2.  Gross Deviations in Mood  Depression: “The Low” –The “Common Cold” of Mental Illness –Major Depressive Episode is Most Common  Mania: “The High” –Abnormally Exaggerated Elation, Joy, or Euphoria  Gross Deviations in Mood  Depression: “The Low” –The “Common Cold” of Mental Illness –Major Depressive Episode is Most Common  Mania: “The High” –Abnormally Exaggerated Elation, Joy, or Euphoria

3. Mania Depression

4.  Unipolar Mood Disorder –Either Depression or Mania  Bipolar Mood Disorder –Alternates Between Depression and Mania  Important to Determine the Course –Temporal Patterning of the Episodes  Unipolar Mood Disorder –Either Depression or Mania  Bipolar Mood Disorder –Alternates Between Depression and Mania  Important to Determine the Course –Temporal Patterning of the Episodes

5.  Depressive Disorders –Major Depression –PDD, formerly Dysthymic Disorder –“Double Depression” - - dysthymia punctuated by period of major depression  Bipolar I and Bipolar II Disorders –Cyclothymic Disorder  Depressive Disorders –Major Depression –PDD, formerly Dysthymic Disorder –“Double Depression” - - dysthymia punctuated by period of major depression  Bipolar I and Bipolar II Disorders –Cyclothymic Disorder

6.  Extremely Depressed Mood –Lasting at Least 2 Weeks  Cognitive Symptoms  Anhedonia  Vegetative Symptoms  Single or Recurrent Episode –No Manic or Hypomanic Episodes  Extremely Depressed Mood –Lasting at Least 2 Weeks  Cognitive Symptoms  Anhedonia  Vegetative Symptoms  Single or Recurrent Episode –No Manic or Hypomanic Episodes  Clinical Description

8.  Similar to Major Depression BUT With a Different Course –Symptoms are Milder –Symptoms can Last 20-30+ Years  Persistently Depressed Mood for 2+ Years –Cannot be Symptom Free > 2 Months  Similar to Major Depression BUT With a Different Course –Symptoms are Milder –Symptoms can Last 20-30+ Years  Persistently Depressed Mood for 2+ Years –Cannot be Symptom Free > 2 Months  Clinical Description

9.  Facts and Statistics  Mean Age of Onset Early 20s  Onset Prior to Age 20 –Greater Chronicity –Poor Prognosis  Major Depressive Episodes are Common  Mean Age of Onset Early 20s  Onset Prior to Age 20 –Greater Chronicity –Poor Prognosis  Major Depressive Episodes are Common

10.  Suffer From Both –Major Depression Episodes –PDD - Dysthymic Disorder  Dysthymia Usually Begins First  Associated With Severe Pathology  A Problematic Future Course  Suffer From Both –Major Depression Episodes –PDD - Dysthymic Disorder  Dysthymia Usually Begins First  Associated With Severe Pathology  A Problematic Future Course  Clinical Description

11. Dysthymia Major Depression Major Depression Dysthymia  Clinical Description

12.  Major Features  Experience Both –Manic Episodes –Major Depressive Episodes  Roller Coaster of Mood  Experience Both –Manic Episodes –Major Depressive Episodes  Roller Coaster of Mood  What are Manic Episodes?

13.  Mania and Hypomania  Elevated Mood  Grandiosity  Increased Activity  Varied Impairment

14. Major Depression Major Depression Mania  Clinical Description

15.  Major Depressive Episodes Alternate With  Hypomanic Episodes  Major Depressive Episodes Alternate With  Hypomanic Episodes  Clinical Description

16.  Milder Depressive Episodes Alternate With  Hypomanic Episodes  Milder Depressive Episodes Alternate With  Hypomanic Episodes  Clinical Description

17. Dysthmia Hypomania

18.  General Facts and Statistics  Bipolar I –Onset Around 18 Years  Bipolar II –Onset Around 22 Years  16% Commit Suicide  Cyclothymia –Typically Chronic  Bipolar I –Onset Around 18 Years  Bipolar II –Onset Around 22 Years  16% Commit Suicide  Cyclothymia –Typically Chronic

19.  Descriptions of Recent Episode and Pattern Varies  1. Atypical –Pertains to Depressive Episodes and Dysthymia, not Manic Episodes –Typically Overeat and Oversleep  1. Atypical –Pertains to Depressive Episodes and Dysthymia, not Manic Episodes –Typically Overeat and Oversleep

20.  Recent Episode and Pattern  2. Melancholic –Pertains to Major Depressive Episode Only –More Severe Symptoms –Strong Biological Component  2. Melancholic –Pertains to Major Depressive Episode Only –More Severe Symptoms –Strong Biological Component  Atypical (overeat, oversleep, wght gain – keep interested, can experience pleasure)

21.  Recent Episode and Pattern  3. Mixed Features –With some mania symptoms  3. Mixed Features –With some mania symptoms  Atypical  Melancholic

22.  Recent Episode and Pattern  4. Catatonic –Can be part of Major Depression and Mania –Very Serious Condition –Catalepsy (“Muscle Rigidity”)  4. Catatonic –Can be part of Major Depression and Mania –Very Serious Condition –Catalepsy (“Muscle Rigidity”)  Atypical  Melancholic  Mixed

23.  Recent Episode and Pattern  Catatonic  Atypical  Melancholic  Mixed  5. Psychotic –Hallucinations and Delusions –Very Rare but Serious Condition –Poor Treatment Response  5. Psychotic –Hallucinations and Delusions –Very Rare but Serious Condition –Poor Treatment Response

