Mood disorder pt 1 (MOST IMPORTANT)

Major depressive episodes

• Most commonly diagnosed and most severe mood disorder

• Anhedonia → Inability to feel pleasure (things that should be or have been pleasurable in the past are not anymore)

Mania

Extreme pleasure in every activity; excessive euphoria

Hypomanic episode

• Less severe version of manic episode

• Lots of positive emotions but doesn’t create as much dysfunction as mania

Unipolar mood disrder

Either depression or mania

Bipolar mood disorder

Alternate between depression and mania

Mixed features

Experience of both, feel depressed and manic at the same time

Major depressive disorder main symptoms

• Depressed mood for most of the day, for more days than not for 2 weeks

• Physical and cognitive symptoms

  • Disruptions in sleep, appetite, sexual drive (can be too much or too little, sexual is always too little)

  • Feelings of worthlessness, guilt

Major depressive disorder duration

• Single episode

  • Average duration of first episode if untreated = 9 months

• Recurrent episodes

  • Two or more depressive episodes separated by at least two months

  • Chronic course

    • Median number of episodes 4-7

    • Median duration of recurrent episodes is 4-5 months

Major depressive disorder DSM criteria (1-4)

Five or more of the following symptoms during the same 2 week period (at least one has to be depressed mood or loss of interest or pleasure)

• Depressed mood most of the day

• Diminished interest or pleasure in all, or almost all activities most of the day

• Weight loss or weight gain (not dieting)

• Insomnia or hyper insomnia

Major depressive disorder DSM criteria (5-9)

• Psychomotor agitation or retardation

  • Agitation = severe restlessness

  • Retardation = low amount of movement

• Fatigue or loss of energy

• Feelings of worthlessness

• Diminished ability to think or concentrate

• Recurrent thoughts of death

Persistent depressive disorder

Also known as Dysthymia

• Last 2+ years and the individual is never without symptoms for more than 2 months

• Chronic state of depression (20-20 years)

• Symptoms are same as MDD but less severe

Double depression

• Individuals who suffer with both major depression episodes and PDD

• Most challenging disorder to treat within depressive disorders

Depressive disorder specifiers (1-4)

with:

• Psychotic features

• Anxious distress

• Mixed features

• Melancholic features

Depressive disorder specifiers (5-8)

with:

• Atypical features

• Catatonic features

• peripartum onset

• Seasonal pattern

MDD with peripartum onset (main symptoms)

• Mother’s functional impairment

• Involves temperamental, social, emotional, cognitive, behavioral difficulties in children

• rates peak 2-6 months after delivery

MDD w Peripartum etc.

• rates increase if there is an unsupportive partner

• Can also be non birthing parent

• Rare subtype:

  • Postpartum mood episodes with psychotic features

Depressive disorders epidemiology pt 1

Depression carries a large burden for both individuals and society

• Depression ranks 4th in terms of global burden of disease

• People with depression are five times more likely to take time off of work

Depressive disorder epidemiology pt 2

• Mean age of onset for MDD is 25

  • There is a trend developing depression at increasingly earlier ages

• Adolescent onset of PDD

  • More risk of being chronic

  • Not as responsive to treatment

  • Suggests genetic reasoning which is why it’s harder to treat

  • Reasons?

    • We develop our sense of self during this time period → ingrains certain parts of depression into our identity

Depressive disorders: sex differences pt 1

MDD → twice as many females than males

• May be because:

  • men don’t seek help bc of culture

  • Different presentation in males (more aggresive)

  • More socially acceptable for women to feel emotions and get treatment

Depressive disorders: sex differences pt 2

Depressive symptoms are more common among women who:

• have few financial resources

• Have less education

• Are unemployed

Women’s reproductive events are risks for mood disturbances (Because of hormones?)

Depressive disorder: other depressive disorders:

• Premenstrual dysphoric disorder (PMDD)

  • Characterized by severe emotional reactions during the few days leading up to a women’s period

  • Criticized because it’s normal for mood to change due to hormones

• Disruptive mood dysregulation disorder:

  • Children and adolescents who have repeated verbal and behavioral outbursts that are not appropriate to the situation 3 or more times a week

  • Treatment may involve an individual education plan

Depressive disorder: grief to depression

Integrated grief:

• Typical experience of grief

• Acute period of grieving that we learn to live with

Complicated grief

• Grief lasts beyond expected amount of time

• More intense symptoms