MOOD DISORDERS

Mood Disorders

• Mental disorders characterized by disturbances of mood that are intense and persistent enough to be maladaptive

• Normal range of mood…–Major Depressive disorder–Dysthymic disorder–Bipolar disorder

Approximately 20.9 million American adults, or about 9.5 percent of the U.S. population age 18 and older in a given year, have a mood disorder.

The median age of onset for mood disorders is 30

Depressive disorders often co-occur with anxiety disorders and substance abuse.

Who is Affected by Depression?

•Major depressive disorder affects approximately 14.8 million American adults, or about 6.7 percent of the U.S. population age 18 and older, in a given year. 

•While major depressive disorder can develop at any age, the median age at onset is 32. 

•Major depressive disorder is more prevalent in women than in men. 

•As many as one in 33 children and one in eight adolescents have clinical depression. 

•People with depression are four times as likely to develop a heart attack than those without a history of the illness.

•Eating disorders: 50-75% of eating disorder patients (anorexia and bulimia) experience depression.

•Substance use: 27% of individuals with substance abuse disorders (both alcohol and other substances) experience depression.

•Diabetes: 8.5-27% of persons with diabetes experience depression.

Women and Depression

•Women experience depression at twice the rate of men.

•This 2:1 ratio exists regardless of racial or ethnic background or economic status.

•The lifetime prevalence of major depression is 20-26% for women and 8-12% for men.

•Postpartum mood changes can range from transient "blues" immediately following childbirth to an episode of major depression and even to severe, incapacitating, psychotic depression.

•Studies suggest that women who experience major depression after childbirth very often have had prior depressive episodes even though they may not have been diagnosed or treated.

Economic Impact of Depression

•Major depressive disorder is the leading cause of disability in the U.S. for ages 15-44.

•Major depression is the leading cause of disability worldwide among persons five and older.

•Depression ranks among the top three workplace issues, following only family crisis and stress.

•Depression’s annual toll on U.S. businesses amounts to about $70 billion in medical expenditures, lost productivity and other costs.

Major Depressive Disorder

•Clinical depression/Major Depression•Unipolar depression•Single-episode or recurrent episodes•Symptoms must occur for at least 2

weeks•Subtypes:

–Post-partum onset–S.A.D.

•Secondary symptoms…

Depression…symptoms

SSleep disturbance

IInterest GGuilt/worthlessness

EEnergy = fatigue

CConcentration AAppetite disturbance/weight gain/loss

PPsychomotor agitation/retardation

SSuicidal/thoughts of death

Causes of Depression

•Genetic Predisposition–+ stressful life events

•Neurotransmitters–Serotonin –Dopamine

•Cognitive Theories•Behavioral Theories

SEROTONIN

Plays important role as a neurotransmitter in the modulation & control of: anger, aggression, body temperature, mood, sleep, sexuality, appetite and metabolism. A hormone most commonly associated with mood. Release of the chemical by the brain linked with well-being. Found in pineal gland, blood platelets, digestive tract, brain & nerve tissue. Concentrated in certain areas of the brain:Hypothalamus and Midbrain contain large amountsCortex and Cerebellum contain low concentrations.

SEROTONIN

Like most neurotransmitters, stored in granules inside nerve endings.

Serotonin is a chemical derived from the amino acid tryptophan.

Brain concentrations are affected by diet: Generally, carbohydrate-rich diets increase tryptophan levels, accelerating serotonin production.

Some protein-rich diets compete with tryptophan to get across the blood-brain barrier, depress tryptophan uptake into the brain, and reduce serotonin levels.

DOPAMINE Hormone-like substance, is an important neurotransmitter.

When present in normal quantities, dopamine facilitates critical brain functions

More recently, researchers have explored dopamine neurotransmission role in the abuse of drugs

ranging from stimulants, such as amphetamines and cocaine, to depressants, such as morphine and other opioids, and alcohol.

