Mood Disorders and Suicide

Mood disorders involve severe and persistent alterations in mood for extended periods.
The two key moods commonly recognized are:
- Depression: Characterized by feelings of extraordinary low mood and dejection.
- Mania: Defined by intense and unrealistic feelings of excitement and euphoria.

Major Depressive Disorder (MDD):
- Lifetime prevalence: approximately 17%.
- Annual prevalence: around 7%.
- Occurs about twice as often in women compared to men.
Bipolar Disorder:
- Lifetime prevalence: about 1%.

Data collected via household surveys as part of the WHO World Mental Health Survey Initiative.
- Reference: WHO World Mental Health Surveys, 2004.

The data represent the estimated share of people with depressive disorders, both diagnosed and undiagnosed.
Significant disparities exist across demographics, necessitating age-standardization for comparative analysis.

Criteria: History of one or more major depressive episode(s) without previous manic, hypomanic, or mixed episodes.
Relapse vs Recurrence:
- Relapse refers to the return of symptoms after recovery, while recurrence means the development of a new episode after full remission.
MDD can begin at any point in life, with incidence peaking during adolescence.

Criteria: At least five symptoms present for a minimum of two weeks, including at least one from the first two:
1. Constantly depressed mood.
2. Anhedonia (loss of interest or pleasure).
3. Significant weight change (gain/loss).
4. Sleep disturbances (hypersomnia or insomnia).
5. Changes in psychomotor activity (restlessness or psychomotor retardation).
6. Fatigue or loss of energy.
7. Feelings of worthlessness or excessive or inappropriate guilt.
8. Diminished ability to think or concentrate or indecisiveness.
9. Recurrent thoughts of death or suicide, or a suicide attempt.
Specifiers may include atypical vs melancholic features, seasonal patterns, and presence of psychotic symptoms.

Formerly known as dysthymia and chronic MDD, combined for DSM-5.
Criteria: Persistently depressed mood most of the day, more days than not, for at least two years (one year for children/adolescents).
- Must meet at least two of the following:
1. Changes in appetite.
2. Sleep problems.
3. Low energy.
4. Poor concentration.
5. Low self-esteem.
6. Feelings of hopelessness.
Specifiers include purely dysthymic, persistent major depressive episode, and mixed features.
Prevalence: Lifetime prevalence of approximately 2.5-6%.

Refers to the occurrence of both PDD and MDD, typically characterized by episodes of major depression occurring during persistent depressive states.

Biological Factors:
- Genetic influences estimated to range between 80-90% heritability.
- Neurotransmitter activity:
- Low serotonin, norepinephrine, and dopamine activity are associated with depressive episodes.
- Altered hormone and immune system regulation, as seen with elevated cortisol.
- Neurophysiological and neuroanatomical influences.
- Sleep and biological rhythms are crucial to mood regulation.
Psychological Factors:
- Stressful life events, particularly early adversities, contribute.
- Behavioral perspective highlights a vicious cycle stemming from a lack of positive reinforcement leading to learned helplessness.
- Cognitive perspective involves the formation of dysfunctional beliefs, leading to negative automatic thoughts and symptoms of depression.
- Interpersonal factors: Lack of social support, hostility, and marital dissatisfaction impact the risk and severity.

Bipolar disorders are characterized by the presence of manic or hypomanic episodes.

Duration: At least one week of an abnormally elevated or irritable mood with three or more of the following:
1. Inflated self-esteem or grandiosity.
2. Decreased need for sleep.
3. Increased talkativeness or pressure to keep talking.
4. Flight of ideas or racing thoughts.
5. Distractibility.
6. Increased goal-directed activity.
7. Excessive involvement in risky activities.

Bipolar I: Characterized by at least one manic episode, which may be preceded or followed by hypomanic or major depressive episodes.
Bipolar II: Defined by at least one major depressive episode and at least one hypomanic episode without a history of manic episodes.

Involves repeated experiences of hypomanic-like symptoms and dysthymic symptoms over at least two years, with periods of no more than two months symptom-free.

Pharmacotherapy:
- Antidepressants (e.g., MAOIs, tricyclics, SSRIs) typically require about one month to take effect.
- Mood stabilizers and atypical antipsychotics are used for bipolar disorders.
- Statistically, ~50% of patients may need to switch medications if no improvement is seen.
Psychotherapy:
- Cognitive-behavioral therapy (CBT) focuses on behavior modification.
- Interpersonal therapy (IPT) and family therapy are also effective approaches.

Suicide is defined as the intentional act of taking one's own life, with approximately 90-95% of those who die by suicide having a history of psychological disorders.
It is important to distinguish between suicidal self-injury and nonsuicidal self-injury.

Suicide ranks as the 15th leading cause of death globally, accounting for roughly 1.4% of all deaths.
In the U.S., the rate is about 10 deaths per 100,000 people, amounting to over 33,000 annually.
Notably, males have a higher rate of suicide deaths while females exhibit higher rates of suicidal ideation and attempts.

Many individuals reveal ambivalence about death prior to suicide, often influenced by situational factors like substance abuse or emotional crises.
Crisis Intervention: Here are steps to take during a crisis:
1. Maintain supportive contact and show that distress may impair judgment.
2. Ensure immediate threats are addressed, especially urging help through mental health professionals or emergency services.

Debates exist on whether there is a right to die, including cultural and societal norms surrounding suicide and suicide prevention.