1. Mood Disorders

2. 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

3. Mood Episodes Major Depressive Episode Manic Episode Hypomanic Episode Mixed Episode

4. Mood Disorders Major Depressive Disorder Dysthymic Disorder Bipolar Disorder Bipolar I Bipolar II Cyclothymic Disorder

5. Major Depressive Disorder Lifetime risk: Women: 10% - 25% Men: 5% - 9% Point prevalence: Women: 5% - 9% Men: 2% - 3%

6. 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

7. 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

8. Antidepressants MAOIs Side effects can include: Dizziness Headaches Drowsiness Insomnia Fatigue Tremors Twitching Convulsions Constipation Dry mouth Weight gain Skin irritation Blurred vision High blood pressure Eldepryl Marplan Nardil Parnate

9. Antidepressants Selective Serotonin Reuptake Inhibitors (SSRIs) Side effects include These are among the most popular used Celexa Luvox Paxil Prozac Zoloft Decrease in sex drive Fatigue agitation

10. Antidepressants Other commonly used antidepressants include: Wellbutrin Ludiomil Remerone Effexor

11. Bipolar I Disorder Variations: Bipolar I Disorder, Single Manic Episode Bipolar I Disorder, Most Recent Episode Hypomanic 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

12. Bipolar II Disorder Defined by recurrent Major Depressive Episodes with Hypomanic Episodes There are no Manic or Mixed Episodes

13. 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)

14. 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

15. 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

16. Bipolar Disorders Treatment Mood Stabilizers Tegretol Neurontin Lamictal Topamax Depakote Side effects include: Gastrointestin al distress Weight gain Decrease in cognition/me mory Nausea Vomiting Tremors

17. Bipolar Disorder Treatment Antipsychotic medications may also be used, particularly to treat mania Antidepressants are used sometimes, but may set off manic episodes

18. 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

19. 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

20. Mood Disorder Specifiers Catatonic Features Melancholic Features Atypical Features

21. 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

22. Mood Disorder Specifiers – Melancholic Features A. Either of the following, occurring during the most severe period of the current episode: 1. Loss of pleasure in all, or almost all, activities 2. Lack of reactivity to usually pleasurable stimuli (does not feel much better, even temporarily, when something good happens)

23. 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

24. 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. Significant weight gain or increase in appetite 2. Hypersomnia 3. Leaden paralysis (i.e., heavy, leaden feelings in arms or legs) 4. 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

25. Suicide A large percentage of people with mental illness attempt or commit suicide Particularly common in: Mood Disorders Schizophrenia Eating Disorders, especially anorexia Borderline Personality Disorder

26. Age group, Method, Fatality

27. High School Students, Attempts by Gender

28. Additional Information About Suicide 3 rd 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

29. Additional Information About Suicide Depression is the most common diagnosis Higher risk among people with bipolar disorder 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

30. Additional Information About Suicide Particularly dangerous during the time a person is, or seems to be, coming out of a depression 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

31. 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

32. Summary and Notes Risk factors/protective factors Nothing to suggest that there’s a seasonal increase

33. Summary and Notes Risk Factors 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

34. 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)