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Mood Disorders
The Mood Disorders
 Major Depressive Disorder
 Dysthymic Disorder
 Bipolar
 Bipolar I Disorder
 Bipolar II Disorder
 Cyclothymic Disorder
The mood disorders are built from the presence and
combinations of mood episodes
Mood Episodes
 Major Depressive Episode
 Manic Episode
 Hypomanic Episode
 Mixed Episode
Mood Disorders
 Major Depressive Disorder
 Dysthymic Disorder
 Bipolar Disorder
 Bipolar I
 Bipolar 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: Course
 Can begin at any age, but the average is in the mid 20s
 The average age of onset has been decreasing
 At least 60% of people who have one Major Depressive
Episode will have a second
 70% of people who have had 2 episodes will have a third
 90% of people who have had 3 episodes will have a
fourth
 5% - 10% of people with MDD who have one Major
Depressive Episode develop a Manic Episode
Depression: Treatment
 Therapy
 Traditional “talk therapy”
 Cognitive behavioral therapy
 Medication
 Most 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
Antidepressants
 MAOIs
•Eldepryl
•Marplan
•Nardil
•Parnate
 Side effects can include:
•Dizziness
•Headaches
•Drowsiness
•Insomnia
•Fatigue
•Tremors
•Twitching
•Convulsions
•Constipation
•Dry mouth
•Weight gain
•Skin irritation
•Blurred vision
•High blood
pressure
Antidepressants
 Selective Serotonin Reuptake Inhibitors (SSRIs)
•Celexa
•Luvox
•Prozac
•Zoloft
•Paxil
 Side effects include
•Decrease in sex drive
•Fatigue
•agitation
 These are among the most popular used
Antidepressants
 Other commonly used antidepressants include:
 Wellbutrin
 Ludiomil
 Remerone
 Effexor
Bipolar I Disorder
 Variations:
 Bipolar I Disorder, Single Manic Episode
 Bipolar I Disorder, Most Recent Episode Hypomanic
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There has been at least 1 Manic Episode or Mixed Episode in
the past
 Bipolar I Disorder, Most Recent Episode Manic
 Bipolar I Disorder, Most Recent Episode Mixed
 Bipolar I Disorder, Most Recent Episode Depressed
Bipolar II Disorder
 Defined by recurrent Major Depressive Episodes with
Hypomanic Episodes
 There are no Manic or Mixed Episodes
Bipolar II Disorder: Notes
 Lifetime prevalence is approximately .5%
 60% - 70% of Hypomanic Episodes in Bipolar II occur
immediately before or after a Major Depressive
Episode
 The interval between episodes tends to decrease with
age
 10% - 15% have rapid cycling
 Over 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 therapy
 Some people with Bipolar Disorder may need to take
medications for all or most of their lives
Bipolar Disorders Treatment
Mood Stabilizers
 Lithium based medications
 Eskalith
 Lithobid
 Lithonate
 A downside of these medications is that lithium levels
in the bloodstream need to be carefully monitored
Bipolar Disorders Treatment
Mood Stabilizers
•Tegretol
•Neurontin
•Topamax
•Depakote
•Lamictal
Side effects include:
•Gastrointestin •Weight gain
al distress
•Decrease in
cognition/me
mory
•Nausea
•Tremors
•Vomiting
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 Specifiers
 Mild, Moderate, Severe Without Psychotic Features
 Based on the severity of the symptoms, number of
symptoms, and impairment
 Severe With Psychotic Features includes delusions
and/or hallucinations (typically auditory) during the
episode
 Mood congruent: guilt, punishment, somatic sensations
of death, auditory hallucination of a voice berating the
person
 Mood incongruent
Mood Disorder Specifiers
 Full Remission: at least 2 months in which there are no
significant symptoms of depression
 Partial 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 Features
 Melancholic Features
 Atypical Features
Mood Disorder Specifiers –
Catatonic Features
The Clinical picture is dominated by at least two of the
following:
1. Motoric immobility as evidenced by catalepsy or
stupor
2. Excessive motor activity
3. Extreme negativism
4. 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.
2.
Loss of pleasure in all, or almost all, activities
Lack of reactivity to usually pleasurable stimuli (does
not feel much better, even temporarily, when
something good happens)
Mood Disorder Specifiers –
Melancholic Features
B. 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 morning
3. Early morning awakening (at least 2 hours before
usual time of awakening)
4. Marked psychomotor retardation or agitation
5. Significant anorexia [loss of appetite] or weight loss
6. Excessive or inappropriate guilt
Mood Disorder Specifiers:
Atypical Features
A. Mood reactivity (i.e., mood brightens in response to
actual or potential positive events)
B. Two (or more) of the following features:
1.
2.
3.
4.
Significant weight gain or increase in appetite
Hypersomnia
Leaden paralysis (i.e., heavy, leaden feelings in arms or legs)
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
Suicide
 A large percentage of people with mental illness
attempt or commit suicide
 Particularly common in:
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Mood Disorders
Schizophrenia
Eating Disorders, especially anorexia
Borderline Personality Disorder
Age group, Method, Fatality
High School Students, Attempts by Gender
Additional Information About
Suicide
 3rd 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 rates
 Also higher rates in people with general medical
conditions
Additional Information About
Suicide
 Depression is the most common diagnosis
 Higher risk among people with bipolar disorder
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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
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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
Suicide
 Suicidal ideation is not uncommon in the general
population
 Affects all groups
 highest rates among white people
 Socio-economic status/income has an ambiguous role –
mixed findings
 Unemployed 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 Notes
 Risk factors/protective factors
 Nothing to suggest that there’s a seasonal increase
Summary and Notes
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Risk Factors
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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 Notes
 Protective 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 relationships
 Skills in problem solving, conflict resolution, and nonviolent ways
of handling disputes
 Cultural and religious beliefs that discourage suicide and support
instincts for self-preservation
 (U.S. Public Health Service 1999)