Depressive disorders Notes

NOTES NOTES DEPRESSIVE & BIPOLAR DISORDERS GENERALLY, WHAT ARE THEY? PATHOLOGY & CAUSES Mental disorders involving mood changes ▪ Often involve depression, sometimes mania/hypomania (see below) CAUSES ▪ Genetic (especially between close relatives) ▪ Linked to neurotransmitter regulation (norepinephrine, serotonin, dopamine) ▪ High comorbidity with other mental disorders COMPLICATIONS ▪ Self-harm/suicide ▪ Social consequences (e.g. losing friends) SIGNS & SYMPTOMS ▪ Manic episodes featuring a mood disturbance, increased energy/activity, and ≥ three of following for ≥ one week, affecting day-to-day functioning ▪ Hypomanic (“less than manic”) episodes featuring a mood disturbance, increased energy/activity, and ≥ three of the above during a period > four days, not affecting day-to-day functioning ▪ Major depressive episodes featuring ≥ five of following in a two week period ▪ Other mood changes, including more mild depression; see individual disorders 700 OSMOSIS.ORG DIAGNOSIS ▪ ▪ ▪ ▪ ▪ Excessive, unreasonable fear/distress Struggle to control symptoms Lasts > six months Affects day-to-day functioning Not explained by other condition/substance TREATMENT MEDICATIONS ▪ Antidepressants, lithium PSYCHOTHERAPY ▪ See individual disorders OTHER INTERVENTIONS ▪ Lifestyle changes ▫ Improved diet, more exercise, more sunlight

Chapter 92 Depressive & Bipolar Disorders BIPOLAR I DISORDER osms.it/bipolar-I PATHOLOGY & CAUSES Bipolar disorder characterized by extreme mood swings with combination of manic, hypomanic, depressive episodes CAUSES ▪ ▪ ▪ ▪ Genetic (especially between close relatives) Medications (e.g. SSRIs) Often no particular trigger High comorbidity with other mental disorders MNEMONIC: DIG FAST Characteristics of manic episode Distractibility Indiscretion: excessive involvement in pleasurable activities Grandiosity Flight of ideas Activity increase Sleep deficit/decreased need for sleep Talkativeness/pressured speech SIGNS & SYMPTOMS ▪ Mood swings ▪ Manic episodes ▪ Usually, hypomanic and depressive episodes DIAGNOSIS ▪ ≥ one manic episode ▪ Symptoms affect day-to-day functioning ▪ Not caused by other condition/substance TREATMENT MEDICATIONS ▪ Atypical antipsychotics (e.g. olanzapine), in combination with mood stabilizers (esp. lithium) PSYCHOTHERAPY ▪ E.g. cognitive behavioral therapy, interpersonal OTHER INTERVENTIONS ▪ Electroconvulsive therapy (ECT) OSMOSIS.ORG 701

BIPOLAR II DISORDER osms.it/bipolar-II DIAGNOSIS PATHOLOGY & CAUSES Bipolar disorder characterized by mood swings with hypomanic, depressive episodes. CAUSES ▪ ▪ ▪ ▪ Genetic (especially between close relatives) Medications (e.g. SSRIs) Often no particular trigger High comorbidity with other mental disorders SIGNS & SYMPTOMS ▪ Mood swings ▪ Hypomanic, depressive episodes ▪ ▪ ▪ ▪ ≥ one hypomanic episode ≥ one major depressive episode Symptoms affect day-to-day functioning Not caused by other condition/substance TREATMENT MEDICATIONS ▪ Atypical antipsychotics (e.g. olanzapine), in combination with mood stabilizers (esp. lithium) PSYCHOTHERAPY ▪ E.g. cognitive behavioral therapy, interpersonal MAJOR DEPRESSIVE DISORDER osms.it/major-depressive-disorder PATHOLOGY & CAUSES Depressive disorder characterized by one or more episodes of a strongly depressed mood ▪ Episodes interfere with day-to-day life in activities such as eating, working, and sleeping CAUSES ▪ Exact cause unknown; runs in families, especially between close relatives; linked to neurotransmitter regulation (norepinephrine, serotonin, dopamine); high comorbidity with other mental disorders 702 OSMOSIS.ORG SIGNS & SYMPTOMS ▪ Major depressive episodes DIAGNOSIS ▪ One or more major depressive episodes ▪ The symptoms cause distress in other areas of life ▪ The disturbance is not better explained by or accounted for by another medical condition or substance ▫ There has not been a manic or hypomanic episode

Chapter 92 Depressive & Bipolar Disorders MNEMONIC: SIG ED CAPS Diagnostic criteria for Major depressive disorder Sleep: increased or decreased Interest: decreased Guilt/worthlessness Energy: decreased or fatigued Depressed mood most of the day Concentration/difficulty making decisions Appetite and/or weight increase or decrease Psychomotor activity: increased or decreased Suicidal ideation/ thoughts of death TREATMENT MEDICATIONS ▪ Antidepressants (SSRIs, SNRIs, NDRIs) PSYCHOTHERAPY ▪ E.g., cognitive behavioral therapy, interpersonal OTHER INTERVENTIONS ▪ Improved diet, more exercise, more sunlight PREMENSTRUAL DYSPHORIC DISORDER osms.it/premenstrual-dysphoric-disorder PATHOLOGY & CAUSES ▪ Depressive disorder characterized by mood changes during menstrual cycle CAUSES ▪ Unknown; possible sensitivity to hormonal changes SIGNS & SYMPTOMS ▪ Emotional ▫ Affective lability ▫ Irritability/anger ▫ Anxiety/angst ▪ Other symptoms ▫ Diminished interest/pleasure ▫ Decreased concentration ▫ Fatigue ▫ Weight loss/gain ▫ Inability to sleep/oversleeping ▫ Feelings of being overwhelmed ▫ Mild physical symptoms (e.g. tenderness/swelling) DIAGNOSIS ▪ Mood changes ≤ one week before menses, as evidenced by presence of ≥ five of symptoms (≥ one from each category), resolving within one week post-menses ▪ Must occur during majority of menstrual cycles over past year ▪ Symptoms affect day-to-day life ▪ Not caused by other condition/substance OSMOSIS.ORG 703

TREATMENT MEDICATIONS ▪ SSRIs, oral contraceptives PSYCHOTHERAPY ▪ E.g. cognitive behavioral therapy, interpersonal OTHER INTERVENTIONS ▪ Lifestyle changes: improved diet, more exercise, more sunlight SEASONAL AFFECTIVE DISORDER osms.it/seasonal-affective-disorder PATHOLOGY & CAUSES ▪ Depressive disorder characterized by one or more episodes of a strongly depressed mood ▪ Episodes interfere with day-to-day life in activities such as eating, working, and sleeping ▪ Occurs most commonly in seasons of lower light, like winter CAUSES ▪ Exact cause unknown; runs in families, especially between close relatives; linked to neurotransmitter regulation (norepinephrine, serotonin, dopamine); high comorbidity with other mental disorders SIGNS & SYMPTOMS ▪ Major depressive episodes DIAGNOSIS ▪ One or more major depressive episodes ▪ The symptoms cause distress in other areas of life ▪ The disturbance is not better explained by or accounted for by another medical condition or substance ▫ There has not been a manic or hypomanic episode TREATMENT MEDICATIONS ▪ Antidepressants (SSRIs, SNRIs, NDRIs) PSYCHOTHERAPY ▪ E.g. cognitive behavioral therapy, interpersonal OTHER INTERVENTIONS ▪ Improved diet, more exercise, more sunlight 704 OSMOSIS.ORG