MOOD DISORDERS
(Group 2)
MAJOR DEPRESSIVE DISORDER
MOOD DISORDERS
 also referred to as an affective disorder
 characterized by a serious change in mood that
cause disruption to life activities.
 Struggling mood disorder may experiencing
moods that may range from extremely low
(depressed) to extremely high or irritable
(manic)
 With the recent update of the Diagnostic and
Statistical Manual of Mental Disorders (DSM-V),
mood disorders are now separated into bipolar
disorder and depressive disorders
CHANGES FROM DSM-IV-TR TO DSM-5
DSM-5 CRITERIA FOR MAJOR DEPRESSIVE DISORDER
CAUSES
 prolonged and persistent periods of extreme
sadness
 are characterized by an overwhelming feeling of
sadness, isolation, and despair that lasts two
weeks or longer at a time.
 Depression isn’t just an occasional feeling of
being sad or lonely, like most people experience
from time to time. Instead, a person feels like
they’ve sunk into a deep, dark hole with no way
out — and no hope for things ever changing.
 MDD is one of the most prevalent psychiatric
disorders
 5.8% of Men and 9.5% of Women suffer from a
depressive episode annually according to the
World Health Organization, or 1,116,900,000
roughly people
Sad mood or loss of pleasure in usual activities.
At least five symptoms (counting sad mood and
loss of pleasure):
 Sleeping too much or too little
 Psychomotor retardation or agitation
 Weight loss or change in appetite
 Loss of energy
 Feelings of worthlessness or excessive
guilt
 Difficulty concentrating, thinking,or
making decisions
 Recurrent thoughts of death or suicide
Symptoms are present nearly every day, most
of the day, for at least 2 weeks.
There are no specific exact causes of
depression, as it varies largely person to person,
and causes are not limited to but include:
MOOD DISORDERS
(Group 2)
 Use of particular medications and substance
abuse problem
 Interpersonal conflicts
 Personal loss or death of a loved one
 Genetics
 Major life events
 Personal problems, such as being socially
outcast/isolated
 Serious illnesses
TREATMENT
MEDICATION
Antidepressants. Selective serotonin reuptake
inhibitors (SSRIs), such as fluoxetine (Prozac,
Sarafem, others) and sertraline (Zoloft)
PSYCHOTHERAPY
 COGNITIVE BEHAVIORAL THERAPY
 INTERPERSONAL PSYCHOTHERAPY
 ELECTROCONVULSIVE THERAPY
PERSISTENT DEPRESSIVE DISORDER (DYSTHYMIA)
 It is a continuous long-term (chronic) form of
depression.
 It may lose interest in normal daily activities,
feel hopeless, lack productivity, and have low
self-esteem and an overall feeling of
inadequacy
 These feelings last for years and may
significantly interfere relationships, school,
work and daily activities
 It affects 1.5% of the population with the high
prevalence among older adults
DSM-5 CRITERIA FOR DYSTHYMIA
Depressed mood for most of the day more than
half of the time for 2 years (or 1 year for
children and adolescents).
At least two of the following during that time:
 Poor appetite or overeating
 Sleeping too much or too little
 Poor self-esteem
 Low energy
 Trouble concentrating or making decisions
 Feelings of hopelessness
The symptoms do not clear for more than 2 months at a
time.
PREMENSTRUAL DYSPHORIC DISORDER
 New to DSM
 Is a depressive disorder exclusive to women and
is characterized by intense emotional and
physical that occur in days prior to the onset of
menses and often continuing menstruation
 This diagnosis is based on the presence of
specific symptoms in the week before the onset
of menses, followed by the resolution of these
symptoms after onset.
 is a severe, sometimes disabling extension of
premenstrual syndrome (PMS)
 Although regular PMS and PMDD both have
physical and emotional symptoms, PMDD
causes extreme mood shifts that can disrupt
your work and damage your relationships.
