Chapters 7 & 8: Depressive & Bipolar Disorders & Treatment

Question 1

Unipolar depression

Answer 1

Depression without a history of mania. Have no history of mania and return to a normal or nearly normal mood when their depression lifts

Question 2

Symptoms of unipolar depression

Answer 2

• Emotional: feel sad and dejected, miserable, empty, Anhedonia (inability to experiences any pleasure at all), anger, anxiety, agitation
• Motivational: typically lose the desire to pursue their usual activities, lack of drive
• Behavioral: usually less active and less productive, may move and speak more slowly
• Cognitive: hold extremely negative views of themselves (inadequate, undesirable, inferior, and perhaps even evil), blame themselves
• Physical: physical alignments such as headaches, indigestion, constipation, dizzy spells, general pain, disturbances in sleep/appetite

Question 3

Major depressive disorder

Answer 3

• A severe pattern of depression that is disabling and is not caused by such factors as drugs or a general medical condition
• Associated Symptoms: seasonal (changes with seasons), catatonic (marked by either immobility or excessive activity), peripartum (occurs during pregnancy or within 4 weeks of giving birth), melancholic (if person is almost totally unaffected by pleasurable events)

Question 4

Persistent depressive disorder

Answer 4

• A chronic form of unipolar depression marked by ongoing and repeated symptoms of either major or mild depression
• Associated Symptoms: some people have repeated major depressive episodes, a pattern technically called persistent depressive disorder with major depressive episodes. Others have less severe and less disabling symptoms, a pattern technically called persistent depressive disorders with dysthymic syndrome

Question 5

Premenstrual dysphoric disorder

Answer 5

A disorder marked by repeated episodes of significant depression and related symptoms during the week before menstruation

Question 6

Bipolar I disorder

Answer 6

• A type of bipolar disorder marked by full manic and major depressive episodes
• Most of them experience and alternation of the episodes (e.g., weeks of mania followed by a period of wellness, followed in turn by an episode of depression), some have mixed features, which they display both manic and depressive symptoms within the same episode (e.g., having racing thoughts amidst feelings of extreme sadness)

Question 7

Bipolar II disorder

Answer 7

• A type of bipolar disorder marked by mildly manic (hypomanic) episodes and major depressive episodes
• Some people with this pattern accomplish huge amounts of work during their mild manic periods

Question 8

Cyclothymic disorder

Answer 8

A disorder marked by numerous periods of hypomanic symptoms and mild depressive symptoms

Question 9

Dysthymic Disorder and Symptoms

Answer 9

• Less severe but more chronic depression
• Depressed mood plus 2 additional symptoms (Poor appetite/overeating, Insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, Feelings of hopelessness)
• A mild but long-term form of depression. Defined as a low mood occurring for at least 2 years, along with at least 2 other symptoms of depression. Examples of symptoms include lost interest in normal activities, hopelessness, low self-esteem, low appetite, low energy, sleep changes, and poor concentration

Question 10

What is meant by bipolar disorder?

Answer 10

People with bipolar disorder experience both the lows of depression and the highs of mania. Many describe their lives as an emotional roller coaster, as they shift back and forth between extreme moods. A number of sufferers become suicidal. ~ 10% - 15% of them eventually end their own lives, usually out of a sense of hopelessness. Their roller-coaster ride also had a dramatic impact on relatives and friends, and tend to experience depression and mania over the years

Question 11

Psychodynamic Depressive Explanation

Answer 11

• . According to theorists, a series of unconscious processes is set in motion when a loved one dies, unable to accept the loss, mourners at first regress to the oral stage of development, the period of total dependency when infants cannot distinguish themselves from their parents. By regressing to this stage, the mourners merge their own identity with that of the person that have lost, and so symbolically regain the lost person, a process called introjection (they direct all their feelings for the loved one, including sadness and anger toward themselves)
• Symbolic or Imagined Loss: in which a person equates other kinds of events with the loss of a loved one. The loss of a valued object (e.g., loss of employment) that is unconsciously interpreted as the loss of a loved one
• Object Relations Theorists: propose that depression results when people’s relationships – especially their early relationships – leave them feeling unsafe, insecure, and dependent on others

