1. major depressive episode depressed mood or loss of interest/pleasure appetite or body weight change (5%+) sleep problems psychomotor agitation or retardation fatigue feelings of worthlessness or guilt poor concentration thoughts of death or suicide (distress or impairment) (lasts 4-9 mo if left untreated) For 2 weeks, 5+: exception for bereavement (grief over death of loved one)

2. manic episode inflated self-esteem/grandiosity less need for sleep excessively talkative racing thoughts too easily distracted increased goal-directed activity/ psychomotor agitation excessive pleasurable but risky activities (lasts 3-6 mo if untreated) 1 week of elevated, expansive, or irritable mood and 3+:

3. mixed manic episode Meets criteria for both major depressive episode & manic episode (except duration is 1+ week). hypomanic episode Less severe than mania & does not cause impairment (at least 4 days)

4. unipolar mood disorder Major Depressive Disorder, single episode (rare!) Major Depressive Disorder, recurrent dysthymic disorder 2+ years depressed mood, more days than not double depression dysthymic disorder + major depressive episode

5. bipolar I disorder a manic episode bipolar II disorder hypomanic episode + major depressive episode cyclothymic disorder 2+ years alternating dysthymia & hypomania the following are all chronic w/ poor prognosis rapid cycling?

6. theories for depression BIOLOGICAL VULNERABILITY genes - concordance evidence from family & twin studies - 40% genetic & 60% nonshared environmental factors - (diathesis-stress or reciprocal gene-env model) biochemistry - low serotonin = dysregulation of norepinephrine & dopamine - high stress hormones

7. PSYCHOLOGICAL VULNERABILITY ANXIETYDEPRESSION Gives up hope. Uncertain of control. two cognitive theories for hopelessness: 1.learned helplessness (Seligman) 2.negative cognitive style (Beck) theories for depression

8. two cognitive theories for hopelessness: 1.learned helplessness (Seligman) a. convinced that you cannot control events b. convinced that such is: 1.negative cognitive style (Beck) a. cognitive triad (negative focus on you, world, future) b. errors of logic e.g. arbitrary inference (neg conclusions w/o evidence) internal (“I am the reason.”) global (“I ruin everything.”) stable (“I always will.”) theories for depression

9. VULNERABILITY IS TRIGGERED exogenous depression A.K.A. reactive depression triggered by identifiable stressor endogenous depression no identifiable stressor “internal” more about stressors - “Kindling Effect” - reciprocal-gene environment theories for depression

10. Genes - 80-90% genetic & 10% nonshared env factors biochemistry - low serotonin ion theory - Irregular transport of sodium & potassium - neurons fire too easily (mania) - neurons resist firing (depression) theories for bipolar disorder High norepinephrine (mania) Low norepinephrine (dep)

11. antidepressant meds SSRIs - selective serotonin reuptake inhibitors - most commonly prescribed, due to safety TRICYCLICS - monoamine reuptake inhibitors - reserved for severe pts not responsive to other meds - drops BP & potentially deadly changes in heart rhythm MONOAMINE OXIDASE INHIBITORS (MAO-Is) -tyramine too high = dangerously high BP causes stroke or death - skin patch exception gives low dose (no diet restrictions)

12. mood stabilizers LITHIUM - treats mania & depression (doesn’t trigger mania as does antidepressants) (lower suicide rates) - therapeutic vs. lethal dosage window - seizures, kidney dysfunction, death ANTICONVULSANTS (valproate, carbamazepine) -AKA anti-seizure medication

13. ECT 65-140 volts for half second produces seizure for 30 secs to few minutes. Applied 3x/week for 4 weeks.

14. TMS - left prefrontal cortex - 40 mins/day, 5x/week for 6 weeks transcranial magnetic stimulation