Affective Disorders Outline
What is a mood disorder?
The etiology of an affective disorder:
1. biological process? What is the evidence?
2. problems with studying biological processes.
3. are biological abnormalities unrelated to the primary disorder?
Biological Theories of Affective Disorders
Familial & Genetic Influences
• Probands 2-3x higher than in normal probands.
• Proband with bipolar disorder – relative has unipolar depression,
• Adoption studies mixed.
• Twin studies: identical – other twin 3x as likely than fraternal twin
to have mood disorder.
• Sex differences – higher for females.
• Environment – higher role in males.
• Unipolar & bipolar seem to be inherited separately.
• Low levels of serotonin in relation to other neurotransmitters,
including norepinephrine & dopmine.
• Serotonin’s function = to regulate systems involving norepinephrine
• Permissive Hypothesis – stipulates that where serotonin levels are
low, other NTs are permitted to range more widely, become
dysregulated, and contribute to mood problems.
• Endorine system involvement, e.g. elevated levels of cortisol. The
relationship of dexamethasone suppression test (DST) = less
suppression of cortisol.
• Sleep disturbance – depressed individuals move into REM sleep
more quickly and shows diminished slow wave sleep.
• Bipolar individuals show increased sensitivity to light.
• Different alpha EEG values reported in 2 hemispheres of brains of
Is depression similar to the common cold?
The history of depression
• Disruptions of balance among four fluids or humors in the body
• Melancholia = imbalance of black bile.
• Sadness, a tendency to suicide, feelings of indifference,
• Kant = emotions don’t cause mental illness.
• Abraham (1960) & Freud (1917) psychological/emotional factors in
onset & maintenance of depression
Issues with Diagnosis of Mood disorders
• Mood should be separate from melancholia characterized by psychosis or
• Kraeplein (1904/1968) Mania separate disorder from schizophrenia or
other psychotic disorders.
• Other early theorists did not make this distinction.
• Current evidence: difference in unipolar versus bipolar disorder.
• Other distinctions: endogenous (naturally occurring depression) versus
psychogenic or reactive depression.
• Personality “trait” versus reactive “state”
• Issues of bereavement (Beckham, Leber, & Youll, 1995)
• Cyclothymia, bipolar I, bipolar II
• Adjustment disorder with depressed mood
• Major depression
• Cognitive versus biologically mediated depression
• Nonaxious versus anxious depression
• Mood state
• Classification category
• Depression as a symptom
• Depression as a syndrome
• Categorical conceptualization used by DSM-IV
• Issues of continuum
Epidemiology of Depression
• Prevalence 5 to 44%
• Estimates vary depending on sample/measurement/children versus adults
• Lifetime prevalence 4.9%
• Lifetime rates 17.1%
• Estimates in population between 3 to 5.3%
• 20% display chronic course
• sex differences – 2x more frequently with women versus men
• Age: more common in younger versus older adults; highest 25-45.
• First onset 30s to 40s.
• 50% before age 40.
• Rates lower for adults over 65.
• Gender differences don’t start until mid-adolescence; estimates same for
boys and girls.
• Not much difference with ethnicity when SES controlled.
• Symptom constellations within cultures.
• Worldwide, depression problematic.
Models of Depression
• Historically, single causal agents.
• Contemporary approaches are multifactorial and integrative.
Life Events Model
• Problem with self-report checklist methods
• Possible problems with memory / validity of self-reports
• Is negative life events a consequence or a cause?
• Investigator-based assessment procedures, e.g. Shrout et al (1989)
individuals with depression are 2.5x more likely than nondepressed
individuals to have experienced one or more fateful loss events.
• Semistructure interview method (Brown & Harris, 1986) – severe events.
• Finlay-Jones & Brown, 1981 – loss events especially when they involve a
threat to self-identity & self-worth.
• Additive threats, e.g. Vinokur et al (1996).
• Brown & Harris (1989) – 3/4ths of recently depressed individuals
experienced a preceding negative life event. Also, 1/5 individuals went on
to develop depression.
• Women 3x more likely to develop depression.
• Vulnerability factors = low social support & low self-esteem.
• But…women contributory role? Poor interpersonal problem solving?
Behavioral & Interpersonal Models
• Problematic interactions with others.
• Social behaviors of the depressed individual?
Lewinsohn’s Behavioral Model of Depression
• Lewinsohn (1974) – depression is the result of a low rate of response-
contingent positive reinforcement, e.g. initiating a conversation.
• Low rate of behavioral responding.
• Depressive symptoms reinforced by social environment.
• Social skills deficit theory?
• The link to negative life events?
• Depressed individuals feel they are less socially skilled.
• They differ on a variety of social skills.
• They speak differently.
• They are more self-demeaning.
• But…negative life events do correlate with depression, but are not a
sufficient cause of depression.
Lewinsohn Revised Model
• Depression caused by stressful life events in people with inadequate
• Cognitive changes.
• Behavioral changes.
• Person becomes more negative.
• Behaves less competently socially.
• Vicious Cycle.
Coyne’s Interpersonal Model
• Stressful life events, especially loss of significant relationships, =
• Goal: restore social support, gain acceptance.
• Friends & family respond with concern & support = reinforces the
• But …. Eventually aversive responding.
• Depressed people are rejected, but features of the person matters.
• Why rejected? Joiner et al (1992); Segrin & Abramson (1994)
Beck’s Cognitive Theory of Depression
• Activation of depressive self-schema.
• This could be relative to a social stressor.
Information-Processing Models of Depression
• Latent structures that have been activated by life event stressors.
• Depressed people think negatively about themselves.
• More critical.
• High recurrence & runs in families.
• Selective encoding of negative information.
• These symptoms disappear when they are not depressed.
• Cognitive distortions? == re-evaluation of Beck’s theory – not inaccuracy
or distorted thought content; negative thought content.
Learned Helplessness (Seligman, 1975)
• Expectations that they are helpless to control aversive outcomes.
• 1978 revision – beliefs about the causes of events – attributional style
Abramason et al (1989)
• hopelessness theory of depression
• Separate subtype?
Sociotropic & Autonomous Depression Subtypes
• Sociotropic individuals
• Autonomous individuals
Self-regulatory approaches to depression
• How people regulate their behavior in the absence of external
• The role of cognitive processes.