24.  Recent Episode and Pattern  Catatonic  Atypical  Melancholic  Mixed  6. Peripartum –Major Depression and Mania –Prior to…Four Weeks Following Birth…and up to a year: high % –Mood Episodes of a Psychotic Nature Relatively Rare  6. Peripartum –Major Depression and Mania –Prior to…Four Weeks Following Birth…and up to a year: high % –Mood Episodes of a Psychotic Nature Relatively Rare  Psychotic

25.  Recent Episode and Pattern  Catatonic  Atypical  Melancholic  Mixed  Peripartum  Anxious Distress  Peripartum  Anxious Distress  Psychotic

26.  Course and Pattern  Rapid-Cycling  Seasonal Pattern –Bipolar and Recurrent Major Depression –Episodes During Certain Seasons  Seasonal Pattern –Bipolar and Recurrent Major Depression –Episodes During Certain Seasons

27. Premenstrual Dysphoric Disorder (PMDD) –2- 5% of women meet criteria Disruptive Mood Dysregulation Disorder –Children: increased diagnosis for bipolar, up 40% between 1995 and 2005 Bipolar (NOS) Other Depressive Disorders - new to DSM-5

28.  About 16% Lifetime Global Prevalence MDD  Past Year: Bipolar-.8%Maj Depression-6%  Females > Males –Major Depression and Dysthymia  Females = Males –Bipolar Disorders  About 16% Lifetime Global Prevalence MDD  Past Year: Bipolar-.8%Maj Depression-6%  Females > Males –Major Depression and Dysthymia  Females = Males –Bipolar Disorders

30.  Biological Dimensions  Family Studies  Twin Studies –As Severity Increases, so Does the Genetic Connection  No Single Genetic Link  Family Studies  Twin Studies –As Severity Increases, so Does the Genetic Connection  No Single Genetic Link

31.  Neurotransmitters  The Serotonin Connection  Endocrine Function  Elevated Cortisol  Dexamethasone Suppression Test: cortisol suppressed in non- depressed people, not in severely depressed….but….  Elevated Cortisol  Dexamethasone Suppression Test: cortisol suppressed in non- depressed people, not in severely depressed….but….

32.  Sleep and Circadian Rhythms  Sleep Disturbances are Common  More intense and earlier start to REM Sleep among the Depressed  Diminished Deep Sleep  Disruption of Circadian Rhythms  Sleep Disturbances are Common  More intense and earlier start to REM Sleep among the Depressed  Diminished Deep Sleep  Disruption of Circadian Rhythms

33.  Stressful Life Events; Loss  Learned Helplessness  Attributional Style  Stressful Life Events; Loss  Learned Helplessness  Attributional Style  Internal  Stable  Global  Internal  Stable  Global

34.  Negative Cognitive Biases  Beck’s Cognitive Triad  Negative Cognitive Biases  Beck’s Cognitive Triad  Negative Schema About Self, World, & Future  Negative Schema About Self, World, & Future

35.  In the United States:  About 30,000 Kill Themselves Annually  More Die from Suicide Each Year Than Homicide (about 20,000)  More Common Among Whites, Native Americans  Increasing in Adolescents (3rd leading cause of death) & Elderly (globally, the elderly have highest suicide rate, esp. males)  Males > Females in Killing Themselves  Females > Males in Attempts  About 30,000 Kill Themselves Annually  More Die from Suicide Each Year Than Homicide (about 20,000)  More Common Among Whites, Native Americans  Increasing in Adolescents (3rd leading cause of death) & Elderly (globally, the elderly have highest suicide rate, esp. males)  Males > Females in Killing Themselves  Females > Males in Attempts

36.  Approximately 500,000 people each year require ER treatment as a result of attempted suicide  Suicidal behavior typically occurs in the presence of mental illness or substance use disorders  Firearms account for 59% of all suicide deaths  Website of Extreme and Urgent Interest  suicidology.org  Approximately 500,000 people each year require ER treatment as a result of attempted suicide  Suicidal behavior typically occurs in the presence of mental illness or substance use disorders  Firearms account for 59% of all suicide deaths  Website of Extreme and Urgent Interest  suicidology.org

37.  Medications  Tricyclic Antidepressants Imipramine (Tofranil) Amitriptyline (Elavil)  Block Neurotransmitter Reuptake  Side Effects  Tricyclic Antidepressants Imipramine (Tofranil) Amitriptyline (Elavil)  Block Neurotransmitter Reuptake  Side Effects

38.  Medications  MAO Inhibitors  Block Enzyme MonoAmine Oxidase  The Result? More Neurotransmitter is Available  Side Effects and Complications  MAO Inhibitors  Block Enzyme MonoAmine Oxidase  The Result? More Neurotransmitter is Available  Side Effects and Complications

39.  Medications  SSRIs  Block Reuptake of Serotonin- Prozac  SSNRIs  SSRIs  Block Reuptake of Serotonin- Prozac  SSNRIs

40.  Medications - Bipolar  Lithium, Depakote, Lamictal…Effective for Manic Episodes  Lithium Must be Carefully Regulated  Lithium, Depakote, Lamictal…Effective for Manic Episodes  Lithium Must be Carefully Regulated  Other Medical Treatments  Electroconvulsive Therapy (ECT)  TMS  Electroconvulsive Therapy (ECT)  TMS

41.  Psychological Interventions           Combined Treatments?