Unipolar Depression: The Depressive Disorders

• Depression: A low, sad state in which life seems dark and its challenges overwhelming

• Mania: A state of breathless euphoria / frenzied energy in which people may have an exaggerated belief that the world is theirs for the taking

• Unipolar Depression: Depression without a history of mania

• Bipolar Disorder: A disorder marked by alternating or intermixed periods of mania and depression

How Common Is Unipolar Depression?

• About 8% of adults in the US suffer from a severe unipolar patten of depression, about 5% suffer from mild forms

• The rate of depression is higher among poor ppl than wealthier ppl

• Women are twice as likely to have episodes of severe unipolar depression

• An episode of severe depression can occur at any point of life

  • Average onset: 19 yrs

  • Peak age: late adolescence / early adulthood

• People who are depressed have more medical problems and a higher mortality rate than other people

• 85% of ppl with unipolar depression recover within 6 months

• More than half of ppl who recover from severe depression have at least one more episode later in life

What Are the Symptoms of Depression?

• Emotional Symptoms

  • Anhedonia: An inability to experience any pleasure at all

  • Miserable, empty, humiliation

  • Anxiety, anger, agitation

• Motivational Symptoms: Lose the desire to pursue their usual activities

• Behavioral Symptoms

  • Less active

  • Less productive

  • Spend more time alone

  • Stay in bed for long periods

  • May move and speak slower

• Cognitive Symptoms

  • Hold extremely negative views of themselves

  • Consider themselves inadequate, undesirable, inferior, evil

  • Blame themselves for nearly every unfortunate event

  • Rarely credit themselves for positive achievements

  • Pessimism: Convinced that nothing will ever improve, feel helpless to change any aspect of their lives

  • Expect the worst

  • Procrastinate

  • Sense hopelessness and helplessness

• Physical Symptoms

  • Headaches, indigestion, constipation, dizzy spells, general pain

  • Eat less, sleep less, feel more fatigued - may also eat and sleep excessively

Diagnosing Unipolar Depression

• Major Depressive Episode: Period of two+ weeks marked by at least 5 symptoms of depression, including sad mood and/or loss of pleasure

  • May include psychotic symptoms (loss of contact w reality)

    • Delusions: Bizarre ideas without foundation

    • Hallucinations: Perceptions of things that are not actually present

• Major Depressive Disorder: A severe pattern of depression that is disabling and is not caused by such factors as drugs or a general medical condition

  • Seasonal Depression: Depression that changes with the seasons (ex: recurs each winter)

  • Catatonic Depression: Depression marked by either immobility or excessive activity

  • Peripartum Depression: Depression that occurs during pregnancy or within four weeks of giving birth

  • Melancholic Depression: Depression where the person is almost totally unaffected by pleasurable events

  • When a person has a manic episode at a later time, the diagnosis is changed to bipolar disorder

• Persistent Depressive Disorder: A chronic form of unipolar depression marked by ongoing and repeated symptoms of either major or mild depression

• Premenstrual Dysphoric Disorder: A disorder marked by repeated episodes of significant depression and related symptoms during the week before menstruation

• Disruptive Mood Dysregulation Disorder: A combination of persistent depressive symptoms and recurrent outbursts of severe temper

  • Emerges during mid-childhood or adolescence

What Causes Unipolar Depression?

• Episodes of unipolar depression are triggered by stressful events in a person’s life

  • 80% of all severe episodes occur within a month or two of a significant negative event

  • Reactive (exogenous) Depression: Follows clear-cut stressful events

  • Endogenous Depression: A response to internal factors

The Biological View

• Genetic Factors

  • Some people inherit a predisposition to unipolar depression

  • Family Pedigree Studies: Select people with unipolar depression as probands, examine their relatives, and see whether depression also afflicts other members of the family

    • If a predisposition to unipolar depression is inherited, a proband’s relatives should have a higher rate of depression than the population at large

    • Proband: The person who is the focus of a family pedigree study

  • Twin Studies: When an identical twin has unipolar depression, there’s a 38% chance that the other twin already has / will have the same disorder (compared to 20% for fraternal twins)

  • People who are depressed often have an abnormality of their 5-HTT gene

• Biochemical Factors

  • Low activity of norepinephrine and serotonin have been strongly linked to unipolar depression

  • Hypothalamic-Pituitary-Adrenal Pathway: Brings about the release of hormones at various locations throughout the body

    • For ppl with depression: Overactive in the face of stress, causing excessive and enduring releases of cortisol and related hormones at times of stress

• Brain Circuits: Dysfunction of the depression-related circuit is found in ppl with depression

