Psych220 Lecture22 Chp15 Essays

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Chapter 15: Mood
Disorders and

Lecture Outline

Course evaluations


Affective Disorders

Mood Disorders
Unipolar Mood Disorders
 Major Depressive Disorder (MDD)
 Dysthymic Disorder – not as severe

Bipolar Mood Disorders
 Bipolar I
 Bipolar II
 Cyclothymic Disorder

Major Depressive Disorder
DSM-IV-TR criteria
 Presence of at least one major depressive episode
 No manic (or hypomanic) episodes
Five or more during a 2-week period
 Depressed mood
 Anhedonia
 Decreased (or increased) appetite
 Insomnia (or hypersomnia)
 Psychomotor agitation (or retardation)
 Fatigue
 Feelings of worthlessness or guilt
 Diminished ability to concentrate
 Recurrent thoughts of death/suicidal ideation

MDD: A few notes…
Women: 2x as often as men
Uncommon in children
Within any given year, 5% of

US adults have clinically significant depression

Lifetime prevalence: 10%

Various duration and


MDD: Genes & The Environment
Moderate degree of

Linked to ↑ anxiety

disorders, ADD, substance abuse, OCD, bulimia, migraines, IBS, and other syndromes among relatives
Relatives of women with

early-onset depression have
↑ risk

MDD: Gene + Environment Interaction
5-HTT (Serotonin Transporter)
 Short-short, short-long, long-long
 Short form: reduced ability to produce
5HTT & Stress
 Short-short: high stress, ↑ risk of MDD
 Long-long: stress does not significantly increase risk of depression
Gene + environment interaction

is key

Postpartum Depression
Estrogen levels gradually rise to

1000x during pregnancy
20% of women report some degree, but less than .1% enter severe, long-lasting depression
More common in women who were previously diagnosed with depression Treatment Options


Atypical antidepressants Antidepressants
Tricyclics (example: Tofranil)
 1950s
 Non-addictive
 Risk of overdose
 Block transporter proteins that reabsorb 5-HT,

Prolong NTs in synaptic cleft (prolong stimulation of post-synaptic cell)

Block histamine receptors,

acetylcholine receptors, certain Na channels Highly effective, but replaced by SSRIs and newer antidepressants

Treatment-resistant depression

SSRIs (example: Prozac, Zoloft, Paxil)
 Similar to tricyclics (specific to 5-HT)

Milder side effects
Similar efficacy

Most widely prescribed

MAOIs (example: Nardil)
 Block monoamine oxidase
 Last line of treatment
 “Cheese effect”- pay attention to diet
Atypical antidepressants

Example: Wellbutrin inhibits reuptake of dopamine, but not serotonin

Where do drugs come from?

Herbal Remedies
• No regulation by FDA
• Does not go through the screening process
• Less expensive; no prescription
• But no guarantee what you are getting
• St. John’s Wort
• “Nutritional Supplement”
• How does it work?
• Increases efficacy of liver enzyme that breaks down most medicines

Decreases effectiveness of other drugs (including birth control!) Antidepressants

Not great, but they do work somewhat…

We don’t actually know!
 SSRIs block reuptake of 5-HT; however, some studies show an increase in 5-HT turnover in depression
 Time course: many people don’t experience relief until after weeks of taking the drug (though the drugs exert their effects on synapses within hours)
 Mood elevation
 Repairing damaged cortex and hippocampus?
 Release of neurotrophins?

Electroconvulsive Therapy (ECT)
Schizophrenia, epilepsy
Current use
 Informed consent; severe cases; strong suicidal tendencies
 Every other day (2 weeks)

Muscle relaxants or anesthetics used to to minimize discomfort
Side effects: memory loss (unless the shock is limited to right hemisphere) Risk of relapse
Mechanism unknown; alters gene expression of neurotrophic factors, arachidonic acid, neurogenesis in the hippocampus Altered Sleep Patterns