Major Depressive Episode:  loss of interest and pleasure for at least 2 weeks Manic Episode:  elevated an expansive mood for at least 1 week Mixed Episode:  alternating moods that last at least 1 week, must meet criteria for both manic and depressive almost daily Hypomanic Episode:  expansive, irritable, and elevated mood that lasts at least 4 days

 Bipolar I  Bipolar II  Cyclothymia (We expect major changes in this criteria with regard to children in DSM-5)  Major Depressive Disorder  Dysthymia (different criteria for children)

Types of Mood Disorders  Bipolar I Disorder: one or more manic episodes, usually with a history of depressive episodes (can have psychotic aspects)  Bipolar II Disorder: one or more depressive with at least one hypomanic episode, no psychosis  Cyclothymic Disorder: persistent mood disturbance lasting at least two years, must not be without for two months, less severity than bipolar  Bipolar Disorder NOS

Unipolar Mood Disorders  Major Depressive Disorder: one or more major depressive episodes, episodes must last at least two weeks  Dysthymia: two-year history of depressed mood, must not be without for two months, less severity than major depression, constant for a period of two years (children one year agitated depression)

 More information on co-morbidity of alcohol and substance abuse (Bipolar Disorders)  Major Depressive Disorder: now the symptoms must last two months after loss of a loved one (used to be two weeks) tried to separate from condition called Bereavement.  Dysthymia—in DSM-IV-TR—outcome is better with active treatment

 New diagnosis proposed: mixed anxiety depression.  Each mood disorder diagnosis is accompanied by some type of anxiety dimension.  A rating of anxiety should be included from 0 (no anxiety) to 4 (severely anxious with 5 symptoms and motor agitation).

Medications for Depression Tricyclics (TCA): Examples of TCAs include: Tofranil (generic name Imipramine) Elavil/Amitriptyline MAO Inhibitors: Many dietary restrictions, no foods with the chemical tyramine (e.g., cheese, beef or chicken liver, pickled herring, red wine, chocolate, coffee, raisins, pineapple, bananas) Eldepryl (Selegiline) Other Anti-Depressants: Selective Serotonin Re-uptake Inhibitors (SSRIs). Prozac/Fluoxetine Paxil/Paroxetine hydrochloride Zoloft Side effect of the SSRIs: sexual disinterest and ORGASMIC DELAY

Black Box Warning In 2004, the FDA ordered the strongest safety warning possible: Antidepressants increase the risk of suicidal thinking and behavior (suicidality) in children and adolescents with major depressive disorder (MDD) and other psychiatric disorders. Anyone considering the use of [Drug Name] or any other antidepressant in a child or adolescent must balance this risk with the clinical need. (Prozac is the exception.) In 2006 added “young adults.”

Anafranil (clomipramine) Asendin (amoxapine) Aventyl (nortriptyline) Celexa (citalopram hydrobromide) Cymbalta (duloxetine) Desyrel (trazodone HCl) Effexor (venlafaxine HCl) Elavil (amitriptyline) Etrafon (perphenazine/amitriptyline) Fluvoxamine maleate Lexapro (escitalopram hydrobromide) Limbitrol (chlordiazepoxide/amitriptyline) Ludiomil (maprotiline) Marplan (isocarboxazid) Nardil (phenelzine sulfate) Norpramin (desipramine HCl) Pamelor (nortriptyline) Parnate (tranylcypromine sulfate) Paxil (paroxetine HCl) Pexeva (paroxetine mesylate) Prozac (fluoxetine HCl) Remeron (mirtazapine) Sarafem (fluoxetine HCl) Serzone (nefazodone HCl) Sinequan (doxepin) Surmontil (trimipramine) Symbyax (olanzapine/fluoxetine) Tofranil (imipramine) Tofranil-PM (imipramine pamoate) Triavil (perphenazine/amitriptyline) Vivactil (protriptyline) Wellbutrin (bupropion HCl) Zoloft (sertraline HCl) Zyban (bupropion HCl)