Mood Disorders and Suicide

Anergia

means lack of energy. It is commonly seen in depression. It is more than just being tired — it is a persistent lack of energy that interferes with normal functioning.

Mood disorders

serious and long-lasting disturbances in mood that interfere with daily life.

Depression

A prolonged feeling of helplessness, hopelessness, and sadness

Mania

a mood disorder marked by a hyperactive, wildly optimistic state. lasts about 1 week or longer (or shorter if hospitalized).

trephination

An ancient operation in which a stone instrument was used to cut away a circular section of the skull, perhaps to treat abnormal behavior.

Major Depressive Disorder

A mood disorder in which a person experiences, in the absence of drugs or a medical condition, two or more weeks of significantly depressed moods, feelings of worthlessness, and diminished interest or pleasure in most activities. These symptoms must cause significant distress or impairment in work, relationships, or daily functioning.

Psychotic Depression

Expression of intensely negative mood shifts and unusual behaviors involving hallucinations, delusions, disorganized speech patterns, or loss of contact with reality.

Bipolar Disorder

A mood disorder in which the person alternates between the hopelessness and lethargy of depression and the overexcited state of mania. Previously called manic-depressive illness

Changes in appetite → unplanned weight gain or loss

Insomnia or hypersomnia

Fatigue (anergia)

Poor concentration and decision-making

Feelings of worthlessness, guilt, hopelessness

Rumination and pessimistic thinking

Thoughts of death or suicide

Inability to cope with daily life

Common symptoms of MDD

Elevated, expansive, or irritable mood

Inflated self-esteem or grandiosity

Decreased need for sleep

Pressured speech (rapid, nonstop talking)

Flight of ideas (racing thoughts)

Distractibility

Increased goal-directed activity

Risk-taking behaviors (spending sprees, sexual indiscretions, impulsive decisions

Common symptoms of Mania

Hypomania

Milder form of mania with less severe symptoms, no psychotic features, and does not significantly impair functioning

Mixed Episode (Rapid Cycling)

Symptoms of mania and depression happen nearly every day. Last at least 1 week. The person may have depressive hopelessness. But also manic energy → increased suicide risk

Bipolar I Disorder

one or more manic or mixed episodes usually accompanied by major depressive episodes

Bipolar II Disorder

One or more major depressive episodes. At least one hypomanic episode. No full manic episode

Lithium

Antimanic agent, naturally present in the body as a trace element. Treats acute mania and depression; prevents cycling of mood episodes. Affect synapses to degrade catecholamines (dopamine, norepinephrine) and inhibit neurotransmitter release. Crosses blood-brain barrier, placenta, distributed in sweat and breast milk

Anticonvulsants as Mood Stabilizers

Used for clients nonresponsive to lithium or with contraindications (renal disease, side effects). May raise brain threshold to stimuli, reducing mood destabilization

Carbamazepine, Valproic acid, Gabapentin, Clonazepam

Anticonvulsants that are used as Mood Stabilizers

Antipsychotics

Used during acute mania or psychosis alongside mood stabilizers

Psychotherapy

Useful during mild depression or euthymic (normal) phases. Not effective during acute mania due to short attention span and poor insight

Persistent Depressive Disorder (Dysthymia)

a chronic, long-term depressed mood lasting at least 2 years (1 year in children/adolescents). Symptoms are milder than major depression but are long-lasting and persistent.

Disruptive Mood Dysregulation Disorder (DMDD)

a depressive disorder in children characterized by persistent irritability and frequent episodes of out-of-control behavior. Onset before age 10. This diagnosis helps distinguish chronic irritability from pediatric bipolar disorder.

Cyclothymic Disorder

a disorder marked by numerous periods of hypomanic symptoms and mild depressive symptoms. No full manic or major depressive episodes. Functioning is generally maintained, and symptoms last at least 2 years (1 year in children).

Seasonal Affective Disorder (SAD)

a mood disorder caused by the body's reaction to low levels of sunlight in the winter months. Begins in late autumn → improves in spring/summer. Treatment often includes light therapy.

Postpartum (Maternity) Blues

a mild, predictable mood disturbance occurring in the first several days after delivery of a baby - symptoms include labile mood, and affect, crying spells, sadness, insomnia, and anxiety - symptoms subside without treatment. Resolves without treatment but requires support from family and friends.

Postpartum Depression

a mood disorder characterized by feelings of sadness and the loss of pleasure in normal activities that can occur shortly after giving birth. Onset within 4 weeks after delivery. Symptoms consistent with major depression. Most common complication of pregnancy in developed countries. Requires treatment and monitoring.

Postpartum Psychosis

a rare and severe form of depression that occurs in women just after giving birth and includes delusional thinking and hallucinations. A severe psychiatric emergency, Immediate treatment is required.

Premenstrual Dysphoric Disorder (PMDD)

A severe form of premenstrual syndrome (PMS) associated with severe emotional and physical problems that are closely linked to the menstrual cycle

Nonsuicidal Self-Injury (NSSI)

direct, deliberate destruction of body tissue in the absence of any intent to die

serotonin (5-HT) and norepinephrine (NE)

Depression is associated with decreased levels or impaired function of key neurotransmitters—particularly

Antidepressants

primarily work by blocking the reuptake of serotonin and/or norepinephrine, allowing them to remain longer in the synapse and enhance receptor stimulation. Over time, they also increase postsynaptic receptor sensitivity.

