Mood Disorders: Depression and Bipolar Disorders

Mood Disorders

Prolonged fluctuations in mood, significantly impairing daily life

Major Depressive Disorder (MDD)

Severe depressive episodes without mania or hypomania.

Persistent Depressive Disorder (PDD)

Chronic form of depression that is less severe than MDD but still significantly impairs daily life.

Depressive Episode

Persistent low mood with specific symptoms for two weeks.

Protective Factors for Suicide

Access to care and strong social support.

How long must MDD symptoms persist to meet the diagnostic criteria?

Every day, all day, for at least two weeks.

What is the key factor in diagnosing MDD beyond symptom presence?

Symptoms must cause significant impairment or dysfunction in daily life.

Significant life changes, Clear deviation.

What is anhedonia?

Loss of interest and pleasure in activities

Which of the disorders is characterized by a reduced brain activity?

Major Depressive Disorder (MDD)

What are the recurrence rates of MDD after one, two, and three episodes?

50% after one episode, 70% after two episodes, 90% after three episodes.

How does the Kindling-Sensitization Hypothesis explain the recurrence of MDD?

Each depressive episode alters brain function, increasing vulnerability to future episodes.

Why is early-onset MDD (before age 20) associated with a poorer prognosis?

It leads to chronic psychosocial issues, treatment resistance, and a higher risk of suicide attempts.

What are the 4 associated features of MDD and PDD?

Specifier: Anxious Distress

Specifier: Mixed Features

Specifier: Melancholic Features

Specifier: Atypical Features

What are atypical features in mental health?

Symptoms include hypersomnia, heavy feeling in limbs, rejection sensitivity, and mood reactivity.

What is hypersomnia?

Hypersomnia is excessive sleeping.

What does a heavy, leaden feeling in arms/legs refer to?

It refers to a symptom of atypical features in mental health.

What is rejection sensitivity?

Rejection sensitivity is a symptom associated with atypical features.

What is mood reactivity?

Mood reactivity is a temporary improvement in mood in response to positive events.

How do atypical features affect functioning?

They can manifest as diminished functioning due to fear, nervousness, or stress.

Are emotional responses in atypical features usually permanent?

No, they are usually temporary with spontaneous recovery.

Do atypical features always require treatment?

No, in some cases, they do not require treatment.

What are the symptoms of melancholic features?

Symptoms include early morning awakening, mood worse in the morning, and not reactive to positive events.

What can infrequent symptoms of melancholic features manifest as?

Diminished functioning due to fear, nervousness, or stress.

How do emotional responses in melancholic features typically behave?

They are usually temporary, with spontaneous recovery and no need for treatment in some cases.

What does the specifier 'Anxious Distress' indicate?

It is used when anxiety symptoms (tension, worry) are present but do not meet criteria for an anxiety disorder.

What is the relationship between depressive and anxiety disorders in the context of 'Anxious Distress'?

There is high comorbidity between depressive and anxiety disorders.

What is the purpose of the 'Anxious Distress' specifier?

It helps acknowledge the presence of anxiety symptoms.

What are symptoms of a manic episode?

Racing thoughts

What is the significance of the Specifier: Mixed Features in diagnosis?

It helps differentiate depression with manic elements from bipolar disorders.

What prevents a bipolar disorder diagnosis in the context of Mixed Features?

Not enough symptoms to be considered hypomania.

When do the baby blues typically begin?

Within days of delivery.

How long do the baby blues usually last?

Resolves within a month without treatment.

What are the common symptoms of baby blues?

Mild mood swings, irritability, tearfulness.

What is the primary cause of baby blues?

Likely hormonal changes after childbirth.

What percentage of women experience baby blues after childbirth?

Up to 75% of women.

When can postpartum depression develop?

Within 4 weeks of delivery or later.

How do the symptoms of PPD compare to those of a Major Depressive Episode (MDE)?

PPD symptoms are the same as MDE, with severe mood disturbances.

Why does PPD require medical and psychological intervention?

Because it is a clinical condition that does not resolve on its own and can significantly impact the mother's well-being and family dynamics.

What distinguishes clinical depression from normal sadness?

Clinical depression is extreme, persistent, and disrupts daily life, while normal sadness is a temporary emotional response to negative events.

What role does cognitive impairment play in clinical depression?

It affects concentration, decision-making, and the ability to complete tasks at work, school, or in daily life.

Why is normal sadness considered a transient emotional state?

It naturally resolves over time without the need for treatment.

What is the minimum duration of symptoms required for a PDD diagnosis in adults?

At least 2 years.

How does PDD differ from MDD in terms of severity and duration?

PDD is less severe but lasts longer (≥2 years in adults, ≥1 year in youth).

What are some common symptoms of PDD?

Low self-esteem, fatigue, poor concentration, appetite/sleep disturbances, and feelings of helplessness.

How does PDD impair quality of life despite being less severe than MDD?

It causes long-term distress and functional limitations.

How does the onset of PDD differ from MDD?

PDD develops gradually, while MDD has a sudden onset.

Why do individuals with PDD often function better than those with MDD?

Because PDD symptoms are milder and allow for some level of normal activity

Why is it important to rule out medical conditions and medications before diagnosing MDD or PDD?

To ensure symptoms are not caused by an underlying medical issue or substance use.

How does a history of manic or hypomanic episodes affect the diagnosis of depressive disorders?

It suggests bipolar disorder rather than MDD or PDD.

Why must PDD symptoms not occur exclusively during a chronic psychotic disorder?

To differentiate it from schizophrenia or other psychotic conditions.

Why is late-life depression not considered a normal part of aging?

Aging itself does not cause depression, but it is often under-detected.

