Mood Disorders Flashcards
What are the major types of unipolar disorders?
1) Adjustment disorder with depressed mood - excessive distress or impairment within 3 months of stressor
2) Dysthymic disorder
3) Major depression
What are the major types of bipolar disorder?
1) Bipolar I - mania with or w/o depression
2) Bipolar II - depression with hypomania
How is depression diagnosed?
At least 5/9 of the below symptoms for at least 2 weeks PLUS depressed mood and/or anhedonia (loss of interest):
- Guilt (feelings of worthlessness/self reproach)
- Loss of energy/fatigue
- Diminished ability to think/concentrate
- Increased or decreased appetite
- Psychomotor agitation/retardation
- Insomnia or hypersomnia
- Suicidal ideation
Describe the diurnal component of depression.
Depression can be most severe in the morning and improve toward the evening
What is the leading cause of disability/burden of disease worldwide?
Depression (particularly in middle/high income countries)
What is minor depression?
3 symptoms for > 2 weeks but < 2 years
What symptoms are associated with depression?
- Anxiety => 50%
- Psychosis => 1%
- Somatization:
- Body aches, pains, headaches, GI distress
What is the lifetime prevalence of a Major Depressive Disorder in the U.S.?
20%
What is the prevalence of Major Depression amongst men and women in the U.S.?
Women> Men (2:1)
Describe the role of family history on Major Depression.
A family history of Major Depression increases a patient’s risk of depression by 1.5-3 times
How does depression impact health care costs?
Depression is associated with a doubling of health care costs and overall worsens health outcomes
What is primary depression?
Primary depression is depression not related to a pre-existing, chronic, non-mood disorder
What is secondary depression?
Secondary depression is related to pre-existing chronic, non-mood disorder - ie anorexia, somatization, psychoactive substance dependence, anxiety disorder, rheumatoid arthritis
What is dysthymic disorder?
Dysthymic disorder is diagnosed after 2 years of depressed mood NOT MEETING CRITERIA FOR MDE
- only 2/9 symptoms required
- 1 year of symptoms in children (for diagnosis)
- No more than 2 months symptom free
- Increased risk of suicide (>> MDD)
What are the features of psychotic depression?
- Perception distortion
- Delusional thought content
- Auditory hallucinations
- Persecutory in nature
- Delusional guilt
- Somatic delusions
What is mania?
In mania, mood is abnormally elevated, expansive, or irritable for at least ONE WEEK
What are the diagnostic behaviors for mania?
3 of the following:
- Grandiosity
- Decreased need for sleep
- Pressured speech
- Flight of ideas
- Distractibility
- Increase in activity
- Activities resulting in painful consequences
What is hypomania?
Hypomania is similar to mania, except that individuals are fully function and are usually more productive than usual
- Symptoms must last longer than 4 days
What is the male/female prevalence of dysthymic disorder?
Male = Female
What is a mixed mood disorder?
A mixed mood disorder includes mania and depressive symptoms > 1 week with SIGNIFICANT dysfunction
Define cyclothymia.
Cyclothymia includes fluctuating minor depressive, hypomanic episodes
- No prior major depressive, manic, or mixed episodes over a 2 year period
- Symptom free periods do NOT last longer than 2 months
- Bipolar (I or II) may develop after 2 years
What is the age of onset for major affective disorders?
Dysthymic disorder:
- Early onset 21
Major Depressive Disorder:
- Mostly 20s and 40s
- First time depression >50yo considered medical in etiology
Biopolar:
- 15-19 (Treatment sought 20-24)
When are women most vulnerable to mood disorders?
Women are most vulnerable to mood disorders when the rate of change of estrogens is the greatest:
- Menarche
- Pregnancy
- Post partum
- Late luteal phase of the menstrual cycle
- Perimenopause
What is the relationship with mood disorders and socioeconomic status (SES)?
- Increased depression in lower SES groups
- Increased bipolar disorder in higher SES groups
What is the role of family history with mood disorders?
- Family history is greater in Bipolar (60-70%)
- 10-20% risk for MDD or Bipolar I with family history
- 1-5% increased risk for Bipolar II
What are the major medications for depression?
- Selective serotonin reuptake inhibitors (SSRIs)
- Tricyclic antidepressants (TCAs)
- Monoamine oxidase inhibitors (MAOIs)
- Other: venlafaxine, mirtazapine, trazodone, nefazodone, vilazodone, bupropion
What are non-pharmacological treatments for depression?
- Electroconvulsive therapy (ECT)
- Light therapy: effective for SAD (winter depression)
- Vagus nerve stimulation (VNS)
- Transcranial magnetic stimulation (TMS)
- Cingulotomy, capsulotomy, subcaudate tractotomy
- Deep brain stimulation (DBS)
What is the most effective treatment for depression?
ECT is the most effective treatment for depression
What are the side effects of ECT?
- High remission rate
- Headache, nausea, muscle pain
- Cognitive impairment (usually temporary)
- Complications from anesthesia
- Should NOT be used in patients who have had an MI in the past 4-6 weeks
What pharmacological mood stabilizers are used for bipolar disorder?
- Lithium: Mania, depression and prevention of mood episodes
- Valproic acid (Depakote), carbamazepine (Tegretol), and Lamotrigine (Lamictal): Prevent depressive episodes
- Atypical antipsychotics
How prevalent is treatment resistant depression?
1-3%
What is TMS/rTMS?
Non-invasive technique for generating current in cortex and modulating neural network activity
* With TMS, a large electromagnetic coil is placed against your scalp near your forehead.
The electromagnet used in TMS creates electric currents that stimulate nerve cells in the region of your brain involved in mood control and depression.
Who is TMS best suited for?
TMS is used in patients who have treatment resistant depression (or not responsive to one med)
* Effective in 50% of TRD patients
What is vagus nerve stimulation (VNS)?
Vagus nerve stimulation chronically/intermittently stimulate CN X. An electrode is surgically attached to the vagus nerve and a generator is implanted in the chest wall
What is VNS used for?
VNS is used in treatment resistant patients (effective in 30-40%)
What is Deep Brain Stimulation used for?
Used in patients with treatment resistant stimulation.
What are the benefits proposed in many studies for Deep Brain stimulation in the subcalllosal cingulate?
- No relapse in remitters
- No adverse acute/chronic stimulation effects
- No mania/hypomania
- No cognitive side effects
