Bipolar and Depressive Disorders: Treatment and Etiology

What is the typical treatment approach for bipolar disorder?

A combination of psychosocial interventions and pharmacotherapy.

Bipolar Disorders

The bipolar disorders include bipolar I disorder, bipolar II disorder, and cyclothymic disorder.

Bipolar Disorder I

The diagnosis of bipolar I disorder requires at least one manic episode that may or may not have been preceded or followed by one or more major depressive or hypomanic episodes.

Bipolar Disorder II

The diagnosis of bipolar II disorder requires at least one hypomanic episode and at least one major depressive episode.

What is cyclothymic disorder?

A mood disorder characterized by numerous periods of hypomanic symptoms and depressive symptoms that do not meet the criteria for hypomanic or major depressive episodes.

What is the minimum duration of symptoms for cyclothymic disorder in adults?

Two years

What is the minimum duration of symptoms for cyclothymic disorder in children and adolescents?

One year

What are some evidence-based psychosocial interventions for bipolar disorder?

Psychoeducation, interpersonal and social rhythm therapy, cognitive-behavior therapy, and family-focused therapy.

What is the role of family-focused therapy in bipolar disorder treatment?

It is based on the assumption that high expressed emotion by family members can trigger relapse.

Which medication is usually most effective for classic bipolar disorder?

Lithium.

What characterizes classic bipolar disorder?

Low likelihood of mixed mood states and rapid cycling, long periods of recovery between episodes, and onset between 15 and 19 years of age.

What types of medications are effective for atypical bipolar disorder?

Anticonvulsant drugs (e.g., carbamazepine, valproic acid) and second generation antipsychotic drugs.

What characterizes atypical bipolar disorder?

Mixed mood states, rapid cycling, lack of full recovery between episodes, and onset between 10 and 15 years of age.

What is the distinction between classic and atypical bipolar disorder according to DSM-5-TR?

The distinction is not a DSM-5-TR categorization; DSM-5-TR provides the specifier 'with atypical features' for bipolar disorder.

What are the depressive disorders included in the classification?

Major depressive disorder, persistent depressive disorder, and disruptive mood dysregulation disorder.

What are the criteria for diagnosing major depressive disorder?

Five or more symptoms of a major depressive episode for at least two weeks, with at least one symptom being depressed mood or loss of interest or pleasure.

What is required for a diagnosis of persistent depressive disorder?

A depressed mood with two or more characteristic symptoms for at least two years in adults or one year in children and adolescents.

What are the criteria for disruptive mood dysregulation disorder?

Severe and recurrent temper outbursts occurring three or more times each week and a persistently irritable or angry mood observable to others most of the day.

What are the specifiers for major depressive disorder in DSM-5-TR?

With peripartum onset and with seasonal pattern.

What does the specifier with peripartum onset indicate?

Onset of symptoms occurs during pregnancy or within four weeks after delivery.

What percentage of women experience 'baby blues' after childbirth?

Up to 80%.

What are effective treatments for peripartum depression?

Cognitive-behavioral therapy and interpersonal therapy.

Which antidepressant is noted as effective for peripartum depression?

Sertraline.

What factors must be considered before prescribing antidepressants to pregnant or breastfeeding women?

Potential negative effects for the developing fetus and newborns, and the impact of untreated maternal depression.

What is the relationship between exercise and peripartum depression according to studies?

Exercise reduces symptoms of peripartum depression, but studies show inconsistent results regarding the magnitude of its effects due to methodological differences.

What were the findings of the meta-analysis comparing aerobic exercise alone to aerobic exercise with co-occurring interventions?

The meta-analysis found that exercise alone had a non-significant beneficial effect on depressive symptoms, while exercise with co-interventions was significantly more effective than the co-interventions alone.

What is seasonal affective disorder (SAD) and what are its symptoms?

SAD is a disorder characterized by a temporal relationship between mood episodes and time of year, usually winter, with symptoms including hypersomnia, overeating, weight gain, and carbohydrate cravings.

What hormonal levels are associated with seasonal affective disorder?

SAD has been linked to lower-than-normal levels of serotonin and higher-than-normal levels of melatonin.

How is seasonal affective disorder often treated?

SAD is often responsive to phototherapy, which involves exposure to bright light that suppresses melatonin production.

How do rates of depression differ between boys and girls during childhood?

During childhood, rates of depression are similar for boys and girls, but the rate for females increases in early adolescence while the rate for males remains stable.

What factors contribute to the gender difference in depression rates during adolescence?

Biological and psychological factors, including hormonal changes at puberty that sensitize females and desensitize males to stress from negative life events.

What is the rate of depression in female adolescents and adults compared to males?

