View source for The Theory of Recovery Psychology/Psychological Disorders/Mood Disorders

Most people have moods which are transient. They have feelings of elation or sadness and these feelings are considered to be understandable responses to daily events. Such emotions do not affect the overall tenor of a person’s life. A person with a mood disorder will have moods that effect the individuals’ interaction with the world; it will disturb the individuals functioning. Virtually all the individuals’ actions will be dictated by mood. 
[[Category:The Theory of Recovery Psychology]]
'''Depression''' and '''mania''' are the domineering moods of these disorders. In depression a person will feel a low, sad state in which life seems to be bleak, and the challenges of life will seem to be overwhelming. Mania on the other hand is the extreme opposite; this is a state of breathless euphoria, or frenzied energy, in which the individual believes that the whole world is theirs for the taking.
[[Category:The Theory of Recovery Psychology]]
Most people with a mood disorder suffer exclusively from clinical depression, or unipolar depression. Such individuals will have no history of mania and return to a normal mood or nearly normal mood state after their depressed subsides. Others undergo periods of mania that alternate with periods of depression, a pattern called bipolar depression or as it was once known, manic-depressive disorder. Another pattern of mood disorder, unipolar mania (in which people suffer from mania only) is so rare that there is an ongoing controversy over whether or not it even exists at all {{ref|APA, 1994}} unless brought about by a medical condition.

Mood disorders have always captured people’s interest, probably because of the many prominent people who have suffered from them. Queen Victoria of England and Abraham Lincoln seemed to have had depression. Edgar Allan Poe, Pablo Picasso, Ernest Hemingway, Virginia Woolf, Robert Lowell and Sylvia Plath have all been documented as having depression and mania {{ref|Andreasen, 1980}}. The plight of these famous persons, which is shared by millions and the economic consequences amounts to 40 billion dollars per year {{ref|Simon & Katzelnick, 1997}}.

== Unipolar Depression ==

People more unhappy more often than usual are said to be depressed. Often a person is depressed in response to a situation. There is a lot of confusion between this short term unhappiness and a diagnosis of depression; since both are conditions are referring to as depression. 

A typical spell of depression is rarely so severe that it interferes with an individual’s ability to function in life; and it dissipates fairly rapid. Such a spell often leads a person to get to know their own self, values, and their situations. It is a time when persons may reflect about themselves. 

Clinical depression may though, be a serious mental illness that brings on severe long lasting, debilitating psychological pain. This pain may intensify over time, and the person may become unable to carry out what others would consider to be the most simplest of life’s activities.

Often persons who have depression feel intensely sad and dejected, they describe themselves as being “miserable,” “empty,” or “humiliated.” They may say that they have lost the ability to experience the feeling of pleasure and they tend to lose their sense of humor. Some may experience agitation, anger or anxiety. They may have crying spells as an expressive activity.

Persons with depression may lose interest in participating in their accustomed activities. Most persons with depression report having a lack of drive, initiative, and spontaneity. Some have reported that they feel they have to force themselves in to going to work, conversing with others, eating meals or having sex {{ref|Buchwald & Ruddick-Davis, 1993}}. In 1967 cognitive psychologist Aaron T. Beck coined this syndrome the name “paralysis of will”.

Activity of persons with depression decreases dramatically; they do less and are less productive than prior to the onset of the illness. They may spend more time alone than with others, may sleep for long periods of time or just lay in bed for a long time. A person with depression may have slow, quiet, monotone speech with eyes cast downward. Researchers have videotaped persons who are depressed and observed that persons with depression tend to make little to no eye contact in conversation when compared to other persons {{ref|Waxer, 1974}}.

Persons with depression hold negative views of themselves. They consider themselves to be inadequate, undesirable, inferior or even perhaps shamefully guilty. They may blame themselves for things that have nothing to do with themselves and rarely credit themselves for any positive achievements or accomplishments. A cognitive feature of depression is a negative view of the future. Persons with depression may be convinced that nothing will ever improve and they may feel hopeless to ever gain any control over any aspect of their lives.

People with depressed complain frequently that their intellectual capacity is one of complete impairment. They typically have no faith in their mental faculties. They feel confused and unable to remember things. Research has shown that subjects with depression to lack memory, attention and reasoning skills {{ref|Lemelin et al., 1996}}{{ref|Baker & Channon, 1995}}{{ref|Smith et al., 1995}}. However these deficits may be characteristic of motivation difficulties rather than cognitive impairments {{ref|Lachner & Engel, 1994}}{{ref|Hartlage et al., 1993}}.

