Dr Aseni Wickramatillake

What is a mood disorder? Mood: An individual’s personal state of emotions Affect : An individual’s appearance of mood Moods can be elevated or depressed

Mood Disorders DepressionMania intense sadness, feelings of futility and worthlessness, and withdrawal from others ten times greater than mania elevated mood, expansiveness, or irritability, often resulting in hyperactivity. ten times less than depression Emotional state characterized by

Causes of Mood Disorders Childhood loss, bereavement Genetic influences The depressed brain Negative moods feed negative thoughts Helplessness/Hopelessness Negative attribution: negative reasons we give for why an event occurred Poor social networking

Causes of Mood Disorders Neurotransmitters Circadian Rhythms High levels of cortisol Stress

Neurotransmitters Depression is associated with low levels of serotonin or norepinephrine Serotonin regulate our emotional reactions more impulsive and wide moods swings are seen during low serotonin levels Medications increase the availability of serotonin and/or norepinephrine in the synapse

Neurotransmitters and Mood Disorders Serotonin (5-HT) Sex Appetite Aggression Norepinephrine (NE) Concentration Interest Motivation Both Depressed Mood Anxiety Irritability Thought process Vague aches and pain

Symptoms of Depression Depressed mood Dejection Excessive and prolonged mourning Worthlessness, lack of joy. Pessimism Decreased energy Disinterest and loss of motivation Self-accusations of being incompetent

Symptoms of Depression Social Withdrawal Lowered Work Productivity Lack Of Personal Cleanliness Slow Speech And Bodily Movements Loss Of Appetite/Weight Constipation Sleep Disturbance Disruption Of Menstrual Cycle And Aversion To Sexual Activity.

Types of Mood Disorders Depressive Disorders / Unipolar Disorders Major depressive disorders Dysthymic disorder Depressive disorders not otherwise specified Bipolar Disorders: Characterized by one or more manic or hypomanic episodes + one or more depressive episodes Bipolar disorder I Bipolar disorder II Cyclothymic disorder

Major Depressive Disorder No history of mania, hypomania, or mixed episode Prevalence : Female > Male Average age of onset in mid-20’s If untreated, average duration of first episode is 6-9 months; often recur Recurrent episodes(2 or more episodes)

Major Depressive Episode 5 or more symptoms (1 must be either depressed mood or loss of interest) for ≥ 2 weeks Symptoms: 1. Depressed mood 2. Loss of interest in activities (anhedonia) 3. Significant weight loss or gain; decrease or increase in appetite 4. Insomnia or hypersomnia 5. Psychomotor agitation or regardation 6. Fatigue or loss of energy 7. Feelings of worthlessness or guilt 8. Poor concentration or indecisiveness 9. Recurrent thoughts of death or suicide or attempts of suicide

Dysthymic Disorder Less severe Chronic “low grade” depression Depressed mood nearly every day for > 2 years No more than 2 months symptom free Prevalence equal in males and females Age on onset in the 20’s Slow response to treatment – may need higher doses, longer duration of treatment

Symptoms of Dysthymic Disorder Depressed mood most of day for most days plus ≥ 2 of the following for >2 years poor appetite or overeating insomnia or hypersomnia low energy or fatigue low self-esteem poor concentration or difficulty making decisions feelings of hopelessness

Hypomania and Mania Hypomania Mania “High” Mood Overactive Behavior Poor Judgment Delusions (Rare), Attempts To Be Dominating Grandiose. Pronounced overactivity Grandiosity Irritability incoherent speech Lack of tolerance for criticism Lack of restraint

Diagnosis of Manic Episodes Abnormally and persistently elevated, expansive, or irritable mood for at least 1 week With 3 additional symptoms

Symptoms of Manic Episodes 1. Inflated self-esteem/grandiosity (Belief that one has special talents, powers, and abilities) 2. Decreased need for sleep (3 hrs.) 3. Unusual talkativeness or rapid speech 4. Flight of ideas/racing thoughts 5. Irritable

Symptoms of Manic Episodes 6. Marked distractibility 7. Increased energy, enthusiasm, self- assertion at work, school, or in social situations Increased 8. Excessive involvement in pleasurable activities with potential for painful consequences (spending money, excessive alcohol/drug use, reckless driving, and risky sex)

Hypomanic Episode Elevated, expansive, or irritable mood for at least 4 days Symptoms similar to manic episode, except no marked impairment/hospitalization

Mixed Episode criteria for both major depressive episode and a manic episode at the same time Symptoms persist for at least 1 week

Bipolar Affective Disorder Lifetime prevalence is 1% Average onset age is late teens-early 20 Occurs equally often in men and women Stronger genetic relationship

Bipolar Disorder I Single manic episode no past major depressive episode Most recent episode hypomanic at least 1 past manic or mixed episode Most recent episode manic at least 1 past major depressive, manic, or mixed episode Most recent episode mixed at least 1 past major depressive, manic, or mixed episode Most recent episode depressed at least 1 past manic or mixed episode

Bipolar Disorder II Alternate between hypomanic and major depressive episodes At least 1 or more Major Depressive Episode At least 1 Hypomanic Episode Never a Manic or Mixed Episode

Bipolar Affective Disorder Bipolar I Bipolar II At least one manic or mixed episode No need for a prior depressive episode More severe illness than Bipolar II and easier to diagnose Prevelance : men= women At least one previous major depressive episode At least one hypomanic episode Less severe than Bipolar I and more difficult to diagnose Prevelance: women>men

Cyclothymic Disorder Alternate between numerous episode of depressed and hypomanic symptoms which does not meet criteria for major depressive episode Present for at least 2 yrs Never free of symptoms for longer than 2 months. No major depressive, manic, or mixed episode

Rapid cycling Change in four or more mood episodes within any 1 year period Can be very difficult to treat

Comparison Depressive Disorder Bipolar Disorders Age of onset : late 20s than unipolar.ikely to exhibit anxiety Prevelance: 8-19% of adult population has major depressive disorder. Age of onset : early 20s Greater psychomotor retardation and risk of suicide greater for bipolar Prevelance: 1%-2% of adult population Respond to lithium

Treatment of Depression Medical Antidepressants tricyclics MAO inhibitors SSRIs others Psychosocial Cognitive-behavioral therapy Interpersonal therapy Other Electroconvulsive therapy (ECT) Light

Treatment of Bipolar Disorder Lithium is the best treatment Lithium blood levels should be monitored Large number respond well initially Side effects Excessive thirst and urination Damage to kidneys and thyroid Adjunctive treatments Benzodiazepines Seclusion and restraint Sleep aids ECT Psychosocial treatment