Mood Disorders

Gross Deviations in MoodDepression: The LowThe Common Cold of Mental IllnessMajor Depressive Episode is Most CommonMania: The HighAbnormally Exaggerated Elation, Joy, or Euphoria

ManiaDepression

Unipolar Mood DisorderEither Depression or ManiaBipolar Mood DisorderAlternates Between Depression and Mania

Important to Determine the CourseTemporal Patterning of the Episodes

Depressive DisordersMajor DepressionPDD, formerly Dysthymic DisorderDouble Depression - - dysthymia punctuated by period of major depressionBipolar I and Bipolar II DisordersCyclothymic Disorder

Extremely Depressed MoodLasting at Least 2 WeeksCognitive SymptomsAnhedoniaVegetative SymptomsSingle or Recurrent EpisodeNo Manic or Hypomanic Episodes

Clinical Description

Similar to Major Depression BUT With a Different Course Symptoms are MilderSymptoms can Last 20-30+ YearsPersistently Depressed Mood for 2+ YearsCannot be Symptom Free > 2 Months

Clinical Description

Facts and Statistics Mean Age of Onset Early 20sOnset Prior to Age 20Greater Chronicity Poor Prognosis

Major Depressive Episodes are Common

Suffer From Both Major Depression EpisodesPDD - Dysthymic DisorderDysthymia Usually Begins FirstAssociated With Severe PathologyA Problematic Future Course Clinical Description

DysthymiaMajorDepressionDysthymia Clinical Description

Major Features Experience BothManic EpisodesMajor Depressive EpisodesRoller Coaster of MoodWhat are Manic Episodes?

Mania and Hypomania Elevated Mood Grandiosity Increased Activity Varied Impairment

MajorDepressionMania Clinical Description

Major Depressive Episodes Alternate WithHypomanic Episodes Clinical Description

Milder Depressive Episodes Alternate WithHypomanic Episodes Clinical Description

Clinical Description DysthmiaHypomania

General Facts and Statistics Bipolar IOnset Around 18 YearsBipolar II Onset Around 22 Years16% Commit SuicideCyclothymiaTypically Chronic

Descriptions of Recent Episode and Pattern Varies

1. AtypicalPertains to Depressive Episodes and Dysthymia, not Manic EpisodesTypically Overeat and Oversleep

Recent Episode and Pattern 2. MelancholicPertains to Major Depressive Episode OnlyMore Severe SymptomsStrong Biological ComponentAtypical (overeat, oversleep, wght gain keep interested, can experience pleasure)

Recent Episode and Pattern 3. Mixed FeaturesWith some mania symptomsAtypicalMelancholic

Recent Episode and Pattern 4. CatatonicCan be part of Major Depression and ManiaVery Serious ConditionCatalepsy (Muscle Rigidity)AtypicalMelancholicMixed

Recent Episode and Pattern CatatonicAtypicalMelancholicMixed 5. PsychoticHallucinations and DelusionsVery Rare but Serious ConditionPoor Treatment Response

Recent Episode and Pattern CatatonicAtypicalMelancholicMixed 6. PeripartumMajor Depression and ManiaPrior toFour Weeks Following Birthand up to a year: high % Mood Episodes of a Psychotic Nature Relatively RarePsychotic

Recent Episode and Pattern CatatonicAtypicalMelancholicMixed PeripartumAnxious DistressPsychotic

Course and Pattern Rapid-CyclingSeasonal PatternBipolar and Recurrent Major DepressionEpisodes During Certain Seasons

Premenstrual Dysphoric Disorder (PMDD)2- 5% of women meet criteria

Disruptive Mood Dysregulation Disorder

Children: increased diagnosis for bipolar, up 40% between 1995 and 2005Bipolar (NOS)Other Depressive Disorders - new to DSM-5

About 16% Lifetime Global Prevalence MDDPast Year:Bipolar-.8%Maj Depression-6%Females > MalesMajor Depression and DysthymiaFemales = MalesBipolar Disorders

Biological Dimensions Family StudiesTwin StudiesAs Severity Increases, so Does the Genetic ConnectionNo Single Genetic Link

Neurotransmitters The Serotonin Connection Endocrine Function Elevated Cortisol Dexamethasone Suppression Test: cortisol suppressed in non-depressed people, not in severely depressed.but.

Sleep and Circadian Rhythms Sleep Disturbances are CommonMore intense and earlier start to REM Sleep among the Depressed Diminished Deep Sleep Disruption of Circadian Rhythms

Stressful Life Events; Loss Learned Helplessness Attributional Style Internal Stable Global

Negative Cognitive Biases Becks Cognitive Triad Negative Schema About Self, World, & Future

In the United States: About 30,000 Kill Themselves AnnuallyMore Die from Suicide Each Year Than Homicide (about 20,000)More Common Among Whites, Native Americans Increasing in Adolescents (3rd leading cause of death) & Elderly (globally, the elderly have highest suicide rate, esp. males) Males > Females in Killing Themselves Females > Males in Attempts

Approximately 500,000 people each year require ER treatment as a result of attempted suicide Suicidal behavior typically occurs in the presence of mental illness or substance use disordersFirearms account for 59% of all suicide deaths Website of Extreme and Urgent Interestsuicidology.org

Medications Tricyclic Antidepressants Imipramine (Tofranil) Amitriptyline (Elavil) Block Neurotransmitter Reuptake Side Effects

Medications MAO Inhibitors Block Enzyme MonoAmine Oxidase The Result? More Neurotransmitter is Available Side Effects and Complications

Medications SSRIs Block Reuptake of Serotonin- Prozac SSNRIs

Medications - Bipolar Lithium, Depakote, LamictalEffective for Manic Episodes Lithium Must be Carefully Regulated Other Medical Treatments Electroconvulsive Therapy (ECT)TMS

Psychological Interventions Combined Treatments?

*The gender disparity in depression diagnoses worldwide, expressed asodds ratios. These odds ratios express the comparative likelihood of women experiencing amajor depressive episode in the past year, relative to men. In Brazil, for example, women are2.6 times more likely than men to report having had a major depressive episode in the lastyear. (Adapted from Bromet et al. [2011], p. 11 of 16.)

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