Mood Disorders

Depression, bipolar illness, mania

Mood Disorder Defined

Disturbances in affect (observed emotional state) or emotion (patient’s feelings) but will effect cognition and behavior

Mood Disorder Diagnostic

Disturbance in mood longer than 1-2 weeks

Psychosis

Caused by severe mood disorders

Major Depression

Sad empty feelings with diminished interest and pleasure in all activities

Mania

Period of euphoric impulsive hyperactivity last at least one week

Bipolar Disorder (manic-depression)

Episodes of mania and depression occur; one or the other may predominate Bipolar 1 is more severe than Bipolar 2

Mood Disorders: Definitions

Seasonal Affective Disorder (SAD): depression which occurs in the winter

Dysthymia: milder depression which tends to be chronic (greater than 1 year).

Cyclothymia: periods of mild hypomania and mild depression over a period of 2 years or more

Seasonal Affective Disorder (SAD)

Depression which occurs in the winter

Dysthymia

Milder depression which tends to be chronic (greater than 1 year

Cyclothymia

Periods of mild hypomania and mild depression over a period of 2 years or more

Mood Disorders: Epidemiology

• Depression is one of the most common psychiatric problems

• 20% of women and 10% of men will experience at least one depressive episode during their lives

• Bipolar disorder occurs in 1% of population.

• It was once believed that children did not experience depression because their adaptations are different from an adult.

• Children have a 3% incidence of depression.

• Teens have a 8-15% incidence of depression.

• Rates of pediatric bipolar illness are not known. Many children are thought to be misdiagnosed with other disorders such as ADHD, conduct disorders, and personality disorders.

• Up to 10% of women will experience a postpartum depression.

The most common psychiatric problem

Depression

Mood Disorders: Risk Factors

Depression and bipolar disorder have similar risk factors:

• Genetics

• Neurotransmitter imbalances

• Physiological factors

• Endocrine imbalances

• Unresolved grief

• Unexpressed anger (turned inward)

• Cognitive distortions

• Learned helplessness

• Behavioral reinforcement for maladaptive actions

• Ineffective coping to social stresses

Mania may be an overcompensation for feelings of depression

Genetics (depression)

• Family history of a member with depression increases incidence 1.5- 3 times

• If one identical twin has depression, there is a 50% chance the other will experience depression.

Genetics (mania)

• For the general population, a conservative estimate of an individual's risk of having full-blown bipolar disorder is 1 percent. Disorders in the bipolar spectrum may affect 4-6%.

• When one parent has bipolar disorder, the risk to each child is l5-30%.

• When both parents have bipolar disorder, the risk increases to 50-75%.

• The risk in siblings and fraternal twins is 15-25%.

• The risk in identical twins is approximately 70%.

Neurotransmitter Imbalances (Depression)

• Decrease in norepinephrine, serotonin, and dopamine

• It is uncertain about the effects of acetylcholine

Neurotransmitter Imbalances (Mania)

• Increase in norepinephrine, serotonin, and dopamine

Physiological Factors

• Medication reactions (steroids, beta blockers, sedatives)

• Street drugs

• Change in amount of sunlight (pineal gland/melatonin)

• CVA’s and other cardiovascular problems

• Postpartum

Stroke and Myocardial Infarctions Patients (Physiological)

Research has shown that patients who receive antidepressants during the acute phase have faster rehabilitation

Endocrine Imbalances (Depression)

• Elevated cortisol levels

• Decreased thyrotropin-releasing factor

Endocrine Imbalances (Mania)

Sodium and calcium changes at the cellular level

Estrogen and progesterone (Endocrinological)

Research has shown these to have effects on depression