Question 12

Cognitive-Behavioral Depressive Explanation

Answer 12

• Cognitive-behavioral theories contend that unipolar depression results from a combination of problematic behaviors and dysfunctional ways of thinking
• Behavioral Dimension: Peter Lewinsohn linked depression to significant changes in the number of rewards and punishments people receive in their lives = the positive features in their lives decrease even more, and the decline in rewards leads them to perform still ewer constructive behaviors and in this manner, spiral towards depression. Lewinsohn and other theorists have further proposed that social rewards are particularly important in the downward spiral of depression
• Negative thinking: Aaron Beck believes that negative thinking, rather than underlying conflicts or a reduction in positive rewards, lies at the heart of depression. According to Beck, maladaptive attitudes, a cognitive triad, errors in thinking, and automatic thoughts combine to produce unipolar depression
• Learned Helplessness: A Cognitive Behavioral Interplay: according to psychologist Martin Seligman, feelings of helplessness are at the center of depression. People become depressed when they think (1) they no longer have control over the reinforcements (rewards and punishments) in their lives (2) that they themselves are responsible for this helpless state

Question 13

Biological Depressive Explanation

Answer 13

• Genetic factors (e.g., suggest that some people inherit a predisposition to unipolar depression) use family pedigree studies = select people with unipolar depression, examine their relatives, and see whether depression also afflicts other members of the family.
• Biochemical factors, low activity of 2 neurotransmitter chemicals, norepinephrine (a neurotransmitter whose abnormal activity is linked to depression) and serotonin (a neurotransmitter whose abnormal activity is linked to depression)
• Brain Circuits: point to several brain structures that are likely members of this circuit, including the prefrontal cortex, hippocampus, amygdala, and subgenual cingulate (A.K.A. Brodmann Area 25), several of these structures in this circuit are also members of the brain circuits that contribute to certain anxiety disorders and PTSD. However, the subgenual cingulate, a subregion of the brain’s anterior cingulate cortex, is distinctly part of the depression-related circuit
• Immune System: when people are under intense stress for a while, their immune systems may become dysregulated, leading to slower functioning and important white blood cells called lymphocytes and to increased production of C-reactive protein (CRP), a protein that spreads throughout the body and causes inflammation and various illnesses = immune system dysregulation of this kind helps produce depression

Question 14

Sociocultural Depressive Explanation

Answer 14

• Sociocultural theorists propose that unipolar depression is strongly influenced by the social context that surrounds people. Their belief is that depression is often triggered by outside stressors
• The family-Social Perspective: the same perspective as cognitive-behavioral theorists, believe that a decline in social rewards is particularly important in the development of depression. The social contact and rewards of depressed people decrease, and, as they participate in fewer and fewer social interactions, their social skills deteriorate even further

Question 15

Biological Bipolar Explanation

Answer 15

• Neurotransmitters: ties between bipolar disorder and abnormal activity of other neurotransmitters, such as GABA, the brain chemical
• Ion Activity: irregularities in the transport of these ions may cause neurons to fire too easily (resulting in mania) or to stubbornly resist firing (resulting in depression)
• Brain Structure: brain imaging and postmortem studies have identified a number of abnormal brain structures in people with bipolar disorders
• Genetic Factors: people inherit a biological predisposition to develop bipolar disorders

Question 16

Psychodynamic Depressive Treatments

Answer 16

Believing that unipolar depression results from unconscious grief over real or imagined losses, compounded by excessive dependence on other people, psychodynamic therapists seek to help clients bring these underlying issues to consciousness and work through them. they encourage a depressed client to associate freely during therapy; suggest interpretations of the client’s associations, dreams, and displays of resistance and transference; and help the person review past events and feelings

Question 17

Cognitive-Behavioral Depressive Treatments

Answer 17

• On the behavioral side, they seek to get the clients moving again – to engage in and enjoy more activities
• On the cognitive side, they guide clients to think in more adaptive, less negative ways
• Use behavioral activation & cognitive therapy

Question 18

Biological Depressive Treatments

Answer 18

Usually, biological treatment means antidepressant drugs or popular alternatives such as herbal supplements, but for people whose depression does not respond to medications, psychotherapy, or the like, it sometimes means brain stimulation

Question 19

Sociocultural Depressive Treatments

Answer 19

• designed to address the unique issues faced by members of cultural minority groups. Therapists typically have special cultural training and a heightened awareness of their client’s cultural values and the culture-related stressors, prejudices, and stereotypes that their clients face. Therapists make an effort to help clients develop a bicultural balance and to recognize the impact of their own culture and the dominant culture on their views of themselves and their behaviors.
• Family-Social Treatments: therapists who use family and social approaches to treat depression help clients change how they deal with the close relationships in their lives.

