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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 • • • • 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 • • • • • • • 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