Transcript Mood Disorders: Depression, Bipolar and Adjustment Disorders

Mood Disorders
 Predominant symptom is the dysregulation of mood or
emotion
 High risk of suicide
 Can occur throughout the lifespan
 Types of Mood disorders
 Major Depression

Subcategories of Depression
 Bipolar Disorder (formerly called Manic-Depression)
Co-Morbidity of Mood Disorders
 Medical diseases may contribute to depression:
Myocardial infarct, Stroke, All neurological disorders,
e.g. Parkinson’s, Alzheimer’s, Endocrine Disorders e.g.
Diabetes, Hypothyroidism, Pregnancy and Postpartum period
 Some medications can cause depression or mania as
side effects, e.g. Prednisone, Chantix
 Drugs that deplete catecholamines cause depression
 Dopamine
 Serotonin
 Norepinephrine
Positive Emission Tomography
(PET) Scans
 Altered blood
flow in the brains
of depressed
Persons
 Prefrontal cerebral
cortex and the
limbic system have
look different in
depressed and nondepressed persons
Symptoms of Major Depression
 Emotional Symptoms
 Anhedonia – loss of interest or pleasure in activities
 Depressed mood. Also can be sad, empty, numb or
irritable
 Helplessness, Hopelessness
 Cognitive Symptoms
 Diminished ability to think or make decisions
 Decreased concentration
 Recurrent thoughts of death, disease, illness, suicide
 Focus on self-worthlessness and guilt
 Can have nihilistic delusions, or delusions of
persecution or punishment
Symptoms of Major Depression
 Behavioral Symptoms
 Significant appetite changes – weight loss or gain
 Insomnia or hypersomnia (mid-nocturnal waking)
 Psychomotor agitation – restless, pacing
 Psychomotor retardation – lethargy, slowed down
movements and body
 Fatigue, listlessness, apathy, frequent napping
 Social Symptoms
 Withdrawal from others
 Social isolation
Bipolar Disorder
 Diagnosed when a person has both Depression and
Manic episodes
Bipolar Disorder
 Depressed episodes of bipolar disorder look just like
Major Depression
 Diagnosis is based on the occurrence of manic
episodes
 Cyclical in nature
 Generally occur right before or right after a depressive
episode
 Mania is defined as an abnormal and persistently
elevated, expansive or irritable mood for at least 1 week
Bipolar Disorder - Mania
 In addition to expansive or elevated mood, at least 3 of
the following must also be present:
 Inflated self-esteem (Grandiosity)
 Decreased need for sleep
 More than usual talkativeness
 Racing thoughts
 Distractibility
 Increase in goal-directed activity
 Excessive involvement in pleasurable activities


Risk-taking behaviors
Sexually inappropriate behaviors
Hypomania
 Hypomanic episodes are not severe enough to cause
severe impairment in social/occupational functioning
 Hypomania is very pleasant and productive
- HOWEVER –
 At any point, hypomania may progress into full blown
mania
 As mania progresses, judgment declines. The client
may fail to recognize worsening symptoms
Treatment of Mood Disorders
 Therapy:
Cognitive-behavioral
Approaches
 Electroconvulsive therapy
 Medications:




Antidepressants
Mood stabilizers
Antipsychotics if needed
Adjunctive treatment for
sleep, anxiety
 Transcranial Magnetic
Stimulation
 Vagal Nerve Stimulation
 Phototherapy
 Diet & Nutrition
 L-Methylfolate
Medications for Depression
 Herbal Therapies
 St. John’s Wort – very mild monoamine oxidase
inhibitor. Overall effect is to increase monoamines
(norepinephrine, serotonin, dopamine)
 Prescription Drugs – Five Categories
 Serotonin Reuptake Inhibitors (SSRIs)
 Monoamine Oxidase Inhibitors (MAOIs)*
 Tricyclic Antidepressants (TCAs)*
 Serotonin + Norepinephrine Reuptake Inhibitors (SNRIs)*
 Miscellaneous *
*Will be covered in future classes
Serotonin Reuptake Inhibitors (SSRIs)
 The most commonly prescribed antidepressants
 Blocking the reuptake of serotonin at the nerve synapse
 Also used for treating anxiety disorders and
premenstrual dysphoric disorder (PMS)
 SSRI Common Side Effects:
 GI Upset
 Headaches or dizziness
 Insomnia
 Sexual dysfunction
 Occasionally sleepiness
SSRI Medications
Prototype:
Fluoxetine
(Prozac)
Other SSRIs:
Sertraline (Zoloft)
Paroxetine (Paxil)
Citalopram (Celexa)
Escitalopram (Lexapro)
Serotonin Withdrawal
 Rapid withdrawal of serotonin from the brain can
result in uncomfortable (but not dangerous)
withdrawal symptoms:
 Dizziness
 Flu-like symptoms
 The potent, shorter half-life medications have
more withdrawal risk while the longer half-life
medications have almost none.
Adverse Event – Serotonin Syndrome
This is a reaction that can happen with high dosages of
SSRI’s or when SSRI’s are combined with some other drugs
e.g. tramadol (Ultram) or triptans used in migraine
headache treatment.
Symptoms:
Agitation or restlessness
Diarrhea
Fast heart beat
Hallucinations
Increased body temperature
Nausea/Vomiting
Loss of coordination
Overactive reflexes
Rapid changes in blood pressure
Confusion
Mood Stabilizers
 Drugs for Bipolar disorder are mood stabilizers
 Very few drugs are approved for children yet all are in use
 Side Effects vary greatly based on categories
 Different categories may be combined in treatment
resistant patients
 Categories of Mood Stabilizers
 Antiepileptics
 Lithium*
 Atypical Antipsychotics*
 Benzodiazepines*
*Will be covered in future classes
Mood Stabilizers - AntiEpileptics
These drugs seem to work by:
 Decreasing the neurotransmitter glutamate
(excitability)
 Increasing the neurotransmitter GABA
(inhibitory)
This activity suppresses seizures, reduces mania
and can prevent migraine headaches.
Mood Stabilizers - AntiEpileptics
FDA Approved drugs for Bipolar Disorder:
PROTOTYPE: Valproic acid (Depakote)
Others:
 Carbamazepine (Tegretol)
 Lamotrigine (Lamictal)
Side & Adverse effects vary based on the drug but are commonly:
GI upset
Weight gain
Sleepiness
Changes in CBCs – check CBC
Liver impairment – check liver enzymes ALT/AST
In-class Case Study
 We will next be watching a video of a person with
depression.
 Please answer the following questions during the video
then we will discuss them afterwards.
1. What are the client’s symptoms of depression?
2. What are her psychosocial stressors?
3. How are her clients symptoms interfering with her daily
functioning?
4. How would you assess her safety risk?
5. What are protective (helpful) factors for this person?
Psychiatric Interview:
Depressed Client
https://www.youtube.com/watch?v=4YhpWZCdiZc