Question 20

Cognitive-Behavioral Bipolar Treatments

Answer 20

• Many clinicians now use individual, group, or family therapy as an adjunct to mood-stabilizing drugs
• therapists use these formats to emphasize the importance of continuing to take medications; to improve social skills and relationships that may be affected by bipolar episodes; to educate patients and families about bipolar disorders; to help patients solve the family, school, and occupational problems caused by their disorder; and to help prevent patients from attempting suicide

Question 21

Biological Bipolar Treatments

Answer 21

• Lithium: a metallic element that occurs in nature as a mineral salt and is an effective treatment for bipolar disorders
• Mood Stabilizing Drugs: psychotropic drugs that help stabilize the moods of people suffering from bipolar disorder (A.K.A. antibipolar drugs)

Question 22

Antidepressant Drugs

Answer 22

• MAO Inhibitors: an antidepressant drug that prevents the action of the enzyme monoamine oxidase
• Tricyclics: an antidepressant drug such as imipramine that has 3 rings in its molecular structure
• Second-Generation Antidepressants: Selective Serotonin
• Reuptake Inhibitors (SSRIs): a group of second-generation antidepressant drugs that increase serotonin activity specifically, without affecting other neurotransmitters

Question 23

Brain Stimulation

Answer 23

biological treatments that directly or indirectly stimulate certain areas of the brain

Question 24

Electroconvulsive Therapy (ECT)

Answer 24

a treatment for depression in which electrodes attached to a patient’s head send an electrical current through the brain, causing a convulsion

Question 25

Vagus Nerve Stimulation

Answer 25

treatment for depression in which an implanted pulse generator sends regular electrical signals to a person’s vagus nerve; the nerve then stimulates the brain

Question 26

Transcranial Magnetic Stimulation (TMS)

Answer 26

a treatment in which an electromagnetic coil, which is placed on or above a patient’s head, sends a current into the individual’s brain. TMS appears to increase neuron activity in that structure, and, in turn, may improve functioning throughout the rest of the brain’s depression-related circuit

Question 27

Deep Brain Stimulation (DBS)

Answer 27

treatment for depression in which a pacemaker powers electrodes that have been implanted in subgenual cingulate, thus stimulating that brain area

Question 28

Interpersonal Psychotherapy (IPT)

Answer 28

• a treatment for unipolar depression that is based on the belief that clarifying and changing one’s interpersonal problems helps lead to recovery.
• Interpersonal psychotherapists help depressed individuals develop insight into their interpersonal problems, make useful changes in the interpersonal realm, and learn skills to protect themselves in the future

Question 29

Couple Therapy

Answer 29

a therapy format in which the therapist works with 2 people who share a long-term relationship

Question 30

Lithium

Answer 30

a metallic element that occurs in nature as a mineral salt and is an effective treatment for bipolar disorders

Question 31

Mood Stabilizing Drugs

Answer 31

psychotropic drugs that help stabilize the moods of people suffering from bipolar disorder (A.K.A. antibipolar drugs)

Question 32

The effect of depression on the immune system

Answer 32

• Immune System: when people are under intense stress for a while, their immune systems may become dysregulated, leading to slower functioning and important white blood cells called lymphocytes and to increased production of C-reactive protein (CRP), a protein that spreads throughout the body and causes inflammation and various illnesses = immune system dysregulation of this kind helps produce depression
• people with depression display lower lymphocyte activity, higher CRP production, and greater body inflammation than do other people. Depressed people have a higher incidence of migraines, irritable bowel syndrome, chronic fatigue syndrome, rheumatoid arthritis, and other illnesses caused by CRP production and body inflammation

Question 33

Role of Norepinephrine & Serotoninon Depression

Answer 33

low activity of 2 neurotransmitter chemicals, norepinephrine (a neurotransmitter whose abnormal activity is linked to depression and panic disorder) and serotonin (a neurotransmitter whose abnormal activity is linked to depression, obsessive-compulsive disorder, and eating disorders) has been strongly linked to unipolar depression