Dopamine is produced in several areas of the brain: Ventral tegmental area midbrain affecting: cognition, motivation drug addiction

Substantial nigra midbrain affecting: reward, addiction, and movement

Cocaine—reuptake inhibitor Amphetamines—expulsion of large quantities

Dysthymia

low-level state of depressed mood that lasts a long time. The depressed state of dysthymia is not as severe as with major depression, but can be just as disabling.

Symptoms: * Low self-esteem,self-confidence, feelings of inadequacy * Feelings of pessimism, despair or hopelessness * Generalized loss of interest or pleasure * Social withdrawal * Chronic fatigue or tiredness * Feelings of guilt or brooding about the past * Subjective feelings of irritability or excessive anger * Decreased activity, effectiveness or productivity * Difficulty in thinking: poor memory, poor concentration or indecisiveness

DysthymiaDysthymic disorder is diagnosed when these symptoms last for more than two years in adults and a person has not been symptom-free for > two months at a time.

People with dysthymia may be unaware that they have an illness. They might be able to go to work and manage their lives to some degree.

However, they may be irritable, stressed, or sleepless much of the time.

Many people with dysthymia believe their symptoms are just part of their personality. It may be more difficult for them to seek treatment.

About 3-6% of the population has dysthymic disorder. People with dysthymia often have their first symptoms earlier in life than those with major depressive disorder or bipolar disorder.

Bipolar Disorder

•Previously known as Manic-Depression

•Experience both manic and depressive episodes –Mania = emotional state characterized by intense and unrealistic feelings of excitement and euphoria, along with impulsivity

•Cycles…not mood swings•High rate of suicide

Bipolar Disorder Statistics

Who is Affected by Bipolar Disorder?

•Bipolar disorder affects approximately 5.7 million adult Americans, or about 2.6% of the U.S. population age 18 and older every year.

•The median age of onset for bipolar disorder is 25 years although the illness can start in early childhood or as late as the 40's and 50's.

•An equal number of men and women develop bipolar illness and it is found in all ages, races, ethnic groups and social classes.

•More than two-thirds of people with bipolar disorder have at least one close relative with the illness or with unipolar major depression, indicating that the disease has a heritable component.

Women and Bipolar Disorder

•Although bipolar disorder is equally common in women and men, research indicates that approximately three times as many women as men experience rapid cycling.

•Other research findings indicate that women with bipolar disorder may have more depressive episodes and more mixed episodes than do men with the illness.

Children and Adolescents•Bipolar disorder is more likely to affect the children of parents who have the disorder.

•When one parent has bipolar disorder, the risk to each child is l5 to 30%. When both parents have bipolar disorder, the risk increases to 50 to 75%.

•Bipolar Disorder may be at least as common among youth as among adults. In a recent NIMH study, one percent of adolescents ages 14 to 18 were found to have met criteria for bipolar disorder in their lifetime.

•Some 20% of adolescents with major depression develop bipolar disorder within five years of the onset of depression.

•Up to one-third of the 3.4 million children and adolescents with depression in the United States may actually be experiencing the early onset of bipolar disorder.

Mood Disorders-Bipolar

PET scans show that brain energy consumption rises and falls with emotional swings

Depressed state Manic state Depressed state

Mood Disorders & Suicide

•Not all people who commit suicide are depressed; Not all depressed people commit suicide

•Associated with mood disorders, especially bipolar disorder ~also schizophrenia

Monday 02/23

Option 1 Case Study Mood &/or Anxiety Disorders

Contact Facility/Practice Receive Permission & Interview

(Common Cases, Recidivism, Greatest Challenges, Trends, Pharmaceutical Views Opportunities)

Respect Anonymity Post Results

Option 2: Volunteer Crisis Call Center Locate

ServeReflectRespect AnonymityPost Results

HEADING: Name of Agency/Organization Position of Contact Professional w) Phone &/or Email Time(s)/Date(s) of Interview/Service WRITE-UP: Depth: Minimum 500 words Format: Q & A or Essay Content: Intro Why you selected, what you hoped to find out

Body Range of questions and responses addressing common cases, recidivism/relapse, challenges, trends, opportunities, etc. Conclusion Reflections

Remember: you may use a case study, but that will be considered supplemental (EXTRA) to the primary assignment.

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