Chapter 5 - Mood Disorders

Major Depressive Disorder (MDD)

Severely low mood and experiencing anhedonia

How do physicians diagnose patients with MDD

Symptoms must persist for a minimum of 2 weeks including severly low mood and adjuctive symptoms

Adjunctive symptoms for MDD

sense of guilt, changes in appetite, sleep disturbance, low energy, poor concentration, thoughts of death, etc.

Bereavement exclusion 

Depressive symptoms stemming from loss of loved ones was not deemed major depression 

Controversy of new DSM-V on MDD

May be medicalizing grief or loss and lead to over-treatment

Persistent Depressive Disorder

Less intense version of MDD but is over a period of 2 or more years

Symptoms of Persistent Depressive Disorder

Feeling low, limited/excess appetite, sleep disruption, lethargy, general sense of failure 

Premenstrual Dysphoris Disorder (PMDD)

A significantly distressing form of premenstrual syndrome (PMS)

PMDD Symptoms

changing mood, irritability, appetite change during the luteal phase

Disruptive Mood Dysregulation Disorder (DMDD)

Children who exhibit behaviours such as extreme anger or irritability in situations where it is considered unwarranted

Controversy behind DMDD

• Medicalizes what may be normal phases of emotional development among children and youth 

• Majority diagnosed with DMDD also match symptoms of oppositional defiant disorder 

• Children diagnosed with DMDD are likely treated with antipsychotic medication

Bipolar disorder

Epdisodes of mania and episodes of depression, previously termed “manic depression”

Define mania and depression 

Mania: High energy/excitement

Depression: Melancholy

DSM-V characterization of mania

Distinct periods of abonormally and persistently elevated, expansive, or irritable mood and abonormally and persistently increased goal-directed activity or enrgy lasting at least a week

Hypomania

A milder form of mania — elevated mood with lesser degrees of funtional impairment:

• e.g. less need for sleep, higher energy, and self-confidence, overly optimistic attitude 

Difference between mania and hypomania 

Mania is more severe, may involve psychosis, more likely to lead to incarceration or hospitilization, treatment may also differ 

3 forms of Bipolar Disorder

1. Bipolar I 

2. Bipolar II 

3. Cyclothymic disorder 

Bipolar I

Mania and depression (depression not necessary for diagnosis)

Bipolar II

Hypomania and more severe depression (stronger depressive symptoms, less intense mania)

Cyclothymic Disorder

Mildest form of BPD, with swings between depression and hypomania

Euthymia

Periods without mania and depression

Types of treatment for mood disorders

• Psychotherapy (most common is cognitive behavioural therapy)

• Psychopharmaceuticals (tricyclic antidepressants, SSRI’s, and lithium) 

• Electroconvulsive therapy (ECT) when other treatments fail 

Define iatrogenic

A negative health outcome resulting from medical intervention

Potential biases in evidence on antidepressants

• Inflating positive findings regarding effectiveness

• Deflating negative findings

Case Study 1 Results 

• Most of the benefit seen in antidepressant trials comes from placebo effects, not the drugs themselves

• When unpublished trials are included, only a small fraction show a meaningful advantage of antidepressants over placebo

• Psychotherapy, exercise, and acupuncture work just as well with fewer risks and are preferred by most patients.

Case Study 2 Results

• Depressive episodes often resolve on their own, but medications speed remission—though stopping them too soon raises relapse risk.

• Cognitive-behavioural therapy (CBT) is as effective as antidepressants for even severe depression and has longer-lasting protection against relapse after treatment ends.

• Combining CBT with medication can cancel CBT’s enduring benefits, and some evidence suggests psychiatric drugs may worsen long-term outcomes for some patients.

Case Study 3 Results

Both ADMs (antidepression medication) and psychotherapy have benefits and side effects, but depression remains underfunded despite its high disability and mortality burden.

How does mass media shape people’s experience and meaning

• Shapes the understanding on mental health

• Stigmatizes and sheds a negative light on people living with mental illnesses

How does social media shape people’s experience and meaning

• More space for people to have a voice/platform

• Can share experiences and connect with people 

• Raise awareness and fight stigma

How does art and popular culture shape people’s experience and meaning

• Help convey the complexity of experiences through art