Selective Serotonin Reuptake Inhibitors (SSRIs)

most frequently prescribed antidepressants due to effectiveness and safety. Minimal anticholinergic and cardiovascular effects. Safer in older adults. Better compliance due to fewer side effects

Insomnia improves: 3-4 days

Appetite normalizes: 5-7 days

Energy improves: 4-7 days

Mood and concentration improve: 7-10 days

Clinical Effects Timeline of SSRI use

Fluoxetine, Sertraline, Paroxetine, Citalopram, Escitalopram, Vortioxetine

SSRI Antidepressants

Fluoxetine

Give AM if nervous, PM if drowsy; monitor hyponatremia; encourage fluids; report sexual dysfunction. Best for clients with low energy. May worsen anxiety initially

Paroxetine

Most sedating. better if client has insomnia, Higher risk of weight gain

Common side effects of SSRIs

Sexual dysfunction

Risk for hyponatremia (especially elderly)

Delayed onset (1-4 weeks)

Risk for serotonin syndrome

Do not stop abruptly

Cyclic Antidepressants (Tricyclics and Heterocyclics)

These are older antidepressants introduced in the 1950s. Indicated for depression with hopelessness, guilt, suicidal ideation, Panic disorder, Obsessive-compulsive disorder, and Eating disorders. 10-14 days to begin symptom improvement and 6 weeks for full therapeutic effect

Atypical Antidepressants

Used when clients do not respond to SSRIs or experience intolerable side effects.

Venlafaxine (Effexor), Duloxetine (Cymbalta), Bupropion, Mirtazapine, Vilazodone

Atypical Antidepressants

Monoamine Oxidase Inhibitors (MAOIs)

are effective but used less often due to serious side effects and drug interactions.

Hypertensive Crisis

Occurs when clients ingest tyramine-containing foods while on MAOIs.

Electroconvulsive Therapy (ECT)

involves the controlled delivery of a brief electrical stimulus to the brain through electrodes placed on the scalp. This stimulus produces a therapeutic seizure, typically lasting 20-60 seconds.. A highly effective biological treatment used primarily for severe depressive disorders. It is most often indicated for:. Clients who do not respond to antidepressant medications (treatment-resistant depression). Individuals who cannot tolerate medication side effects. A typical course consists of 6 to 15 treatments

Treatments are usually administered two to three times per week

Bilateral ECT

Faster and more robust improvement. Greater short-term memory impairment

Unilateral ECT

Less memory loss. May require more treatments for comparable effectiveness

Interpersonal Therapy (IPT)

treatment that strengthens social skills and targets interpersonal problems, conflicts, and life transitions. Typically short-term and structured, often lasting 12-16 weeks.

Behavioral Therapy

focuses on increasing engagement in positive, reinforcing activities and reducing avoidance behaviors common in depression.

Negative view of self

Negative view of the world

Negative view of the future

Depressed individuals often exhibit a "cognitive triad":

Absolute (Dichotomous) Thinking, Arbitrary Inference., Selective (Specific) Abstraction, Overgeneralization, Magnification and Minimization, Personalization

Cognitive distortions

Absolute (Dichotomous) Thinking

Viewing situations in extreme, all-or-nothing categories (black-or-white thinking). Help client recognize middle ground; develop more balanced, flexible thinking.

Arbitrary Inference

Drawing conclusions without sufficient evidence, often assuming the worst, Encourage examination of evidence; generate alternative explanations.

Selective (Specific) Abstraction

Focusing on one negative detail while ignoring the overall positive context. Teach clients to evaluate the full context rather than isolating negative elements.

Overgeneralization

Drawing broad conclusions from a single event. Challenge sweeping conclusions; examine patterns over time instead of isolated events.

Magnification and Minimization

Exaggerating the importance of negative events or downplaying positive ones. Help client realistically evaluate importance of events; reframe distortions.

Personalization

Assuming external events are directly related to oneself without evidence. Teach differentiation between internal responsibility and external factors.

Hamilton Rating Scale for Depression (HAM-D)

17 item questionnaire used by clinicians. Clinicians evaluate behaviors such as depressed mood, guilt, suicidality, insomnia, and diurnal variations. Additional sections cover depersonalization, paranoid symptoms, and obsessive thoughts.

Beck Depression Inventory

psychometric assessment created by cognitive theorist Aaron Beck used to assess the severity of depression that has already been diagnosed. These tools provide insight into the client's perception of symptom severity and improvement over time.

Suicide

the intentional act of ending one's own life

Suicidal thoughts (ideation)

Thoughts, ideas, or ruminations about the possibility of ending one's life, ranging from thinking that one would be better off dead to formulation of elaborate plans.

Active suicidal ideation:

Person thinks about and plans ways to commit suicide

Passive suicidal ideation:

Person wishes to die but has no plans to act. Less immediately dangerous but still requires assessment

Plan, Means, Lethality, Preparations, Timing, Belief on lethality

When a client reports suicidal thoughts, assess potential lethality by asking: