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Mood disorders Y.Semnani M.D. Assistant Professor of Psychiatry Shahid Beheshti University of Medical Science Gross Deviations in Mood Depression: “The Low” – The “Common Cold” of Mental Illness Mania: “The High” – Abnormally Exaggerated Elation, Joy, or Euphoria Mania Depression Unipolar Mood Disorder – only Depression Bipolar Mood Disorder – Alternates Between Depression and Mania – Somewhat Misleading Term (only Mania?) Depressive Disorders – Major Depression – Dysthymic Disorder – Double Depression Bipolar Disorders – Bipolar I and Bipolar II Disorders – Cyclothymic Disorder Years Lived with Disability (YLD) Murray & Lopez “Global Burden of Disease” (WHO, Harvard University, World Bank) Disease frequency(million) • Major Depression Iron Deficiency A Falling • Alcohol COPD • Bipolar Dis Congenital malforms Osteoarthritis • Schizophrenia • OCD 50.8 22 22 15.8 14.7 14.1 13.5 13.3 12.1 10.2 percent 10.7 4.7 4.6 3.3 3.1 3 2.9 2.8 2.6 2.2 Clinical Description 2 Weeks or More Major Depressive Episode: DSM-IV Criteria • Depressed mood and/or loss of interest or pleasure 2 weeks duration plus 4 following symptoms: • Associated symptoms – Physical: insomnia/hypersomnia, appetite/weight change, decreased energy, psychomotor change – Psychological: feelings of guilt or worthlessness, poor concentration, thoughts of death/suicidal intentions, hopelessness and helplessness Facts and Statistics Mean Age of Onset is 25 Years Length of Episode Varies Remission is Common Risk of Suicide Somatic presentation in Eastern countries Clinical Description Similar to Major Depression BUT With a Different Course – Symptoms are Milder – Symptoms can Last 20-30+ Years Persistently Depressed Mood for more than 2 Years – Cannot be Symptom Free > 2 Months Clinical Description 2 Years or More Clinical Description 2 Weeks or More Facts and Statistics Mean Age of Onset Early 20s Onset Prior to Age 20 – Greater Chronicity – Poor Prognosis – Stronger Family Link Major Depressive Episodes are Common Clinical Description Suffer From Both – Major Depression Episodes – Dysthymic Disorder Dysthymic Usually Begins First Associated With Severe Pathology A Problematic Future Course Clinical Description Dysthymia Dysthymia Major Depression Double depression Major Features Experience Both – Manic Episodes – Major Depressive Episodes What are Manic Episodes? Manic Episode: Diagnostic Criteria • Elevated, expansive, or irritable mood for 1 week or longer, plus 3 or more of the following – – – – – – Inflated self-esteem or grandiosity Decreased need for sleep Pressured speech Racing thoughts/flight of ideas Distractibility Psychomotor agitation/increased goal-directed activity . – Excessive involvement in high-risk activities Mania and Hypomania 1 Week 4 Days Clinical Description Major Depressive Episodes Alternate With Full Manic Episodes Clinical Description Mania Major Depression Clinical Description Major Depressive Episodes Alternate With Hypomanic Episodes Clinical Description Hypomania Major Depression Clinical Description Milder Depressive Episodes Alternate With Hypomanic Episodes Clinical Description Hypomania Minor depression Mixed Episode: Diagnostic Criteria • Criteria met for both manic episode + Major Depressive Episode for 1 week General Facts and Statistics Bipolar I – Onset Around 18 Years Bipolar II – Onset Around 22 Years 16% Commit Suicide Cyclothymia – Typically Chronic Types of Major Mood Disorders High Recurrent Unipolar Bipolar II Bipolar I Low Medications Tricyclic Antidepressants Imipramine Amitriptyline Nortriptyline Block Neurotransmitter Reuptake Side Effects Medications SSRIs Block Reuptake of Serotonin Flouxetine Citalopram Sertraline Fluvoxamine Side Effects • Manic phase: – – – – – – Lithium Valporate Sodium Carbamazepine Gabapentin Lamotrigine Topiramate • Depressive phase: – Lithium – Lamotrigine • Mixed phase – Valporate Sodium – Carbamazepine – Gabapentin Psychological Interventions Beck’s Cognitive Therapy Interpersonal Psychotherapy Usually Brief and Time Limited Combined Treatments?
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