Female adolescents and adults have a depression rate that is 1.5 to 3 times higher than that of male adolescents and adults.

What are some etiological factors linked to Major Depressive Disorder?

Major Depressive Disorder is linked to heredity, neurotransmitter abnormalities, hormone and brain abnormalities, and cognitive and behavioral factors.

What did Strakowski and Nelson (2015) find regarding genetic components of depression?

They found that concordance rates for unipolar depression in high-quality twin studies ranged from about .30 to .50 for monozygotic twins and .20 to .30 for dizygotic twins.

How does gender affect concordance rates for depression in twins?

Concordance rates are higher for female twins than male twins.

What neurotransmitters are related to depression?

Depression is related to low levels of serotonin, dopamine, and norepinephrine.

What role does the hypothalamic-pituitary-adrenal (HPA) axis play in depression?

The HPA axis is involved in the body's reaction to stress, and chronic stress exposure can lead to hyperactivity of the HPA axis and hypersecretion of cortisol, increasing the risk for depression.

What structural and functional brain abnormalities are linked to depression?

Depression is linked to abnormalities in the prefrontal cortex, cingulate cortex, hippocampus, caudate nucleus, putamen, amygdala, thalamus, and other brain areas.

What is the significance of chronic stress in relation to depression?

Chronic stress, especially early in life, can lead to persistent hyperactivity of the HPA axis and increased cortisol levels, which are associated with a higher risk of depression.

What is the relationship between the ventromedial prefrontal cortex (vmPFC) and depression?

Depression is associated with abnormally high levels of activity in the vmPFC.

What is the relationship between the dorsolateral prefrontal cortex (dlPFC) and depression?

Depression is associated with abnormally low levels of activity in the dlPFC.

What changes in brain activity are associated with remission of depressive symptoms?

Remission is associated with decreased activity in the vmPFC and increased activity in the dlPFC.

What does Lewinsohn's social reinforcement theory suggest about the cause of depression?

It suggests that depression results from a low rate of response-contingent reinforcement for social behaviors due to lack of reinforcement and/or poor social skills.

What are the consequences of low response-contingent reinforcement according to Lewinsohn's theory?

It leads to social isolation, low self-esteem, pessimism, and further decreases the likelihood of positive reinforcement.

What is Seligman's learned helplessness model?

It links depression to repeated exposure to uncontrollable negative life events that result in a sense of helplessness.

What does the reformulated version of Seligman's learned helplessness model emphasize?

It emphasizes the role of a negative cognitive style that attributes negative life events to stable, internal, and global factors.

What is hopelessness theory in relation to depression?

It describes a sense of hopelessness as the proximal and sufficient cause of depression, resulting from negative events and a negative cognitive style.

What does Beck's cognitive theory attribute depression to?

It attributes depression to a negative cognitive triad consisting of negative thoughts about oneself, the world, and the future.

What age-related risk factors are associated with major depressive disorder in younger adults?

Genetics, stressful life events, and limitations in problem-solving and cognitive abilities.

What is a significant risk factor for major depressive disorder in older adults?

Chronic medical illness, especially when it decreases physical functioning and contributes to social isolation.

How do older adults typically express symptoms of major depressive disorder compared to younger adults?

Older adults are less likely to refer to affective symptoms and more likely to refer to somatic symptoms and cognitive changes.

What cultural differences exist in the expression of major depressive disorder?

Members of non-Western cultures often report more somatic symptoms, while Western cultures report more psychological symptoms.

What did Ryder and colleagues find in their comparison of Chinese and Euro-Canadian outpatients regarding depressive symptoms?

Chinese patients emphasized somatic symptoms, while Euro-Canadian patients emphasized psychological symptoms.

What is comorbidity in the context of major depressive disorder?

It refers to the occurrence of major depressive disorder alongside other psychiatric disorders.

What is the most common comorbid disorder reported by U.S. adults with major depressive disorder?

Substance use disorder, especially alcohol use disorder.

What are some sleep abnormalities associated with depression?

Prolonged sleep latency, reduced REM latency, reduced slow-wave sleep, and increased REM density.

Which medical conditions have been linked to depression?

Coronary heart disease, stroke, diabetes, and Parkinson's disease.

How does depression relate to myocardial infarction?

Depression is independently predictive of an increased risk for myocardial infarction.

What psychiatric disorders commonly develop after a myocardial infarction?

Depression and anxiety, with depression being more common.

What are the two main types of treatment for major depressive disorder?

Psychotherapy and pharmacotherapy.

What did a meta-analysis find regarding the effectiveness of combined treatment for major depressive disorder?

Combined treatment was more effective than either psychotherapy alone or pharmacotherapy alone.

What treatment does the APA guideline recommend for children with major depressive disorder?