Question 34

Brain Anatomy & Depression

Answer 34

• Brain Circuits, point to several brain structures that are likely members of this circuit, including the prefrontal cortex, hippocampus, amygdala, and subgenual cingulate (A.K.A. Brodmann Area 25), several of these structures in this circuit are also members of the brain circuits that contribute to certain anxiety disorders and PTSD. However, the subgenual cingulate, a subregion of the brain’s anterior cingulate cortex, is distinctly part of the depression-related circuit
• Brain anatomy: research suggests that among depressed people, 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; and communication between these various structures, called interconnectivity, is problematic

Question 35

The role of real or imagined loss

Answer 35

• Real Loss: when someone really dies (?)
• Symbolic or Imagined Loss: in which a person equates other kinds of events with the loss of a loved one. According to Freudian theory, the loss of a valued object (e.g., loss of employment) that is unconsciously interpreted as the loss of a loved one

Question 36

The role of automatic thoughts in depression

Answer 36

• Automatic Thoughts: numerous unpleasant thoughts that help to cause or maintain depression, anxiety, or other forms of psychological dysfunction
• Depressed people have automatic thoughts, a steady train of unpleasant thoughts that keep suggesting to them that they are inadequate and that their situation is hopeless
• These thoughts seem to just happen, as if by reflex

Question 37

Cognitive Triad

Answer 37

the 3 forms of negative thinking that Aaron beck theorizes lead people to feel depressed. The triad consists of a negative view of one’s experiences, oneself, and the future

Question 38

Negative Thinking Patterns

Answer 38

• Individuals repeatedly interpret (1) their experiences, (2) themselves, and (3) their futures in negative ways that lead them to feel depressed
• According to Beck, maladaptive attitudes, a cognitive triad, errors in thinking, and automatic thoughts combine to produce unipolar depression
• Maladaptive attitudes lead people repeatedly to view themselves, their world, and their future in negative ways – the so-called cognitive triad. Such biased views combine with illogical thinking to produce automatic thoughts, unrelentingly negative thoughts that flood the mind and produce the symptoms of depression

Question 39

Characteristics of Phase One in Cognitive Therapy

Answer 39

• Increasing Activities and Elevating Mood: Using behavioral techniques to set the stage for the cognitive dimensions of treatment, therapists first encourage clients to become more active and confident. Clients spend time during each session preparing a detailed schedule of hourly activities for the coming week. As they become more active from week to week, their mood is expected to improve

Question 40

Characteristics of Phase Two in Cognitive Therapy

Answer 40

Challenging Automatic Thoughts: Once people are more active and feeling some emotional relief, therapists begin to educate them about their negative automatic thoughts. The individuals are instructed to recognize and record automatic thoughts as they occur and to bring their lists to each session. Here again, clients may use smartphone apps to accurately identify and document such thoughts as they arise in their daily lives. The therapist and client then test the reality behind the thoughts, often concluding that they are groundless

Question 41

Characteristics of Phase Three in Cognitive Therapy

Answer 41

Identifying Negative Thinking and Biases: As people begin to recognize the flaws in their automatic thoughts, the therapists show them how illogical thinking processes are contributing to these thoughts. The therapists also guide clients to recognize that almost all their interpretations of events have a negative bias and to change that style of interpretation

Question 42

Characteristics of Phase Four in Cognitive Therapy

Answer 42

Changing Primary Attitudes: Therapists help clients change the maladaptive attitudes that set the stage for their depression in the first place. As part of the process, therapists often encourage clients to test their attitudes

Question 43

Electroconvulsive Therapy (ECT)

Answer 43

• a treatment for depression in which electrodes attached to a patient’s head send an electrical current through the brain, causing a convulsion
• Very effective and fast-acting intervention for unipolar depression
• Particularly effective when patients follow up the initial cluster of sessions with continuation, or maintenance, therapy – either ongoing antidepressant medications or periodic ECT sessions
• ECT also seems to be effective in severe cases of depression that include delusions
• Downside: the memory loss caused by ECT and the frightening nature of the procedure

Question 44

MAO Inhibitors

Answer 44

• an antidepressant drug that prevents the action of the enzyme monoamine oxidase
• ~ ½ of depressed patients who take MAO inhibitors are helped by them
• When people take MAO inhibitors, they need to stick to a rigid diet because certain foods with the chemical tyramine (e.g., bananas, cheeses, certain wines) will cause their blood pressure to rise dangerously

