Mood Disorders Notes

Mood Disorders

Overview of Mood Disorders

  • Fluctuations of mood are normal; everyone experiences ups and downs.
  • Mood disorders consist of problematic mood states impairing social functioning, thinking, behaviors, and physical health.
  • Categories of Mood Disorders:
    • Depressive disorders
    • Bipolar disorders

Mood Episodes

  • Emotional states that exceed normal fluctuations define mood episodes:
  • Major Depressive Episodes:
    • Lack of interest in enjoyable activities, sad mood, cognitive and behavioral symptoms lasting at least two weeks.
  • Dysthymic Episodes:
    • Less severe than major depression, with symptoms lasting at least four days in a row.
  • Manic Episodes:
    • Elevated mood, impulsive emotions, thoughts, and actions lasting 7+ days; often involves risks.
  • Hypomanic Episodes:
    • Similar to mania but less severe; lasts 4+ days; less impairment.

Depressive Disorders

  • Unipolar Depressive Disorders:
  • Exists at one end of the mood spectrum, including:
    • Major Depressive Disorder (MDD)
    • Persistent Depressive Disorder (Dysthymia)
Major Depressive Disorder (MDD)
  • Defined by two weeks of low mood/anhedonia along with four other symptoms.
  • Diagnosis Limitations:
  • Cannot be diagnosed if there has been a manic or hypomanic episode.
  • Presentation varies widely among individuals.
Patterns and Cultural Variations of MDD
  • The most common diagnosis in the US, affecting nearly 1 in 5 adults.
  • Frequency is similar across genders during adolescence; women diagnosed nearly twice as often in early adulthood.
  • Cultural variations exist in symptom clusters across different countries.
Seasonal Affective Disorder (SAD)
  • Major depression occurring during winter, often resolving in spring/summer due to reduced sunlight exposure.
Persistent Depressive Disorder (PDD)
  • Longer duration of symptoms (2+ years) with either hypomanic or major depressive episodes. Less common, affecting 6.4% of the US population annually.
Mood Disorder Specifiers
  • Provides details on mood disorders:
  • With anxious distress
  • With psychotic features
  • With peripartum onset
  • With seasonal pattern

Additional Unipolar Mood Disorders

  • Premenstrual Dysphoric Disorder (PMDD):
  • Severe mood symptoms aligned with menstrual cycles; more intense than typical PMS.
  • Disruptive Mood Dysregulation Disorder:
  • Found in children (ages 6-18) characterized by severe temper tantrums and persistent irritability.
  • Prolonged Grief Disorder:
  • Added to DSM-5TR; involves excessive grief symptoms inconsistent with cultural expectations.

Bipolar Disorders

  • Bipolar I Disorder:
  • Alternating between manic and other mood episodes; possible diagnosis without depression history.
  • Bipolar II Disorder:
  • Characterized by hypomanic and major depressive episodes; more common in women.
  • More persistent depressive symptoms; significant risk of suicide.
  • Cyclothymic Disorder:
  • Symptoms include shifts between hypomanic and dysthymic episodes lasting at least two years; increased risk of developing bipolar I.
Prevalence and Onset
  • Lifetime prevalence of bipolar disorder: approx. 2% globally, 4.4% in the US.

Models & Treatments of Mood Disorders

Biological Models
  • Genetic contributions evidenced by twin studies: 46% monozygotic, 20% dizygotic concordance for depression.
  • Biochemical Models:
  • Monoamine hypothesis indicates neurotransmitter malfunction (dopamine, norepinephrine, serotonin).
  • Potential issues include excessive reuptake, insufficient release, and undersensitive receptor sites.
Biological Treatments
  • Medications:
  • Aimed at correcting neurotransmitter irregularities; finding the right drug may take multiple attempts.
  • Common Types:
    • MAOIs: Prevent breakdown of neurotransmitters; have significant side effects.
    • Tricyclic Antidepressants: Prevent reuptake; risk of lethal overdose.
    • SSRIs: More selective with fewer side effects but risks include serotonin syndrome.
  • Lithium: Effective for bipolar, stabilizes glutamate; requires monitoring due to narrow therapeutic window.
Non-Medication Biological Treatments
  • ECT: Induces seizures; can stimulate neurogenesis.
  • TMS: Non-invasive; fewer side effects than ECT.
  • Surgical Techniques: Vagus nerve stimulation and deep brain stimulation.
Psychological Models and Treatments
  • Behavioral Learning Models:
  • Link between stressful life events and depressive symptoms; focus on reinforcing positive experiences.
  • Cognitive Factors:
  • Beck’s Cognitive Triad explains negative thought patterns;
    • Cognitive Therapy encourages recognition and replacement of irrational thoughts.
  • Sociocultural Perspective:
  • Cultural norms affecting expressions of depression; importance of relationships.
  • Treatments include interpersonal therapy, addressing contextual factors related to mood symptoms.