• Emotional: sadness, anhedonia: even when they try to do something enjoyable, they feel no emotional reaction
• Physiological/behavioral:sleep, appetite, activity levels. anhedonia. early morning wakening. psychomotor retardation or agitation.
• Cognitive: worthlessness, guilt, hopelessness, suicide. rarely, delusions and hallucinations.

• depressed mood or loss of interest in activities for more days than not for two weeks
• plus 4 other depression symptoms
• Over half of ppl. with this or dysthemia also have another psychological problem, namely substance abuse, eating disorer, anxiety disorder

1. Depression with melancholic features:physiological symptoms are especially prominent
2. Depression with psychotic features: experience delusions and hallucinations during major depressive episode.
3. Depression with catonic features: range from complete lack of movement to excited agitation (catatonia)
4. Depression with atypical features: positive mood toward some events, weight gain, heavy feelings in arms and legs, sensitivity to interpersonal rejection
5. Depression with postpartum onset: 30% of women experience blues, but only 1 in 10 experience post partum depression that is really serious.
6. Depression with a seasonal pattern: usually winter (Seasonal Affective Disorder: SAD). History of 2 years of symptoms

• At some point, 16% of Americans experience major depressive episode
• 15-24 year olds at high risk, 45-54 year olds have low rates
• 2x more common among women, adults, minorities
• Study says depression wastes time in workplace (deficit of $44 billion a year in lost productivity)

• Elevated, expansive (everything is perfect) or irritable mood – (at least once a week)
• At least three of the following (or 4, if irritable)
  • Inflated self-esteem or grandiosity
  • Decreased need for sleep (not tired)
  • Talkativeness, pressured speech - they can’t talk fast enough, words pushing each other out of their mouth.
  • Flight of ideas (jump from one topic to another) or racing thoughts (maybe has to do with pressured speech)
  • Distractibility
  • Hyperactivity or agitation
  • Excessive involvement in pleasurable behavior with a high potential for painful consequences

• "Manic Lite"
• Mood elevation for 4 days, not a whole week
• Not severe enough to cause impairment in functioning, but similar symptoms as manic

• Criteria are met for both manic episode and depressive episode, nearly every day, one-week period (down, but irritated)

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  • At least one manic or mixed episode
  • Often, but not always, at least one depressed episode
  • Most recent episode descriptor

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  • At least one depressed episode
  • At least one hypomanic episode
  • No manic episodes
  • Often misdiagnosed as depression, but this can be bad because antidepressants can precipitate a full-blown manic episode

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  • Ends 70% of manic episodes and 40% of depressive episodes
  • Stabilizes neurotransmitters (serotonin, dopamine)
  • May prevent further occurrence of mania
  • Can be toxic, damage liver (jaundice-when skin turns yellow)
  • Some people feel like lithium dulls everything (mania feels so good…some say Van Gogh’s great paintings were made during manic episodes)

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  • Used in treatment of BPD sometimes
  • Affect several neurotransmitter systems
  • Not entirely clear why they have mood stabilizing properties (but don’t know why)
  • May not be as effective in prevention
  • Teratogenic-cause birth defects during first trimester

• Less severe than BPD I and BPD II
• Person alternates between hypomania and moderate depression chronically over at least two years.

BPD

• 62-80% concordance among MZ twins (REALLY high), 14% among DZ
• Adoption studies suggest individual environment important, not shared environment.
• Likely multifactorial rather than s single gene being responsible

• Higher concordance for MZ twins, especially among women
• Perhaps types of genes responsible for women and men are different

• All-or-nothing thinking (perfectionism)
• overgeneralization (negatives generalized to all of life)
• mental filter - filter out only negative info.
• disqualifying the positive
• jumping to conclusions
• magnification/minimization
• emotional reasoning - i feel it, so it must be true
• "should" statements
• labeling and mislabeling - extreme form of overgeneralization (attaching error to self or other-I am a loser, she is mean)
• personalization - see self as cause of negative external event

1. change environment
2. teach skills for changing negative circumstances (esp social) 
3. teach mood-management skills

1. grief/loss: accept feelings and invest in new relationships
2. interpersonal role disputes: help client make decisions and learn better ways to communicate
3. role transitions - help client develop more realistic perspectives toward roles that are lost and regard new roles in more positive manner
4. interpersonal skills deficit: review past relationships and how they might affect current ones, directly teach skills such as assertiveness