 About 8% of menstruating women report
symptoms distressing enough to cause
impairment in daily functioning
DSM-5 CRITERIA FOR PMDD
In most menstrual cycles during the past year,
at least five of the following symptoms were
present in the final week before menses and
improved within a few days of menses onset:
 Affective lability
 Irritability
 Depressed mood, hopelessness, or self-
deprecating thoughts
MOOD DISORDERS
(Group 2)
 Anxiety
 Diminished interest in usual activities
 Difficulty concentrating
 Lack of energy
POSTPARTUM DEPRESSION
 Changes in appetite, overeating, or food craving
 Sleeping too much or too little
 Subjective sense of being overwhelmed or out
of control
 Physical symptoms such as breast tenderness or
swelling, joint or muscle pain, or
 Bloating
Symptoms lead to significant distress or functional
impairment.
Symptoms are not an exacerbation of another
mood or anxiety disorder or a personality disorder.
Symptoms are confirmed with prospective daily
ratings over two cycles.
Symptoms are present when oral contraceptives are
not being taken.
SEASONAL AFFECTIVE DISORDER
 is a form of depression also known as SAD,
seasonal depression or winter depression
 People with SAD experience mood changes and
symptoms similar to depression.
 The symptoms usually occur during the fall and
winter months when there is less sunlight and
usually improve with the arrival of spring.
 SAD has been linked to a biochemical imbalance
in the brain prompted by shorter daylight hours
and less sunlight in winter.
 As seasons change, people experience a shift in
DSM-5 Criteria for Mixed Anxiety-Depressive Disorder
their biological internal clock or circadian
rhythm that can cause them to be out of step
with their daily schedule.
 SAD is more common in people living far from
the equator where there are fewer daylight
hours in the winter.
 Its prevalence is between 1% and 10% of the
population and more typically affects women
than men (with a ratio of 4:1). SAD may begin at
any age, but it typically starts when a person is
between ages 18 and 30.
 Postpartum Depression is a mood disorder that
commences after giving birth
 The DSM does not consider Postpartum
Depression as a separate disorder, but rather a
type of mood disorder categorized by a major
depressive episode
 After pregnancy, hormonal changes in a
woman's body may trigger symptoms of
depression
 It can occur anytime within the first year after
childbirth; however, it usually occurs within the
first couple weeks
MIXED ANXIETY-DEPRESSIVE DISORDER
 Mixed anxiety-depressive disorder is a mental
health disorder characterized by symptoms of
both depression and anxiety.
 However, the symptoms do not meet the
requirements for a diagnosis of either a
depression disorder or anxiety disorder.
 It was recently included in the DSM-5
 Recognition of mixed anxiety-depressive
disorder as a mental health disorder is relatively
new. However, the combination of depression
and an anxiety disorder (comorbid) has been
long recognized as commonly afflicting many
people.
 the prevalence rate associated with mixed
anxiety-depressive disorder is very common at
about 1.3% – 2%
 Three or four of the symptoms of major
depression
 Depressed mood or absence of pleasure
MOOD DISORDERS
(Group 2)
 Anxious distress as evidenced by at least two of
the following: irrational worry, preoccupation
with worries, trouble relaxing,motor tension, or
fear that something awful might happen
 Symptoms are present for at least 2 weeks
 No other DSM diagnosis of anxiety or depression
is present
DISRUPTIVE MOOD DYSREGULATION DISORDER
 Recently added to DSM-5
 It is a chronic, severe and persistent irritability
in children that often includes frequent temper
outbursts that are inconsistent with the child's
developmental age
 Children with DMDD have severe and frequent
temper tantrums that interfere with their ability
to function at home, in school or with their
friends
BIPOLAR DISORDER.
 It was intended for children and adolescent
between the ages of 6 and 18 with onset before
the age of 10
DSM-5 Criteria for Disruptive Mood Dysregulation
Disorder
 Severe recurrent temper outbursts in response
to common stressors, including verbal or
behavioral expressions of temper that are out
of proportion in intensity or duration to the
provocation.
 Temper outbursts are inconsistent with
developmental level.
 The temper outbursts tend to occur at least
three times per week.
 Persistent negative mood between temper
outbursts most days, and the negative mood is
observable to others
 These symptoms have been present for at least
12 months and do not clear for more than 3
months at a time
 Temper outbursts or negative mood are present
in at least two settings (at home, at
 school, or with peers) and are severe in at least
one setting.
