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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
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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 Bipolar
Depression? 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 child
 Patients lack insight to manic symptoms and under report them
Stahl, S., Essential Psychopharmacology, Cambridge Univ Press, 2008
Predictors of Relapse
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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