Many persons with depression are initially misdiagnosed as having other medical problems {{ref|Simon & Katelnick, 1997}}{{ref|Coyne, Schwenk, & Fechner-Bates 1995}}. Physical ailments often accompany depression. These ailments may range from generalized pain to unpleasant sensations in the chest, or may be as various syndromes such as: indigestion, headaches, constipation and dizzy spells. Certain disturbances in sleep patterns and appetites are commonly reported by persons with depression. It is important to note that a majority of depressed persons may increase relaxation and sleep but still not experience relief from rest. They still complain of a lack of sleep. {{ref|Kazes et al. 1994}}{{ref|Spoov et al., 1993}}. Persons with depression usually sleep less than non-depressed people, and they may wake up more frequently during the night. While around 9% of depressed persons will sleep excessively {{ref|Ballenger, 1988}}.

The DSM describes several patterns of unipolar depression. A diagnosis of major depressive disorder is received when a person experiences a major episode of depression lasting for at least two weeks, which is not caused by drugs or a medical condition. In some of these cases the episode may include psychotic symptoms. {{ref|Parker et al., 1997}}{{ref|Coryell et al., 1996}}{{ref|APA, 1994}}. The DSM describes a major depressive disorder as recurrent if it has occurred in the past prior to current episode; seasonal if it onsets and offsets with the changing on the seasons, postpartum if the onset is occurring after giving child birth, kcatatonic if it is characterized by immobility or excessive activity, or melancholic if the person is almost totally unaffected by pleasurable events {{ref|Kendler, 1997}}{{ref|APA 1994}}.

Persons with a more chronic but less disabling pattern of unipolar depression may be diagnosed as having dysthymic disorder. This diagnosis is characterized as a depressed mood and two or three symptoms and it persists for two years, one year for adolescents and children. If this dythymic disorder leads to a major depressive disorder, the sequence is termed as double depression {{ref|Donaldson et al., 1997}}{{ref|Henderstein et al., 1994}}{{ref|APA, 1993}}.

Episodes of unipolar depression often are triggered by stressful events in life {{ref|Brown, Harris, & Hepworth, 1995}}. Some clinicians prefer to distinguish reactive (exogenous) depression from endogenous depression. The prior follows a precipitating event, where as the latter seems to be responding internal factors; such as neurotransmitter imbalance. 

A lot of compelling evidence suggests that biological factors contribute to unipolar depression {{ref|Judd, 1995}}. It appears that reduced activity in the neurotransmitters norepinephrine and serotonin strongly influences unipolar disorder {{ref|Zaleman, 1995}}. Two effective groups of effective antidepressant medications are monoamine oxidase (MAO) and tricyclics which increase either norepinephrine or serotonin activity. This thinking behind this evidence was that if these compounds could alleviate depression; then depression could be attributed to low activity of norepinephrine and serotonin {{ref|Bunney & Davis, 1965}}. 

Researchers concluded that unipolar depression is a result of lower activity of these neurotransmitters reducing neuron firing. Norephinephrine belonging to a class of chemicals called catecholamines and with serotonin belonging to class known as indolemines; thus the theories linking such to depression are the catecholamine theory and the idolemine theory. 

When trying to determine what contributions norepinephrine and serotonin play in depression, researcher Marie Asberg in 1976 found that depressed subjects whose serotonin was depleted were more apathetic and suicidal than depressed subjects with normal serotonin activity. It was also discovered in this research that suicide attempts were more frequent and more violent than those made by other depressed people. 

Biological researchers have also investigated the body’s endocrine system as a factor in mental illness. Cortisol, a hormone released by the adrenal glands, has been implicated by the research in to depression {{ref|Zaleman, 1995}}. This chemical is known as the stress hormone because it dispensed through out the body during times of stress. People with depression often have elevated levels of cortisol. Stressful events have been known to often precipitate episodes of depression. Another hormone that is tied to depression is melatonin.

== Seasonal Affective Disorder ==

The 24 hour day provides of us with a cycle by which we adapt our most common activities: sleeping, eating, working, and socializing. Although our daily rhythms are largely imposed by our environment, they are also driven by an internal clock, consisting of recurrent biological fluctuations called the circadian rhythm. 

A condition called Seasonal Affective Disorder (SAD) has seasonal cycling of manic episodes. These overwhelming mood disorders can involve winter depression and manic summers. A tendency toward excessive sleep patterns, increased appetite and weight gain is common with this disorder. Evidence suggests that SAD may be related to daily circadian and seasonal changes in the production of melatonin, a hormone secreted by the pineal gland.  Exposure to light suppresses melatonin production. Therefore melatonin is produced primarily at night. Melatonin production also tends to increase in the winter because there is less sun light. One theory is that an increase in production of melatonin may trigger depression in people who are vulnerable to depression {{ref|Goodwin & Jamison, 1990}}.

