Major Depressive Disorder

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Feeling Moody?
Is it just a bad mood or is it a disorder?
Mood Disorders
Major Depressive disorder
Persistent Depressive Mood
Disorder (Dysthymia)
Bipolar Disorder (I & II)
Disruptive Mood Dysregulation
Disorder
Cyclothymic Disorder
Major Depressive
Disorder
Prevalence: 7%; 18-29 years old; Female>Male
DDx: Manic episodes with irritable mood or mixed episodes, mood disorder
due to another medical condition, substance/medication-induced depressive
or bipolar disorder, ADHD, adjustment disorder with depressed mood,
sadness
Criteria:
Must have 5+ of the following symptoms during a 2W period:
At least 1 of the symptoms must be – 1) depressed mood or 2) loss of interest
or pleasure
A. Depressed mood most of the day, as indicated by either subjective
report or observation made by others
B. Markedly diminished interest or pleasure in activities
C. Significant weight loss when not dieting, weight gain, or decrease or
increase in appetite
D. Insomnia or hypersomnia
E. Psychomotor agitation or retardation
F. Fatigue or loss of energy
G. Feelings of worthlessness or excessive or inappropriate guilt
H. Diminished ability to think or concentrate, or indecisiveness
I. Recurrent thoughts of death (not just fear of dying), recurrent
suicidal ideation without a specific plan, or a suicide attempt or a
specific plan for committing suicide
Cause: Decreased serotonin, decreased dopamine, genetics
Treatment: Anti-depressant medications (SSRI, SNRI, NDRI, TCA,
MAOI) and therapy
Premenstrual Dysphoric Disorder

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Disruptive Mood Dysregulation Disorder
Prevalence: Male>Female, 2-5%
DDx: Bipolar disorder, oppositional defiant disorder, ADHA, MDD, anxiety disorders, Autism spectrum
disorder, intermittent explosive disorder
Criteria:
A. Severe recurrent temper outbursts (verbal or behavioral) that are out of proportion to the situation
B. Temper outbursts are inconsistent with developmental level
C. Occur 3 or more times a week
D. Mood between outbursts is irritable or angry most of the day almost everyday
E. Criteria 1-4 have persisted for 12 months or more and have not been absent for more than three
consecutive months
F. Outbursts are present in two or more settings
G. Diagnosis should not be made before age 6 or after 18
H. Onset of symptoms is usually before age 10
I. There has never been a distinct period lasting more than 1 day during which the full symptom
criteria except duration for a manic or hypomanic episode have been met
J. The behaviors do not occur exclusively during an episode of major depressive disorder
K. The symptoms are not attributable to the physiological effects of a substance or to another medical
or neurological condition
Persistent Depressive Mood
Disorder (Dysthymia)
Prevalence: 0.5-1.5%
DDx: Major depressive disorder, psychotic disorders,
depressive or bipolar and related disorder d/t another
medical condition, substance/medication-induced
depressive or bipolar disorder, personality disorders
Criteria:
A. Depressed mood for at least 2 yrs
B. The presence of 2+ or more of the following
symptoms:
1. Poor appetite or overeating
2. Insomnia or sleeping too much
3. Low energy or fatigue
4. Low self-esteem
5. Poor concentration or difficulty making
decisions
6. Feelings of hopelessness
Treatment: Anti-depressant medications (SSRI, SNRI,
NDRI, TCA, MAOI) and therapy

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Premenstrual Dysphoric
Disorder (PMDD)
Prevalence: 3-8% of women in the US
Causes: theories of imbalance between estrogen and
progesterone, serotonin imbalance during a normal cycle
DDx: anemia, anxiety disorder, bipolar disorder,
depression, dysthymic disorder, hyperprolactinemia,
hyperthyroidism, panic disorder, personality disorder,
somatoform disorders
Criteria:
A. At least 5 symptoms must be present in the final week before onset of
menses, start to improve within a few days after onset, and minimal or absent
in the week post menses
B. One or more of the following
1. Marked affective lability
2. Irritability, anger, or increased interpersonal conflicts
3. Depressed mood, feelings of hopelessness, or self-deprecating thoughts
4. Anxiety tension and or feeling on edge
C. One or more to reach five symptoms combined with criterion 2
1. Decreased interest in activity
2. Subjective difficulty concentration
3. Lethargy or lack of energy
4. Change in appetite (overeating or food cravings)
5. Hypersomnia or insomnia
6. Feeling overwhelmed or out of control
7. Physical symptoms like breast tenderness, joint pain, bloating, or weight gain
D. Symptoms interfere with daily life
E. Symptoms are not exacerbations of another disorder
F. Criterion 1 should be confirmed after 2 symptomatic cycles
G. Not attributed to substance use/ abuse or medical condition
Treatment: Cognitive behavioral therapy, buspirone

