Update in the Treatment of Depressive Disorders

Renee Lamm MD ABPN, ABAM FAPA, FAAFP

Objectives

• Review the DSM-5 changes to mood disorder diagnostic criteria

• Discuss differential diagnosis of depressive disorders

• Introduce new pharmacological agents for treatment of depressive disorders and strategies for their use

• Discuss the use of diagnostic testing in the treatment of mood disorders

DSM- 5 Types of Mood Disorders

• Bipolar and Related Disorders• Depressive Disorders• Trauma and Stressor Related Disorders• Substance Related and Addictive Disorders

DSM-5 Associated Disorders

• Other disorders that may present with depression:– Schizoaffective Disorder– Neurocognitive Disorders– Adjustment Disorders– Eating Disorders– Obsessive Compulsive Disorders– Possible with all disorders “due to another

medical condition”

DSM-5 Sub Types of Depression

• MDD: mild, moderate, severe, psychotic features

• Single or recurrent• THEN with : anxious features, mixed features ,

melancholic features, atypical features, catatonia, seasonal features, peripartum onset

• OR: unspecified• OR : secondary to another medical condition

What Percentage of Mood Disorders are Bipolar?

Stahl, S, Essential Psychopharm, Oxford Univ Press, 2008

Unipolar or BipolarDepression? What to Ask

• Who’s Your Daddy?– Family history of :

• Psychiatric Hospitalizations• Suicide• ECT• Anyone who took lithium, mood stabilizers, antipsychotics or

antidepressants• Postpartum mood episode, especially psychosis

Who’s Your Momma? Additional history is need from someone close to the patient such

as a parent, spouse or childPatients lack insight to manic symptoms and under report them

Stahl, S., Essential Psychopharmacology, Cambridge Univ Press, 2008

Predictors of Relapse

• Number of past episodes • Interval between episodes• Stressful life events• Medication management and compliance• Demographic and psychosocial factors• Clinical comorbidities and axis II disorders• Substance abuse