  • Circuit operates abnormally in ppl with depression

  • Activity and blood flow are unusually low in certain parts and unusually high in other parts of the prefrontal cortex

  • The hippocampus is undersized and its production of new neurons is low

  • Activity and blood flow are elevated in the amygdala

  • The subgenual cingulate is particularly small and active

  • The connection between these various structures is often problematic

• Immune system

  • When ppl are under intense stress for a while, their immune systems become dysregulated, which helps produce depression

Psychological Views

• The Psychodynamic View

  • Noted similarity between clinical depression and grief in ppl who lose loved ones

  • For some mourners, introjection is temporary, but for others, grief worsens over time, and they develop clinical depression

  • Introjection: A person directs all their feelings for the loved one, including sadness and anger, toward themselves

  • Many ppl become depressed without losing a loved one

  • Symbolic / Imagined Loss: The loss of a valued object that is unconsciously interpreted as the loss of a loved one

  • Research doesn’t indicate that loss or problematic early relationships are always at the core of depression

  • Less than 10% of all ppl who have major losses in life actually become depressed

• The Cognitive-Behavioral View

  • Behavior

    • The positive rewards in life dwindle for some people, leading them to perform fewer and fewer constructive behaviors and spiral toward depression

    • The number of rewards people receive in life is related to the presence or absence of depression

    • Depressed participants typically report fewer positive rewards than nondepressed participants, but when their rewards begin to increase, their mood improved as well

    • Strong relationship between positive life events and feelings of life satisfaction and happiness

    • Social rewards are particularly important in the downward spiral of depression

      • Depressed persons receive fewer social rewards

      • As their mood improves, their social rewards increase

  • Negative thinking

    • Aaron Beck: Maladaptive attitudes, a cognitive triad, errors in thinking, and automatic thoughts combine to produce unipolar depression

    • Some people develop maladaptive attitudes as children

      • Results from their own experiences and the judgments of the people around them

      • Later in life, upsetting situations may trigger an extended round of negative thinking

    • Cognitive Triad: The three forms of negative thinking that lead people to feel depressed. the individuals repeatedly interpret ____ in negative ways that lead them to feel depressed

      • their experiences

      • themselves

      • their futures

    • Depressed people make errors in their thinking

      • Often minimize the significance of positive experiences or magnify that of negative ones

    • Automatic Thoughts: A steady train of unpleasant thoughts that keep suggesting to them that they are inadequate and that their situation is hopeless

    • The more maladaptive attitudes someone holds, the more depressed they tend to be

    • Depressed people seem to recall unpleasant experiences more readily than positive ones

  • Learned helplessness

    • Martin Seligman

    • Feelings of helplessness are at the center of depression

    • People become depressed when they think

      • that they no longer have control over the reinforcements in their lives

      • they are responsible for this helpless state

    • Reinforcements: Rewards and punishments

    • Attribution-Helplessness Theory: When people view events as beyond their control, they ask themselves why this is so

      • If they attribute to an internal, global, and stable cause, they may feel helpless to prevent future negative outcomes and they may experience depression

      • Attributions are likely to cause depression only when they further produce a sense of hopelessness in a person

Sociocultural Views

• Unipolar depression is strongly influenced by the social context that surrounds people

• Depression is often triggered by outside stressors

• Family-Social Perspective

  • Depressed people often display weak social skills and communicate poorly

  • Speak slower and quieter and in more of a monotone

  • Pause longer between words and sentences

  • Take longer to respond to others

  • Seek repeated reassurances from others

  • Social contacts and rewards of depressed people decrease, and as they participate in fewer social interactions, their social skills deteriorate further

  • Depression has been tied to the unavailability of social support

    • High correlation between level of marital conflict and degree of sadness

    • People whose lives are characterized by weak social supports are particularly likely to become depressed and to remain depressed longer

• Multicultural perspective

  • Gender and depression

    • Women are at least twice as likely as men to receive a diagnosis of unipolar depression

    • Artifact Theory: Women and men are equally prone to depression but clinicians often fail to detect depression in men

      • Women are actually no more willing or able than men to identify their depressive symptoms and seek treatment

    • Hormone Explanation: Hormone changes trigger depression in many women

      • Sexist

      • Social and life events that accompany hormonal milestones are also profound and are more likely than hormone shifts to account for experiences of depression

    • Life Stress Theory: Women in our society are subject to more stress than men

      • More poverty, more discrimination, less adequate housing

      • Disproportionate share of responsibility for childcare and housework

    • Body Dissatisfaction Explanation: Women in Western society are taught to seek a low body weight and slender body shape, and when their dissatisfied, they become depressed

