Mood Disorders Overview

Mood Disorders Overview

• Mood disorders involve significant mood changes over extended periods.
• Two main categories of mood disorders:
  • Depressive Disorders: Characterized by only depressive episodes.
  • Bipolar Disorder (Manic Depression): Characterized by alternating manic and depressive episodes.

Periods of Mood Disorders

• Mania: Intense feelings of euphoria and excitement.
• Depression: Profound sadness and dejection.
• Both states can alternate in distinct periods.

Unipolar Mood Disorders: Major Depressive Disorder (MDD)

• Symptoms for Diagnosis: Presence of symptoms for over two weeks without prior manic episodes.
• Duration: Untreated MDD lasts approximately 6-9 months.
• Subtypes of MDD:
  • Single Episode: One depressive episode.
  • Recurrent Episodes: Two or more episodes with at least two months in between.
• Persistent Depressive Disorder: Chronic depression lasting for at least two years (one year for children).

Recurrence of Depression

• Recurrence Types:
  • Relapse: Symptoms return shortly after previous symptoms ended.
  • Recurrence: Full depressive symptoms return after a period of absence.
• Statistics: 40-50% of MDD patients experience recurrence.
• Factors contributing to prolonging depression include high genetic risk and life stressors.

Common Symptoms of Major Depressive Disorder

• Loss of interest (anhedonia).
• Altered sleep patterns (insomnia/hypersomnia).
• Changes in appetite (increase/decrease).
• Psychomotor symptoms:
  • Retardation: Slowed behaviors leading to accidents.
  • Agitation: Involuntary fidgeting and restlessness.

DSM-5 Criteria for MDD

• At least five of the following must be present:
  • Depressed mood or loss of interest most days.
  • Recurring thoughts of death/suicide.
  • Significant changes in sleep or appetite.
  • Fatigue or loss of energy.
  • Impaired concentration or indecisiveness.
  • Feelings of worthlessness or excessive guilt.
  • Symptoms not due to physiological effects or medical conditions.

Subtypes of MDD Explained

• Anxiety Features: Anxiety symptoms co-occurring with depressive symptoms.
• Mixed Features: Meeting criteria for depression with some manic symptoms.
• Atypical Features: Mood improves in response to positive events.
• Melancholic Features: Lack of interest/enjoyment in activities.
• Catatonic Features: Includes psychomotor disturbances.
• Psychotic Features: Experiencing hallucinations/delusions aligned with depression.
• Seasonal Pattern (SAD): Depression linked to seasonal changes.
• Peripartum Onset: Depression related to pregnancy or post-birth.

Comorbidity in Depressive Disorders

• Over 75% of individuals with depression have at least one other disorder (e.g., anxiety, substance use).
• Differential patterns for men (substance abuse) and women (anxiety disorders).

Prevalence of MDD

• Estimated 16% of adults in the U.S. experience MDD.
• Commonly develops in ages 18-29; difficult to detect in older adults.
• Prevalence statistics for children and adolescents: 1–3% schoolchildren and 15%–20% adolescents.
• Gender disparities: women are twice as likely to be diagnosed as men.

Causal Factors of Depressive Disorders

Biological Factors

• Hormones: Affect appetite, sleep, and pleasure perception; HPA axis hyperactivity.
• Neurochemical changes: Imbalances in norepinephrine, serotonin, and dopamine.
• Sleep cycles: Disturbances lead to hypersomnia or insomnia during episodes.

Psychological Factors

• Correlation between marital problems and clinical depression.
• High vulnerability among neurotic individuals; introversion can exacerbate risks.
• Stressful life events are significant predictors of depression.

Behavioral Theories

• Stressful life events can reduce positive reinforcement, leading to depression.
• Learned Helplessness Theory: Perception of lack of control contributes to depression.

Cognitive Theories

• Beck's Cognitive Theory: Negative cognitive patterns precede depression.
• Abramson's Revised Helplessness Theory: Emphasis on hopelessness and attributional style.

Interpersonal Theories

• Focus on relationship difficulties and need for support; rejection sensitivity.

Sociocultural Factors

• Cultural differences affect susceptibility and expression of depressive disorders.

Gender Difference Theories

• Different theories account for higher prevalence among women (stressors, roles, and societal expectations).

Bipolar and Related Disorders Overview

• Bipolar I Disorder: Characterized by severe episodes of depression and mania.
• Bipolar II Disorder: Involves milder manic episodes.
• Cyclothymic Disorder: Chronic, less severe mood changes for at least two years.

Symptoms of Manic Episodes

• Elevated mood, increased energy, and self-esteem; possible irritability or aggression.
• DSM-5 Criteria for Mania:
  • Lasting elevated mood for at least one week and accompanied by 3+ symptoms (e.g., grandiosity, distractibility).

Causal Factors of Bipolar Disorders

• Strong genetic links; environmental triggers can exacerbate episodes.
• Structural brain abnormalities related to emotional processing are implicated.

Treatment Options for Mood Disorders

Biological Treatments

• Antidepressants: Varying effectiveness; SSRIs and SNRIs are common first-line treatments.
• Mood Stabilizers: Help manage bipolar disorder symptoms.
• Electroconvulsive Therapy: For severe cases, particularly when other treatments fail.

Psychological Treatments

• Cognitive Behavioral Therapy (CBT): Focus on modifying cognitive distortions and behaviors.
• Interpersonal Therapy (IPT): Address interpersonal issues and improve social functioning.

Other Treatments

• Light Therapy: Effective for seasonal affective disorder (SAD).
• Vagus Nerve Stimulation (VNS): An emerging treatment option.
• Deep Brain Stimulation: Last resort for treatment-resistant cases.