Why is depression often under-detected in older adults?

Symptoms present differently, often as physical complaints.

How does the presentation of depression differ in older adults compared to younger adults?

Less sadness, more anhedonia, increased social withdrawal, and somatization.

What cognitive symptoms are more common in late-life depression?

Slowed thinking, executive dysfunction, and symptoms resembling dementia.

How many somatic or cognitive symptoms must be present for an MDD diagnosis?

At least four additional symptoms.

What are some common cognitive symptoms of MDD?

Difficulty concentrating, feelings of worthlessness, excessive guilt, and suicidal thoughts.

How does depression increase the risk of suicide?

Individuals with depression are twice as likely to die by suicide compared to the general population.

How does gender impact suicide risk?

Men die by suicide at twice the rate of women globally.

Which group has the highest suicide completion rate?

Depressed men aged 85+ have a suicide completion rate five times higher than the general population.

What is the strongest predictor of future suicide attempts?

A previous suicide attempt.

What are additional risk factors for suicide?

Family history of suicide, feelings of hopelessness, substance abuse, personality disorders, adverse life events, physical illness, and access to lethal means.

Which personality disorder is strongly associated with suicide risk?

Borderline Personality Disorder (BPD) due to emotional instability and impulsivity.

How does bipolar disorder differ from depressive disorders?

It includes episodes of mania or hypomania, whereas depressive disorders do not.

What is required for a Bipolar I diagnosis?

At least one manic episode in a person's lifetime.

How does Bipolar II differ from Bipolar I?

It involves hypomanic episodes rather than full manic episodes and requires major depressive episodes.

What is the key feature of mania?

A distinct period of abnormally elevated, expansive, or irritable mood.

What are some symptoms of a manic episode?

Grandiosity, decreased need for sleep, pressured speech, racing thoughts, distractibility, increased activity, and impulsivity.

How long must a manic episode last?

At least 7 days.

What is the primary treatment for bipolar disorder?

Mood stabilizers (Lithium)

How does a hypomanic episode differ from a manic episode?

It is less severe, lasts no more than 4 days, does not cause significant impairment, and does not include psychosis.

What is Cyclothymic Disorder?

A chronic mood disorder with fluctuating periods of hypomanic and depressive symptoms that do not meet full criteria for mania or major depression.

How does gender affect bipolar disorder?

No significant gender differences in incidence, but women report more depressive episodes.

Which mental health disorder has one of the highest suicide rates?

Bipolar disorder.

What percentage of individuals with bipolar disorder attempt suicide?

Over 50%.

When do most suicide attempts occur in individuals with bipolar disorder?

During manic episodes.

What are common triggers for depressive episodes in bipolar disorder?

Negative life events, stress, social isolation, and high family expressed emotion (criticism, judgment).

What are common triggers for manic episodes?

Sleep disruption, goal attainment, and high sensitivity to rewards.

Depressive episode

A period of at least two weeks in which there is a prominent and persistent depressed mood or lack of interest and at least four other depressive symptoms.

How does reinforcement impact depression?

A lack of response-contingent positive reinforcement can lead to depression.

What is learned helplessness?

A belief that one has no control over life outcomes, leading to passivity and despair.

What is Beck's model of depression?

It involves negative self-schemas, faulty information processing, and pessimistic thinking about the self, world, and future.

What is the helplessness and hopelessness theory?

Depressed individuals attribute failures to internal, stable, and global causes.

What is ruminative response style?

A tendency to dwell on negative thoughts, interfering with problem-solving.

What is the role of unconscious aggression in depression?

Aggressive impulses may be directed inward, leading to self-criticism and low self-worth.

What neurotransmitter imbalances are linked to mood disorders?

Serotonin, norepinephrine, and dopamine deficiencies.

How does the HPA axis contribute to depression?

Dysregulation leads to excessive stress responses and increased vulnerability.

What brain structures are implicated in depression?

Amygdala (emotion regulation), hippocampus (memory), and prefrontal cortex (cognitive flexibility).

What is the heritability rate of bipolar disorder?

Up to 85%.

What is the primary goal of Cognitive-Behavioral Therapy (CBT)?

To challenge negative thoughts and enhance coping skills.

How does Behavioral Activation Therapy (BA) help individuals with depression?

It increases engagement in rewarding activities to improve mood.

What does Interpersonal Therapy (IPT) focus on?

It addresses relationship and social functioning issues.

What is the purpose of Mindfulness-Based Cognitive Therapy (MBCT)?

To reduce rumination and prevent relapse.

How does Acceptance and Commitment Therapy (ACT) differ from other therapies?

It encourages acceptance of distressing thoughts rather than suppressing them.

What are the first-line medications for Major Depressive Disorder (MDD)?

Selective Serotonin Reuptake Inhibitors (SSRIs) like fluoxetine and sertraline.

Which alternative classes of antidepressants can be used if SSRIs are ineffective?

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs), tricyclic antidepressants, and Monoamine Oxidase Inhibitors (MAOIs).

Why should antidepressants be used with caution in bipolar disorder?

They can induce manic episodes.

What are alternative therapies for depression?

Electroconvulsive therapy (ECT), bright light therapy, rTMS, vagus nerve stimulation, and deep brain stimulation.

What is Electroconvulsive Therapy (ECT) primarily used for?

Severe depression, especially when accompanied by psychosis.

What is a noninvasive alternative to ECT for depression treatment?

Repetitive Transcranial Magnetic Stimulation (rTMS).

What are two emerging neuromodulation treatments for mood disorders?

Vagus Nerve Stimulation (VNS) and Deep Brain Stimulation (DBS).