      • Eating and weight concerns are the result of depression, not the cause

    • Lack-of-control Theory: Women are more prone to depression bc they feel less control over their lives

    • Rumination Theory: Women are more likely to ruminate when their mood darkens, making them more vulnerable to the onset of clinical depression

  • Cultural background and depression

    • Depressed people in non-Western countries are more likely to have physical symptoms, and their depression is less often marked by cognitive symptoms

    • Hispanic americans and african americans are twice as likely than white americans to have recurrent episodes of depression

    • Depression is more common among hispanic and african americans born in the US than among hispanic and african american immigrants

The Developmental Psychopathology Perspective

• Genetically inherited predisposition

  • Low activity of key neurotransmitters

  • Overly reactive HPA stress pathway

  • Dysfunctional depression-related brain circuit

• Biological predispositions will likely result in later depression if the individual is also subjected to significant traumas early in life and / or inadequate parenting

• Combination of biological and childhood factors often leads to a low-self concept

  • Low Self-Concept: A temperament marked by feelings such as guilt, a negative style of thinking, general feelings of helplessness, and/or interpersonal dependence

  • Negative Affectivity: Feelings of guilt

• Exposure to severe or repeated traumas at key points early in life may adversely affect an individual’s HPA stress pathway and depression-related brain circuit, even if they had previously been functioning properly

• Individuals who experience moderate and manageable adversities throughout their childhood often develop resilience and become better able to withstand the depressive effects of life stress in adulthood

Bipolar Disorders

What Are the Symptoms of Mania?

• Emotional Symptoms

  • Mood of euphoric joy and well-being that is out of proportion to the actual happenings in the person’s life

  • Some people with mania become very irritable and angry, especially when others get in the way of their exaggerated ambitions

• Motivational Symptoms

  • Ppl with mania want constant excitement, involvement, and companionship

  • Little awareness that their social style is overwhelming, domineering, and excessive

• Behavioral Symptoms

  • Very active

  • Move quickly

  • Talk rapidly and loudly

  • Flamboyance

• Cognitive Symptoms

  • Show poor judgment and planning

  • Rarely listen when others try to slow/stop them

  • Hold an inflated opinion of themselves

  • May have trouble remaining coherent or in touch with reality

• Physical Symptoms

  • Feel remarkably energetic

  • Get little sleep yet feel and act wide awake

  • Energy level remains high

Diagnosing Bipolar Disorders

• People are considered to be in a full manic episode when for at least one week they display an abnormally high or irritable mood, increased activity or energy, and at least three other symptoms of mania

  • Episode may include delusions or hallucinations

• When the symptoms of mania are less severe, the person is said to be having a hypomanic episode

• Bipolar I Disorder: A type of bipolar disorder marked by full manic and major depressive episodes

  • Alternation of the episodes - weeks of mania, period of wellness, episode of depression

  • Mixed features - display both manic and depressive symptoms within the same episode

• Bipolar II Disorder: A type of bipolar disorder marked by mildly manic (hypomanic) episodes and major depressive episodes

  • Hypomanic episodes alternate with major depressive episodes

• Without treatment, the mood episodes tend to recur

• Rapid Cycling: A person with bipolar disorder has 4+ episodes within a year

• Ppl with a bipolar disorder tend to experience depression more than mania over the years

• Statistics

  • 1-2.6% of all adults are suffering from a bipolar disorder at any given time

  • 4% experience one of the bipolar disorders at some time in their life

  • Equally common in women and men

  • More common among ppl w low incomes than those w high

  • Onset usually occurs between 15 and 44

• Cyclothymic Disorder: A disorder marked by numerous periods of hypomanic symptoms and mild depressive symptoms

What Causes Bipolar Disorders?

• Neurotransmitters

  • Norepinephrine activity of people with mania is higher than that of depressed or control participants

  • Mania may be linked to low serotonin activity

  • Low serotonin activity and low epinephrine activity: depression

  • Low serotonin activity and high norepinephrine activity: mania

• Ion Activity

  • Ions help transmit messages down the neuron’s axon to the nerve endings

  • Irregularities in the transport of these ions may cause neurons to fire irregularly

    • Neurons fire too easily - results in mania

    • Neurons resisting firing - results in depression

• Brain Structure

  • Hippocampus, basal ganglia, and cerebellum of ppl with bipolar tend to be smaller

  • Lower amounts of gray matter in the brain

  • Raphe nuclei, striatum, amygdala, and prefrontal cortex have structural abnormalities

• People inherit a biological predisposition to develop bipolar disorders