 Age 6 or higher (or equivalent developmental
level).
 Onset before age 10.
 In the past year, there has not been a distinct
period lasting more than 1 day during which
elevated mood and at least three other manic
symptoms were present.
 The behaviors do not occur exclusively during
the course of another psychotic or mood
disorder and are not better accounted for by
another mental disorder.
 This diagnosis can coexist with oppositional
defiant disorder, attention-deficit/hyperactivity
disorder, conduct disorder, and substance use
disorders
 also called manic depression or bipolar affective
disorder
 A mood disorder in which a person alternates
between the hopeless lethargic state of
depression and the overexcited giddy state of
mania.
Types Include:
 Bipolar 1, the person has had at least one manic
episode in his/her life (major depression and
full mania)
 Bipolar 2, the person cycles between high/low
moods but never reaches manic states ( major
depression and mild mania)
 Cyclothymic Disorder, a milder form of Bipolar
disorder with similar but less severe symptoms.
(mild depression with mild mania )
DSM-5 Criteria for Manic and Hypomanic Episodes
Distinctly elevated or irritable mood for most of
the day nearly every day.
Abnormally increased activity and energy.
MOOD DISORDERS
(Group 2)
At least three of the following are noticeably
changed from baseline (four if mood is
irritable):
 Increase in goal-directed activity or
psychomotor agitation
 Flight of ideas or subjective impression that
thoughts are racing
 Unusual talkativeness; rapid speech
 Decreased need for sleep
 Increased self-esteem; belief that one has
special talents, powers, or abilities
 Distractibility; attention easily diverted
 Excessive involvement in activities that are
likely to have undesirable consequences,
 such as reckless spending, sexual behavior, or
driving
DSM-5 Criteria for Cyclothymic Disorder
For at least 2 years (or 1 year in children or
adolescents):
 Numerous periods with hypomanic symptoms
that do not meet criteria for a manic episode
 Numerous periods with depressive symptoms
that do not meet criteria for a major depressive
episode.
 The symptoms do not clear for more than 2
months at a time.
 Symptoms cause significant distressor
functional impairment
CAUSES OF BIPOLAR DISORDER
 Genetics, as it is found in increasing frequency
amidst parents/children and twins, although it's
unclear what gene causes this
 An imbalance of norepinephrine, dopamine,
and seratonin may cause heightened/lowered
states of mania/depression additionally,
substance use can worsen episodes, especially
depressive ones
 Psychosocial factors and environmental factors
TREATMENTS
The treatment varies based on severity and
type of the disorder, but generally has a strong
regiment of medication, including:
 Mood Stabilizers (and anticonvulsants, which
were originally for seizures but were discovered
to have effects on moods as well), medications
which help to create more consistency in
moods, such as Lithium, Depakote, and Valproic
Acid.
 Antipsychotics, used to treat some of the
symptoms of Bipolar disorder, especially in
conjunction with antidepressants can be used
to relieve episodes of mania/psychosis. Some
antipsychotics include Zyprexa, Abilify, and
Geodon.
 Antidepressants are used to treat some of the
other symptoms of Bipolar disorder, but on
their own can be very dangerous in causing
manic/hypomanic states and are thus usually
taken with mood stabilizers. A few
antidepressants include Prozac, Paxil, and
Zoloft.
 Anti-Anxiety medication is also very common
for people with Bipolar disorder because
anxiety disorders commonly accompany it.
When combined with Medications,
Psychotherapies (many of the same ones used
to treat depression) can be an effective long
term means of helping a person with bipolar
disorder. Such therapies include:
 Cognitive Behavioral Therapy (CBT), therapy in
which patients are taught to change and avoid
negative thought patterns.
 Family-Focused Therapy, which helps to identify
episodes early on and encourages support and
communication with the patients' families.
 Interpersonal and social rhythm therapies,
which helps to improve relationships with
others and a better daily routine.
 Psychoeducation, education about the illness
and it's symptoms, so the patient recognizes
MOOD DISORDERS
(Group 2)
episodes before they happen and can receive
aid