Mood Disorders

Why it is important for dentists to be aware if their patients are experiencing a mood, depressive, or bipolar disorder?

• Neglect of oral hygiene during depressive or manic episodes

• Medications often cause xerostomia/dry mouth

• Depression may be associated with glossodynia or other facial pains

• Local anesthetics with epinephrine may increase blood pressure in patients taking antidepressant medications

• May want to only address more urgent dental needs during depressive episodes

Describe trends of frequency in mood disorders and their demographics, including the average age of onset.

• women are 50% more likely to experience a mood disorder

• average age of onset is around 30 years old

• 9.5% of U.S adult population (12 month prevalence)

• 45% of the 9.5% are considered severe cases

• Non-hispanic blacks are 40% less likely, hispanics are 20% less likely than non-hispanic whites to experience a mode disorder during their lifetime

Which neurotransmitters have been implicated in etiology of mood disorders?

• 5-HT

• Norepinephrine

• Dopamine

• GABA

Dx Criteria for Major Depressive Disorder

5 or more have been present for at least 2 weeks and represent a change from previous functioning:

• Depressed mood most of the day, nearly every day

• Markedly diminished interest in all/almost all activities

• Significant, unintentional weight loss or gain

• Insomnia or hypersomnia

• Psychomotor agitation or retardation

• Fatigue or loss of energy nearly every day

• Feelings of worthlessness or excessive/inappropriate

• Diminished ability to think or concentrate; indecisiveness

• Recurrent thoughts of death or recurrent suicidal ideation

• Know the term anhedonia

Tx for Major Depressive Disorder (Pharmacotherapy)

• Mono-amine oxidase inhibitors (MAOIs)

• Tricyclic antidepressants (TCAs)

• Selective serotonin reuptake inhibitors (SSRIs)

• Serotonin-norepinephrine reuptake inhibitors (SNRIs)

Tx for MDD (Psychotherapy)

Cognitive-Behavioral Therapy: individual or group

Other treatments that can be used for MDD

Electroconvulsive therapy for intractable depressive symptoms

Dx Criteria for Persistent Depressive Disorder (Dysthymia)

2 of the following or more:

- Poor appetite

- Insomnia or hypersomnia

- Low energy or fatigue

- Low self esteem

- Poor concentration or difficulty making decisions

- feeling of hopelessness

Tx for Dysthymia (pharmacology)

• MAOIs

• TCAs

• SSRIs

• SNRIs

Tx for Dysthymia (behavioral)

Cognitive-Behavioral Therapy: individual or group

True or false: electroconvulsive therapy is commonly used to treat Dysthymia as it is more severe than MDD

False; not typically used, and less severe than MDD

Dx Criteria for Premenstrual Dysphoric Disorder (PMDD)

One or more:

• Marked affective lability

• Marked irritability or anger

• Marked depressed mood feeling of hopelessness

• Marked anxiety, tension

One or more:

• Decreased interest in usual activities

• Subjective difficulty in concentration

• Lethargy or marked lack of energy

• Marked change in appetite

• Hypersomnia or insomnia

• Physical symptoms such as breast tenderness, joint or muscle pain

Tx for PMDD

• Changes in diet to increase protein and carbs, decrease sugar, salt, caffeine and alcohol

• Regular exercise

• Stress management

• Vitamin supplements

• Anti-inflammatory medicines

• SSRIs

• Birth control pills to regulate hormones

Dx criteria for Bipolar I

presence of at least one manic episode and may also have a major depressive episode but is not necessary for diagnosis

Dx criteria for BP II:

at least one major depressive episode, at least one hypomanic episode

Dx criteria for cyclothmia

• Hypomanic symptoms that do not meet criteria for a hypomanic episode

• Depressive symptoms that do not meet criteria for a major depressive episode

Tx for bipolar disorder (pharmacology)

• lithium bicarbonate

• anticonvulsants (Valproic acid, carbamazepine)

• Second-generation antipsychotics (quetiapine, combo of olanzepine and fluoxetine [symbax])

Tx for bipolar and related disorders (behavioral)

Cognitive-Behavioral Therapy: individual or group

Other Treatments for bipolar and related disorders

electroconvulsive therapy for intractable depressive symptoms

Describe what a dentist should do in the case of a patient with Bipolar Disorder who stops taking their medications because "they don't feel like themselves," and why a dentist should take this approach.

Ask them about their medication and how their doing if you notice increase in manic symptoms during your time with them and Refer them back to their PCP