• Depressive Disorders
• Bipolar Disorders

• .08 of Americans are diagnosed per year
• .17 lifetime prevalence
• diagnosed 2x in women
• average age of onset is 27

• Major Depression
• Dysthymia

• Depressed mood
• Diminished interest in activities
• Significant weight loss or appetite changes
• Disruptions in sleep
• Agitation or motor retardation
• Loss of energy
• Feelings of worthlessness or guilt
• Difficulty concentrating
• Thoughts of death and/or suicidality

• disabling depression of 2 weeks or more

• person has at least 5 symptoms of depression

• Single episode Vs. recurrent
• Seasonal
• Catatonic
• Melancholic

• delusions (abnormal beliefs) and hallucinations (abnormal perceptions)

• depressed mood for at least 2 years (periods of normal functioning for only a few days)

• person has at least 3 symptoms of depression

• Duration of symptoms

• Severity of symptoms

• .40 MZ twins
• 20% of biological relatives Vs. 10% of general population

• Monoamine Oxidase (MAO) Inhibitors
• Tricyclic Antidepressants
• Selective Serotonin Re-uptake Inhibitors

• Meds prevent this breakdown

• Result: Increase levels of NE and 5HT

• Because also raises tyramine
• Potential for liver damage, hypertension and death

• Patient must control intake of tyramine
• Requires patient�s cooperation and ability to self-monitor

Tricyclic Antidepressants
E.g. Tofranil or Elavil

• Raise NE and 5 HT differently
• Interfere with reuptake NE and 5HT
• Stays in synapse longer

• Effective with melancholic depression
• Side effects: Blurry vision, dry mouth, constipation

• Prozac
• Zoloft

• Specifically target 5HT
• Prevents reuptake
• 5HT stays in synapse >>> greater effect

• Medications are effective for about 2/3 of depressed patients
• Most patient can be weaned from meds.
• Know less about long term effects
• ECT for med. resistant depressions

• each person has a set of "rewards"
• function as positive reinforcers
• E.g. a lover, money, good grades

• # of events a person finds reinforcing
• # of reinforcements available
• skills for securing available reinforcements

• = a lack of positive reinforcement

• and/or a high rate of punishing experiences

• # of reinforcing events
• person�s ability to utilize them
• special attention to social reinforcers

• Behavioral treatment most effective for mild and moderate depressions

• How a person interprets his/her experience
• How a person interprets him/herself
• How a person interprets the future

• Therapist as mentor
• Increase thoughts that promote activity
• Invalidate negative attributions and automatic thoughts

• think they have no control over reinforcements
• believe they are responsible for lack of control

• subjects exposed to inescapable loud noise
• subjects exposed to noise they could diminish
• control subjects (no exposure to noise)

• subjects previously exposed to unavoidable loud noise failed to learn that lever would stop torment

• Mourning
• Anger turned against the self

• Correlation between depression scores and history of parental loss

• Depressed patients� dreams had higher levels of aggression and hostility

• Spitz (1940�s): Parental separation (0-6 yrs.) resulted in depressive symptoms

• Rhesus monkeys separated from mothers and reared alone reacted with a distress reminiscent of depressed people
• Effect is most pronounced with early separation

• early separation experiences can create a neurochemical vulnerability as well

• Human studies show only 10% of subjects have experienced loss (Paykel & Cooper, 1992)
• Suggests separation alone is not the only issue

• depressive episodes
• alternating with episodes of mania
• and being symptom free

• Extreme elevated mood & behavior
• Impulsive behavior (e.g. shopping sprees)
• Grandiose self-concept
• Pressured speech
• Racing thoughts
• Usually psychotic level disturbance

• person at biologic risk because of poor judgment
• devastating consequences (@ work, school, finances, etc.)
• also for social functioning and relationships

• Major Depression and Manic Episodes

• Major Depression and Hypomanic Episodes

• hypomania
• depressed mood for at least 2 years

• Depression is primary
• Mania serves defensive functioning of warding off depression
• Co-incident with patient reports

• Primarily concerned with helping patients cope with the consequences of the disorder

• teach problem solving skills
• social skills training
• contingency management to reinforce adaptive behaviors

• Heritability

• Cerebral-spinal fluid showed high levels of NE metabolites
• Reserpine (which lowers NE) >>> bipolar patients = reduced manic symptoms

• Lithium Carbonate (common salt)
• Lithium reduces NE and increases levels of 5HT
• Hypoth: Low levels of 5HT combined with excess NE produces bipolar disorders

• Therapeutic dosage difficult to determine
• Frequent blood and urine tests
• Patient compliance ("miss" mania)

• Tegretol (an anticonvulsant)
• Medication plus psychotherapy usually the treatment of choice