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Mood Disorders
The Mood DisordersMajor Depressive DisorderDysthymic DisorderBipolar
Bipolar I DisorderBipolar II Disorder
Cyclothymic Disorder
The mood disorders are built from the presence and combinations of mood episodes
Mood EpisodesMajor Depressive EpisodeManic EpisodeHypomanic EpisodeMixed Episode
Mood DisordersMajor Depressive DisorderDysthymic DisorderBipolar Disorder
Bipolar IBipolar II
Cyclothymic Disorder
Major Depressive Disorder
Lifetime risk:Women: 10% - 25%Men: 5% - 9%
Point prevalence:Women: 5% - 9%Men: 2% - 3%
Major Depressive Disorder: CourseCan begin at any age, but the average is in the
mid 20sThe average age of onset has been decreasing
At least 60% of people who have one Major Depressive Episode will have a second70% of people who have had 2 episodes will have a
third90% of people who have had 3 episodes will have a
fourth5% - 10% of people with MDD who have one Major
Depressive Episode develop a Manic Episode
Depression: TreatmentTherapy
Traditional “talk therapy”Cognitive behavioral therapy
MedicationMost effective in combination with therapy
Depression is thought to be caused by a shortage of serotonin and dopamine circulating in the brain
In severe cases, ECT may be used
AntidepressantsMAOIs
Side effects can include:
•Dizziness •Headaches •Drowsiness
•Insomnia •Fatigue •Tremors
•Twitching •Convulsions •Constipation
•Dry mouth •Weight gain •Skin irritation
•Blurred vision •High blood pressure
•Eldepryl •Marplan
•Nardil •Parnate
AntidepressantsSelective Serotonin Reuptake Inhibitors
(SSRIs)
Side effects include
These are among the most popular used
•Celexa •Luvox •Paxil
•Prozac •Zoloft
•Decrease in sex drive
•Fatigue
•agitation
AntidepressantsOther commonly used antidepressants
include:WellbutrinLudiomilRemeroneEffexor
Bipolar I Disorder Variations:
Bipolar I Disorder, Single Manic EpisodeBipolar I Disorder, Most Recent Episode
Hypomanic There has been at least 1 Manic Episode or Mixed
Episode in the pastBipolar I Disorder, Most Recent Episode ManicBipolar I Disorder, Most Recent Episode MixedBipolar I Disorder, Most Recent Episode
Depressed
Bipolar II DisorderDefined by recurrent Major Depressive
Episodes with Hypomanic EpisodesThere are no Manic or Mixed Episodes
Bipolar II Disorder: NotesLifetime prevalence is approximately .5%60% - 70% of Hypomanic Episodes in Bipolar
II occur immediately before or after a Major Depressive EpisodeThe interval between episodes tends to
decrease with age10% - 15% have rapid cyclingOver 5 years, approximately 5% - 15% of
people with Bipolar II will develop a Manic Episode (hence new diagnosis of Bipolar I)
Bipolar Disorders Treatment
Bipolar disorder is thought to be caused by an imbalance of serotonin, dopamine, and norepinephrine
Bipolar Disorder is generally treated with a combination of medications and therapySome people with Bipolar Disorder may need
to take medications for all or most of their lives
Bipolar Disorders Treatment Mood StabilizersLithium based medications
EskalithLithobidLithonate
A downside of these medications is that lithium levels in the bloodstream need to be carefully monitored
Bipolar Disorders Treatment Mood Stabilizers•Tegretol •Neurontin •Lamictal
•Topamax •Depakote
Side effects include:
•Gastrointestinal distress
•Weight gain •Decrease in cognition/memory
•Nausea •Vomiting •Tremors
Bipolar Disorder Treatment
Antipsychotic medications may also be used, particularly to treat mania
Antidepressants are used sometimes, but may set off manic episodes
Mood Disorder SpecifiersMild, Moderate, Severe Without Psychotic
FeaturesBased on the severity of the symptoms, number
of symptoms, and impairmentSevere With Psychotic Features includes
delusions and/or hallucinations (typically auditory) during the episodeMood congruent: guilt, punishment, somatic
sensations of death, auditory hallucination of a voice berating the person
Mood incongruent
Mood Disorder SpecifiersFull Remission: at least 2 months in which there are
no significant symptoms of depressionPartial Remission
Some symptoms are still present, but full criteria are no longer met
There are no significant symptoms, but it has been less than two months
If the Major Depressive Episode was superimposed on Dysthymic Disorder, it is recorded as Major Depressive Disorder, Prior History
Chronic: in the most recent Major Depressive Episode full criteria have been met for at least 2 years
Mood Disorder Specifiers Catatonic FeaturesMelancholic FeaturesAtypical Features
Mood Disorder Specifiers – Catatonic FeaturesThe Clinical picture is dominated by at least
two of the following:1.Motoric immobility as evidenced by catalepsy
