear for several minutes
  - Fear of disaster
  - Fear losing control
  - May feel like heart attack
  - Worry about next attack
- Young Women
  - More common in women
  - More in adolescent & young adult
- Treatment
  - GABA
    - main inhibitory NT in amygdala
    - GABA blockers induce panic
  - Benzodiazepines
    - Diazepam
    - Chlordiazepoxide
    - Alprazolam
    - Bind to GABAA receptor
      - receptor changes shape
      - attach easily & bind more
    - Affect amygdala, midbrain & hypothalamus+
    - Can be addictive
    - Temporary relief
  - Beta-blockers
    - Less sweat & pounding heart
  - Propranolol
    - Drug
    - Affects synapses in amygdala
      - Interferes with protein synthesis
      - Weakens emotional R
    - Persisting decrease in fear intensity
- Runs in families
  - No direct genetic link
4. Social Phobia
- Strong fear of being judged
- Strong feeling of embarrassed
- Fear gets in way of work, etc
- Afraid of doing common things in front of others
  - sign a check in front of a cashier
  - eat or drink in front of others
  - use a public restroom
- Know its irrational but can’t control the fear
- Starts as child-adolescent
  - Diagnoses if symptoms last 6 months+
  - Can last for many years
- Symptoms
  - Anxious being with other people
  - Hard time talking to others
  - Self-conscious
    - Afraid others will judge them
  - Worry for days before an event
  - Avoid groups & crowds
    - Blush or sweat around people
    - Feel nauseous when with others
  - Afraid of being called on in school
  - Hate to meet with my boss
  - Don’t eat lunch with co-workers
  - Worried about being stared at
  - Heart pounds if go to meeting
  - Can’t eat or sleep for days before staff meeting
5. PTSD
- Some get, not most
- See event (observer)
- In event (participant)
- Anyone
- Any age
- Symptoms
  - Three categories:
  - 1. Re-experiencing symptoms
    - Flashbacks
    - Bad dreams
    - Frightening thoughts
  - 2. Avoidance symptoms
    - Stay away from places, events
    - Avoid reminders of experience
    - Emotionally numb
    - Guilty, depressed or worried
    - Loss of interest hobbies, etc
    - Difficulty remembering event
  - 3. Hyperarousal symptoms
    - Relatively constant symptoms
    - Not triggered
    - Easily startled
    - Feel tense or “on edge”
    - Trouble sleeping
    - Angry outbursts
- Diagnosis
  - 1 month+
  - 1+ re-experiencing symptom
  - 3+ avoidance symptoms
  - 2+ hyperarousal symptoms
- Most people don’t get PTSD
- Risk factors
  - Previous dangerous events
  - History of mental illness
  - Getting hurt
  - Seeing people hurt or killed
  - Lack of social support after event
- Resilience factors
  - Support group
  - Feeling did right thing
  - Coping strategies
  - Respond even though afraid
- Medications
  - 1. Zoloft
  - 2. Paxil
    - Both are antidepressants
    - sadness, worry, anger & numb
  - Side effects
    - annoying but go away (few days)
    - headaches, nausea, sleepy
- Other medications
  - Benzodiazepines
    - relax and sleep
    - may cause memory problems or become dependency
  - Antipsychotics
    - Tend to gain weight
- Other antidepressants
  - Prozac & Celexa
  - Feel less tense or sad
  - Co-occurring depression

Mood Disorders

Why is everyone happier than me?

SLIDES

TERMS

NOTES

QUIZ

VIDEO

DISCUSSION ITEM

Why is everyone happier than me?

SLIDES

TERMS

NOTES

QUIZ

VIDEO

DISCUSSION ITEM

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