As one may expect, the prevalence of SAD is higher in northern southern latitudes.  Some clinicians have reasoned that exposure to bright light might slow melatonin production in persons with SAD {{ref|Blehar & Rosenthal, 1989}}, this is the basis for phototherapy or light therapy.

== Bipolar Disorder ==

Bipolar disorder is the experience of both highs of mania and lows of depression. Many persons with bipolar disorder describe their life as a roller coaster. They shift back and forth between these two extreme moods {{ref|Goodwin & Jamison, 1990}}. In a sharp contrast to depression, a person in a manic state is governed by dramatic, inappropriate, and disproportionate elevations of mood. The symptoms of mania encompasses the same areas of functioning as those of depression; emotional, motivational, behavioral, cognitive and physical. 

Mania is characterized by active, expansive emotions that seem to be in need of outlet. This mood of euphoric joy and a sense of well being that is all out of proportion to the actual happening in a persons life. Not all people with mania is picture of happiness, sometimes they are irritable, angry and annoyed {{ref|Verdoux & Bourgeois, 1993}}, this is particularly noticeable when others get in the way of their ambitions.

In the motivational realm, people with mania appear to want constant excitation, involvement and companionship. They enthusiastically search out new friends and old, new interests and old, have little awareness that their social style is overwhelming or domineering or excessive. The behaviors of people who are manic are usually described as hyperactive. They may move quickly, as if here is not enough time to do everything that must be done. They may talk rapidly and loud. They may joke a lot during conversation, punctuated with efforts to be clever; they may speak of many complaints and hostile statements. Flamboyancy may also be a characteristic of manic functioning; dressing in flashy clothing, giving large sums of money to total strangers, or engaging in dangerous activities. 

In manic cognition a person may display poor judgment and planning. Filled with optimism, a person with mania may not be receptive to others who try to slow them down, or interrupt their spending sprees. They may also hold an inflated opinion of themselves, believing that there are few topics or tasks beyond their expertise. In some cases this heightened self-esteem approaches grandiosity {{ref|Silverstone & Hunt, 1992}}.

People with mania are distracted easily by random stimuli in the environment especially during the acute phases of mania. Some have so much trouble keeping thoughts on track that they may become incoherent or lose touch with reality {{ref|Double 1991}}. In the physical dimension of the manic symptoms, people with mania will feel remarkably energetic. They may sleep very little, yet be wide awake even if they miss a night of sleep <ref>Silverstone & Hunt, 1992</ref>.

The DSM-IV TR has distinguishes two general kinds of bipolar disorder, bipolar I and bipolar II disorders. Persons with bipolar I have full manic and minor depressive episodes  Most persons with this disorder experience an alternating between depressive moods and manic moods, however some have what is termed as mixed episodes. In bipolar II a person may have mildly manic episodes alternating with depression. Only persons who have never had a full manic episode at the time of diagnosis receive this diagnosis. 

If a person experiences four or more episodes of mood disturbance in a one year time span, it is further classified as rapid cycling. If such episodes vary with the seasons, the bipolar disorder is further classified as being seasonal. Although women may experience more depressive episodes than men, <ref>Leibenluft, 1996</ref> most of the research that has been done on bipolar disorder, this disorder is equally common in both women and men. Research conducted in the United States indicates that the prevalence of bipolar disorders are equally common in all socioeconomic classes and ethnic groups <ref>APA, 1994</ref><ref>Weissman et al, 1991</ref>. The onset of this disorder usually emerges in persons in the age range of 15 to 44 years of age.

In most untreated cases of bipolar disorder, the episodes last for several months. Periods of normal mood last for two or more years but only briefly in others <ref>Weissman & Boyd, 1984</ref>. In the absence of treatment these episodes may continue to reoccur <ref>Goldberg et al., 1995</ref><ref>APA, 1994</ref><ref>Goodwin & Jamison, 1990</ref>. Generally as espisodes continue to reoccur, the periods of normality tend to decrease in duration.

Cyclothymia is a form of bipolar disorder assigned to persons who have milder symptoms for two or more years, interrupted by occasional normal moods that may last for a few days or weeks. In some cases the cyclothymia develops in to a full blown bipolar disorder.

Mania has been related to high norepinepherine activity along with a lowered level of serotonin activity <ref>Price, 1990</ref>. Researchers suspect that in persons with bipolar disorders, sodium ions and other ions, are improperly transported back and forth between the outside and the inside of neuron’s membrane during synaptic transmission. Some studies have suggested that people may inherit a genetic predisposition for developing bipolar disorder.  