or stupor2.Excessive motor activity 3.Extreme negativism4.Peculiarities of voluntary movement as
evidenced by posturing, stereotyped movements, prominent mannerisms, or prominent grimacing
5.Echolalia or echopraxia
Mood Disorder Specifiers – Melancholic Features
A. Either of the following, occurring during the most severe period of the current episode:
1. Loss of pleasure in all, or almost all, activities2. Lack of reactivity to usually pleasurable
stimuli (does not feel much better, even temporarily, when something good happens)
Mood Disorder Specifiers – Melancholic FeaturesB. Three (or more) of the following:
1. Distinct quality of depressed mood (i.e., the depressed mood is experienced as distinctly different from the kind of feeling experienced after the death of a loved one)
2. Depression regularly worse in the morning3. Early morning awakening (at least 2 hours
before usual time of awakening)4. Marked psychomotor retardation or agitation5. Significant anorexia [loss of appetite] or
weight loss6. Excessive or inappropriate guilt
Mood Disorder Specifiers: Atypical FeaturesA. Mood reactivity (i.e., mood brightens in response to
actual or potential positive events)B. Two (or more) of the following features:
1. Significant weight gain or increase in appetite2. Hypersomnia3. Leaden paralysis (i.e., heavy, leaden feelings in arms or
legs)4. Long standing pattern of interpersonal rejection
sensitivity (not limited to episodes of mood disturbance) that results in significant social or occupational impairment
C. Criteria are not met for With Melancholic Features or With Catatonic Features during the same episode
SuicideA large percentage of people with mental
illness attempt or commit suicideParticularly common in:
Mood Disorders Schizophrenia Eating Disorders, especially anorexia Borderline Personality Disorder
Age group, Method, Fatality
High School Students, Attempts by Gender
Additional Information About Suicide3rd leading cause of death among
adolescents/young adults (15-24)Fastest growing rates among youth
3 times as many women attempt, 3 times as many men “succeed”Men are more likely to use violent methods
Elderly people have the highest suicide ratesAlso higher rates in people with general
medical conditions
Additional Information About Suicide
Depression is the most common diagnosisHigher risk among people with bipolar
disorder Suicide or risky behavior with a high likelihood of
fatality may occur when the person is in a manic phase
Higher risk among people with substance abuse and other dual diagnoses
Additional Information About Suicide Particularly dangerous during the time a person
is, or seems to be, coming out of a depression Before they may have been too depressed to put in
the energy to act on suicidal impulses A person who has decided on committing suicide may
seem happier because he or she is anticipating an end to their pain
Additional Information About SuicideSuicidal ideation is not uncommon in the general
populationAffects all groups
highest rates among white peopleSocio-economic status/income has an ambiguous
role – mixed findingsUnemployed people have higher rates, but this is
correlation not causation A person may be depressed because they lost their job, or
the person may not have been able to perform at their job due to depression
Summary and NotesRisk factors/protective factorsNothing to suggest that there’s a seasonal
increase
Summary and Notes Risk Factors
Family history of suicide Family history of child maltreatment Previous suicide attempt(s) History of mental disorders, particularly depression History of alcohol and substance abuse Feelings of hopelessness Impulsive or aggressive tendencies Cultural and religious beliefs (e.g., belief that suicide is noble resolution of a personal
dilemma) Local epidemics of suicide Isolation, a feeling of being cut off from other people Barriers to accessing mental health treatment Loss (relational, social, work, or financial) Physical illness Easy access to lethal methods Unwillingness to seek help because of the stigma attached to mental health and
substance abuse disorders or to suicidal thoughts
Summary and NotesProtective Factors:
Effective clinical care for mental, physical, and substance abuse disorders
Easy access to a variety of clinical interventions and support for help seeking
Family and community support (connectedness)Support from ongoing medical and mental health care
relationshipsSkills in problem solving, conflict resolution, and
nonviolent ways of handling disputesCultural and religious beliefs that discourage suicide
and support instincts for self-preservation (U.S. Public Health Service 1999)