Insufficient evidence to recommend any particular psychosocial or pharmacological treatment.

What psychosocial interventions does the APA guideline recommend for adolescents?

Cognitive-behavioral therapy (CBT) or interpersonal psychotherapy for adolescents (IPT-A).

What first-line medication is recommended for adolescents with major depressive disorder?

Fluoxetine.

What initial treatment options are recommended for adults with major depressive disorder?

Either psychotherapy or a second-generation antidepressant (SSRI or SNRI).

What psychotherapies are recommended for adults with major depressive disorder?

CBT, mindfulness-based cognitive therapy (MBCT), interpersonal therapy (IPT), behavioral therapy, psychodynamic therapy, and supportive therapy.

What does the guideline suggest for patients with chronic or treatment-resistant depression?

The combination of CBT or IPT and an antidepressant is usually appropriate.

What is the recommendation for older adults with major depressive disorder?

Either group cognitive-behavioral therapy (group-CBT) or the combination of IPT and a second-generation antidepressant.

What does the APA guideline state about recommending one treatment over another for adults?

It does not recommend one treatment option (psychotherapy or antidepressant) over the other.

What is the significance of the relationship between depression and some medical conditions?

The relationship can be bidirectional.

What is the main finding regarding the effectiveness of psychotherapy alone versus pharmacotherapy alone?

No significant differences in effectiveness were found between psychotherapy alone and pharmacotherapy alone.

What does increased REM density indicate in individuals with depression?

More rapid eye movements per unit of time during sleep.

What is the role of clinicians in deciding treatment for major depressive disorder?

Clinicians and patients should decide if combined treatment is desirable.

What is the significance of the studies referenced in the treatment of major depressive disorder?

They provide evidence-based recommendations for treatment options across different age cohorts.

What is the importance of the APA's Clinical Practice Guideline for the Treatment of Depression?

It provides structured treatment recommendations for children, adolescents, adults, and older adults.

What is the evidence regarding self-guided bibliotherapy or life review therapy for older adults?

There is insufficient evidence to recommend these therapies for older adults.

What herb is supported by studies for treating mild and moderate depression?

St. John's wort.

How does St. John's wort compare to SSRIs in terms of treatment for depression?

It has similar therapeutic effects for mild and moderate depression, lower dropout rates, and fewer side effects.

What are the risks associated with taking St. John's wort?

It can interact with SSRIs and other medications, potentially causing serotonin syndrome or reducing the effectiveness of those drugs.

What is ketamine used for in treating depression?

It is effective as a fast-acting treatment for treatment-resistant depression (TRD) and suicidal ideation.

How does ketamine exert its therapeutic effects?

By increasing glutamate levels.

What form is ketamine prescribed for depression?

As a nasal spray (esketamine) used in conjunction with an oral antidepressant.

What is electroconvulsive therapy (ECT) used for?

It is used to treat severe depression, especially when other treatments have not been effective.

What are the reported response and remission rates for ECT?

Response rates approach 80% and remission rates approach 70%.

How quickly does ECT produce remission compared to other treatments?

ECT produces remission within 1 to 3 weeks, while other treatments take longer.

What types of amnesia can result from ECT?

Anterograde amnesia and retrograde amnesia.

How does anterograde amnesia resolve after ECT?

It usually resolves within a few weeks after the last ECT session.

What is a disadvantage of repetitive transcranial magnetic stimulation (rTMS)?

It has lower response and remission rates compared to ECT.

What is a benefit of rTMS compared to ECT?

rTMS does not require sedation or cause memory loss.

What did a meta-analysis find about telepsychology compared to face-to-face psychotherapy?

The two approaches had similar outcomes in terms of depressive symptom severity, quality of life, client satisfaction, and therapeutic alliance.

What trend was observed in suicide rates in the United States from 2000 to 2018?

Suicide rates increased from 2000 to 2018 but decreased slightly from 2018 to 2020.

Which gender has consistently higher suicide rates in the U.S. from 2000 to 2020?

Males.

What age group had the highest suicide rates in 2020?

Individuals ages 75 and older.

Which racial/ethnic group had the highest suicide rates in 2020?

American Indians/Alaska Natives.

What was the highest suicide rate for males in 2020 by age?

For those 75 years of age and older.

What was the highest suicide rate for females in 2020 by age?

For those 45 to 64 years of age.

In 2020, which age group had the highest suicide rates for American Indians/Alaska Natives, Hispanics, and Blacks?

Ages 25 to 34.

What age group had the highest suicide rate for Whites in 2020?

Ages 45 to 54.

What age group had the highest suicide rate for Asians/Pacific Islanders in 2020?

The specific age group is not provided in the notes.