Of the 15 million adults in the U.S. who have a mood disorder, around 41 percent receive treatment <ref>Shelton, 1997</ref><ref>Regier et al., 1993</ref> Most are successful but many suffer a relapse eventually <ref>APA, 1994</ref><ref>APA 1993</ref>. A large and diverse group of therapists treat depression. An average of 10 percent of consumers of mental health services have this disorder <ref>Knesper et al, 1985</ref>. 

Peter Lewison developed a behavioral treatment for depression <ref>Lewinsohn et al., 1990, 1982</ref><ref>Terri & Lewinsohn, 1986</ref>. He traces depression to a drop in positive reinforcements in a person’s life. Therapists who take this approach therefore reintroduce clients to pleasurable events and activities, systematically reinforcing behavior that is not depressive; and then assisting with improving the clients’ social skills. Guided by the clients responses on a questionnaire, which inquires about what the client enjoys doing a schedule of pleasant events in given to the client. Studies have shown that the reintroduction of positive activities does lead to an increased social participation and to a better mood for the client <ref>Leenstra, Ormel, & Giel, 1995</ref><ref>Teri & Lewinsohn, 1986</ref>.

Behaviorists hold the view that when people become depressed, their depressive behaviors keep others at a distance and this lessens the chances for positive reinforcement for non-depressed behavior. Adaptive behavior such as going to work, may replace complaining, crying or brooding. A contingency management approach is used by a behaviorist to eliminate depression. The behaviorist tries not to give any reinforcement for depressive behavior, while reinforcing (giving attention and other rewards) for constructive statements and behaviors. A behaviorist therapist may include family members and friends in this approach by instructing them to avoid reinforcement of the depressive target behavior and only reinforcing adaptive behaviors <ref>Liberman & Raskin, 1971</ref>.

Teaching social skills to help persons with depressive disorders has also been helpful in combating depressive behaviors. Behaviorist therapists also train people with depressive disorders in effective social skills. Behaviors such as eye contact, facial expression, tone of voice and posture are taught to the person so that they can prevent the further loss of social reinforcement. Research has indicated that the social interaction of depressed clients improve with these techniques <ref>Hersen et al., 1984</ref><ref>King et al., 1974</ref>.

Cognitive therapists view depression as a result of a chain of cognitive errors. It is assumed by cognitivists that depressed people have maladaptive attitudes that lead to negative thinking patterns, which are biased ways of viewing themselves, the world, and the future. The cognitive triad of depression is made up maladaptive attitudes, illogical thinking and automatic thinking. This cognitive triad floods the mind with reasons to feel depressed.  Aaron T. Beck has been a leader in cognitive treatment for depression, he emphasizes that assisting clients in identifying their dysfunctional cognitive processes is the first step prior to assisting the client in learning newer and more optimistic or logical ways of thinking. This has improved both the mood and the behavior of clients with depression <ref>Beck, 1997, 1985, 1967, 1997</ref><ref>Hollon & Beck, 1994</ref><ref>Pace & Dixon, 1993</ref>.

== Cognitive Restructuring ==

Various authors have developed different variations of cognitive restructuring. Albert Ellis developed Rational Emotive Therapy. Aaron T. Beck then branched off to work with Cognitive-Behavioral Psychology. David Burns is credited with developing the therapy of Cognitive Restructuring. Basically all of these therapies view the cause and effect relationship between ones thoughts and ones feelings. By changing a depressed person’s way of thinking, the depressed person can develop the proper coping skills to deal with their depression. Consider for a moment the person who says “I can’t read!” and now consider the person who says “I can learn to read” or even “I will learn to read”. Which one sounds like they will become literate in the possible future? The person stating that they are unable to read is putting a limit on their own potential, by cutting themselves off from the future self they can become. This kind of thinking is termed as the thought distortion. 

Self-esteem is said to be at the core issue in these thought distortions. It is because a person does not respect them self or like their own self that they do not feel good about who they are. Often they are trapped in illogical vicious circles, for an example the person who cries that they are worthless tells you about being rejected by the really good looking person. If a person is worthless, why would they want to be accepted by the really good looking people? What value is the good, highly praised or highly valued to a person who is worthless? The contradictory message here is I am good enough to deserve what I perceive as better, but my perceived better has told me to go to hell. Such a person does not ever think maybe this perceived better is not what it is cracked up to be. Instead they blame themselves. 

[[A Textbook on Recovery Psychology/Unit 2/Ch1 Mood Disorders|part1]]
[[A Textbook on Recovery Psychology/Unit 2/Ch1 Mood Disorders/Part2|part2]]
[[A Textbook on Recovery Psychology/Unit 2/Ch1 Mood Disorders/Part3|part3]]
[[A Textbook on Recovery Psychology/Unit 2/Ch1 Mood Disorders/Part4|part4]]

== References ==
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