Mood Disorders

DSM changes in categorization

DSM -IV and DSM -IV -TR :

• Mood Disorders category contains depressive disorders and bipolar disorders

DSM -5 and DSM -5 -TR :

• No longer a Mood Disorders category

• Bipolar and Related Disorders and Depressive Disorders categories

How is depression sometimes distinct from bipolar

Calling depression unipolar depression

Types of depressive disorders

• Disruptive mood dysregulation disorder

• Major depressive disorder (including major depressive

episode)

• Persistent depressive disorder

• Premenstrual dysphoric disorder

• Substance/medication-induced depressive disorder

• Depressive disorder due to another medical condition

• Other specified depressive disorder

• Unspecified depressive disorder

Common themes within different depressive disorders

Depressive/ sad feeling, changes in individual functions, irritability

When Did Disruptive Mood Dysregulation Disorder (DMDD) Become a Diagnosis

Relatively new diagnosis, DSM-5, 2013

Disruptive Mood Dysregulation Disorder (DMDD) symptoms

- persistive irratibilty

- episodes of extreme behavioral dysregulation

DMDD diagnosis age

children and adolescents

not before age 6 or after 18 years

Children with DMDD typically develop

unipolar depression or anxiety disorders later in life

DMDD diagnostic criteria

• Severe recurrent temper outbursts (3+ times per week)

• In between temper outbursts, mood is persistently irritable or angry

Severe irritability... non episodic

How long do symptoms have to occur

Present for a year or more in multiple settings

DMDD cannot coexist with what other disorder

Bipolar

DMDD was mainly added to lessen the diagnosis of

Bipolar disorder

Major depressive episode and major depressive disorder diagnosis difference

• Diagnosis should specify whether there is a single episode or recurrent episodes

• To be considered recurrent, there must be a period of time (2+ months) between episodes where criteria for a major depressive episode are not met

Major depressive disorder (MDD) diagnosis criteria in duration and function

• Duration: 2-week period necessary for diagnosis

• Depressed mood or anhedonia must be present

• Change from previous functioning

• Function: symptoms cause "clinically significant" distress or impairment in several functional domains

• Other diagnoses should be ruled out

Anhedonia

Loss of interest or pleasure in activities

MDD symptoms

• Depressed mood

• Anhedonia

• Changes in weight or appetite

• Insomnia or hypersomnia

• Psychomotor agitation or slowing

• Fatigue or loss of energy

• Feelings or worthlessness, or excessive or inappropriate guilt

• Diminished ability to think or concentrate, or indecisiveness

• Recurrent thoughts of death, or suicidal ideation or plan

Based on MDD symptoms, a clinician may specify

• Single or recurrent episode(s)

• Current severity (if criteria are fully met)

• Remission staus (if criteria are not fully met)

• Additional specifiers

The "Bereavement Exclusion"

present in DSM -IV but removed in DSM -5 and DSM -5 -TR

- Told clinicians not to diagnose MDD to people who were within 2 months of losing a loved one... grief and depression are different

- Arguments for the removal is that individuals may not get proper treatment

Trends in prevalence of MDD

• Women > men

• Young adults > older adults

• Depression rates increased in 2020 over the pandemic

Comordibities with MDD

• Substance-related disorders

• Anxiety disorders

• Posttraumatic stress disorder

• Obsessive-compulsive disorder

• Eating disorders

Development of MDD

MDD can happen at any age but likelihood of onset increases with puberty

- peaks in 20s

Course of MDD

• Recovery from an episode begins within 3 months of onset for 40% of individuals

• Within one year for 80% of individuals

• Risk of recurrence gets lower as duration of remission gets longer

• What appears to be MDD (one or more depressive episodes) may in time present as another disorder

Depression increases

• Risk of self-harm and suicide

• Risk of developing certain chronic diseases