Question 45

Tricyclics

Answer 45

• an antidepressant drug such as imipramine that has 3 rings in its molecular structure
• Depressed patients taking tricyclics have improved significantly more than similar patients taking placebos, although the drugs must be taken for at least 10 days before such improvements take hold
• ~50% - 60% of patients who take tricyclics are helped by them

Question 46

Selective Serotonin Reuptake Inhibitors (SSRIs)

Second Generation Antidepressants

Answer 46

• a group of second-generation antidepressant drugs that increase serotonin activity specifically, without affecting other neurotransmitters
• Effectiveness and speed of action, the second-generation antidepressant drugs are about on a par with the tricyclics, yet their sales have skyrocketed

Question 47

Lithium

Answer 47

• a metallic element that occurs in nature as a mineral and is an effective treatment for bipolar disorders
• All manner of research has attested to the effectiveness of lithium and other mood stabilizers in treating manic episodes
• More than 60% of patients with mania improve on these medications. In addition, most such patients have fewer episodes as long as they continue taking the medication

Question 48

Learned Helplessness

Answer 48

• the perception, based on past experiences, that one has no control over that reinforcements in one’s life
• It holds that people become depressed when they think (1) they no longer have control over the reinforcements (rewards and punishments) in their lives (2) that they themselves are responsible for this helpless state

Question 49

Is there a gender difference in rates and types of depressive disorders

Answer 49

• Women are 2x more likely to use antidepressants than men
• Women are more likely to suffer depressive symptoms and major depressive disorder, but men are more likely to commit suicide
• Women attempt suicide more often than men but men are more successful when trying to commit suicide
• Women in places as far apart as France, Sweden, Lebanon, New Zealand, and the U.S. are at least twice as likely as men to receive a diagnosis of unipolar depression

Question 50

Artifact theory

Answer 50

holds that women and men are equally prone to depression but that clinicians often fail to detect depression in men.

Question 51

The Hormone Explanation

Answer 51

holds that hormone changes trigger depression in many women, particularly in puberty, pregnancy, and menopause.

Question 52

The Life Stress Theory

Answer 52

suggest that women in our society are subject to more stress than men.

Question 53

The body dissatisfaction explanation

Answer 53

states that females in Western society are taught, almost from birth, but particularly adolescence, to seek a low body weight and slender body shape – goals that are unreasonable, unhealthy, and often unattainable

Question 54

The Lack-of-Control Theory

Answer 54

draws on the learned helplessness research and proposes that women may be more prone to depression because they feel less control than men over their lives.

Question 55

Rumination Theory

Answer 55

believes that women are more likely than men to ruminate when their mood darkens, perhaps making them more vulnerable to the onset of clinical depression

Question 56

Vagus Nerve Stimulation

Answer 56

• a treatment for depression in which an implanted pulse generator sends regular electrical signals to a person’s vagus nerve; the nerve then stimulates the brain
• Research has found that it can bring significant relief for depressed patients
• Studies find that a substantial number of severely depressed people who have not responded to any other forms of treatment may improve significantly when treated with vagus nerve stimulation

Question 57

Transcranial Magnetic Stimulation (TMS)

Answer 57

a treatment in which an electromagnetic coil, which is placed on or above a patient’s head, sends a current into the individual’s brain. TMS appears to increase neuron activity in that structure, and, in turn, may improve functioning throughout the rest of the brain’s depression-related circuit

Question 58

Deep Brain Stimulation (DBS)

Answer 58

treatment for depression in which a pacemaker powers electrodes that have been implanted in subgenual cingulate, thus stimulating that brain area

Question 59

What is the difference between transcranial magnetic stimulation and deep brain stimulation?

Answer 59

TMS is a non-invasive and magnetic way to treat patients whereas DBS is invasive since electrodes need to be implanted on the subgenual cingulate

Question 60

Which treatment is most effective for treating depression?

Answer 60

• Cognitive Behavior Therapy and Interpersonal Therapy are evidence-based psychotherapies that have been found to be effective in the treatment of depression
• There is no “best” way. Some popular methods include antidepressant treatments, cognitive-behavioral therapy, phototherapy, electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), and deep brain stimulation