major depressive episode

• depressed mood or loss of interest/pleasure• appetite or body weight change (5%+)• sleep problems• psychomotor agitation or retardation• fatigue• feelings of worthlessness or guilt• poor concentration• thoughts of death or suicide (distress or impairment)

(lasts 4-9 mo if left untreated)

For 2 weeks, 5+:

exception for bereavement

(grief over death of loved one)

manic episode

• inflated self-esteem/grandiosity• less need for sleep• excessively talkative• racing thoughts• too easily distracted• increased goal-directed activity/ psychomotor agitation• excessive pleasurable but risky activities

(lasts 3-6 mo if untreated)

1 week of elevated, expansive, or irritable mood and 3+:

mixed manic episode

Meets criteria for both major depressive episode & manic episode (except duration is 1+ week).

hypomanic episodeLess severe than mania & does not cause impairment(at least 4 days)

unipolar mood disorder

Major Depressive Disorder, single episode (rare!)Major Depressive Disorder, recurrent

dysthymic disorder2+ years depressed mood, more days than not

double depressiondysthymic disorder + major depressive episode

bipolar I disordera manic episode

bipolar II disorderhypomanic episode + major depressive episode

cyclothymic disorder2+ years alternating dysthymia & hypomania

the following are all chronic w/ poor prognosis

rapid cycling?

theories for depressionBIOLOGICAL VULNERABILITY

genes- concordance evidence from family & twin studies- 40% genetic & 60% nonshared environmental factors- (diathesis-stress or reciprocal gene-env model)

biochemistry- low serotonin = dysregulation of norepinephrine & dopamine- high stress hormones

PSYCHOLOGICAL VULNERABILITY

ANXIETY DEPRESSION

Gives up hope.Uncertain of control. Uncertain of control.

two cognitive theories for hopelessness:1.learned helplessness (Seligman)2.negative cognitive style (Beck)

theories for depression

two cognitive theories for hopelessness:1.learned helplessness (Seligman)

a. convinced that you cannot control eventsb. convinced that such is:

1.negative cognitive style (Beck)a. cognitive triad (negative focus on you, world, future)b. errors of logic e.g. arbitrary inference (neg conclusions w/o evidence)

internal (“I am the reason.”)global (“I ruin everything.”)stable (“I always will.”)

theories for depression

VULNERABILITY IS TRIGGERED

exogenous depressionA.K.A. reactive depressiontriggered by identifiable stressor

endogenous depressionno identifiable stressor“internal”

more about stressors- “Kindling Effect”- reciprocal-gene environment

theories for depression

Genes- 80-90% genetic & 10% nonshared env factors

biochemistry - low serotonin

ion theory- Irregular transport of sodium & potassium- neurons fire too easily (mania)- neurons resist firing (depression)

theories for bipolar disorder

High norepinephrine (mania)

Low norepinephrine (dep)

antidepressant medsSSRIs- selective serotonin reuptake inhibitors- most commonly prescribed, due to safety

TRICYCLICS- monoamine reuptake inhibitors- reserved for severe pts not responsive to other meds- drops BP & potentially deadly changes in heart rhythm

MONOAMINE OXIDASE INHIBITORS (MAO-Is)-tyramine too high = dangerously high BP causes stroke or death- skin patch exception gives low dose (no diet restrictions)

mood stabilizers

LITHIUM - treats mania & depression (doesn’t trigger mania as does antidepressants) (lower suicide rates)- therapeutic vs. lethal dosage window- seizures, kidney dysfunction, death

ANTICONVULSANTS (valproate, carbamazepine)-AKA anti-seizure medication

ECT65-140 volts for half second produces seizure for 30 secs to few minutes. Applied 3x/week for 4 weeks.

TMS

- left prefrontal cortex- 40 mins/day, 5x/week for 6 weeks

transcranial magnetic stimulation