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Bipolar Disorder (I & II)
Manic Episode:
A. A period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently
increased goal-directed activity or energy, lasting at least 1 week.
B. During the period of mood disturbance and increased energy or activity, 3+ of the following symptoms (4, if the
mood is only irritable) are present:
1. Inflated self-esteem or grandiosity.
2. Decreased need for sleep.
3. More talkative than usual or pressure to keep talking.
4. Flight of ideas or subjective experience that thoughts are racing.
5. Distractibility (attention easily drawn to unimportant or irrelevant external stimuli)
6. Increase in goal-directed activity (socially, at work or school, or sexually) or psychomotor agitation (i.e.,
purposeless non-goal-directed activity).
7. Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in
unrestrained buying sprees, sexual indiscretions, or foolish business investments).
C. The mood disturbance is sufficiently severe to cause impairment in social or occupational functioning or to
necessitate hospitalization to prevent harm to self or others, or there are psychotic features.
D. The episode is not attributable to the effects of a substance or to another medical condition.
Hypomanic Episode:
A. Same as A of Manic Episode
B. Same as B of Manic Episode
C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when
not symptomatic.
D. The disturbance in mood and the change in functioning are observable by others.
E. The episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate
hospitalization. If there are psychotic features, the episode is, by definition, manic.
F. The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other
treatment).
Depressive Episode:
A. 5+ of the following symptoms have been present during the same 2-week period and represent a change from
previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
1. Depressed mood
2. Markedly diminished interest or pleasure in activities
3. Significant weight loss when not dieting or weight gain, decrease or increase in appetite
4. Insomnia or hypersomnia
5. Psychomotor agitation or retardation.
6. Fatigue or loss of energy
7. Feelings of worthlessness or excessive or inappropriate guilt
8. Diminished ability to think or concentrate, or indecisiveness.
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a
suicide attempt or a specific plan for committing suicide.
B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of
functioning.
C. The episode is not attributable to the physiological effects of a substance or another medical condition.

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Bipolar I
Prevalence: 0.6%, slightly more common in males
DDx: Major depessive disorder, other bipolar
disorders
Cause: Unknown, genetic component
Criteria:
A. Criteria have been met for at least one manic
episode
B. The occurrence of the manic and major
depressive episodes is not better explained by
another psychiatric disorder.
Bipolar II
Prevalence: 0.3-0.8%
DDx: Major depessive disorder, other bipolar
disorders, personality disorders, panic or other
anxiety disorder, cyclothymic disorder, substance-use
disorder, ADD/ADHD.
Cause: Unknown, genetic component
Criteria:
A. Criteria have been met for at least one
hypomanic episode & at least one major
depressive episode
B. There has never been a manic episode.
C. The occurrence of the hypomanic episode
and major depressive episode is not better
explained by another psychiatric disorder
D. The symptoms cause clinically significant
distress or impairment in social,
occupational, or other important areas of
functioning.
Treatment of Bipolar I & II:
• Mood stabilizer (Lithium)
• Anticonvulsant (valproic acid, depakote)
• Antipsychotics (Abilify, seroquel, zyprexa,
resperidol, etc…)
• Antidepressant (SSRI, SNRI,
Benzodiazepine)
Cyclothymic Disorder
Prevalence: 0.4-1%
DDx: seizures, substance-use, medication, other
mood disorders, personality disorders
Criteria:
A. Numerous periods of hypomanic as well
as depressive symptoms for at least 2Y (at
least 1Y for children and adolescent)
B. Individual has not been symptom free for
more than 2 months in these 2 Y.
C. Criteria for hypomanic, major depressive
or manic has never been met.
D. Symptoms cause clinically significant
distress or impairment in social,
occupational, or other important areas of
functioning.
E. Symptoms are not better explained by
other mental disorder such as
schizoaffective disorder, schizophrenia,
schizophreniform, delusional disorder and
other psychotic disorders.
F. Symptoms are not attributable to the
physiological effects of a substance-use or
another medical conditions (e.g.,
hyperthyroidism)
Treatment: Anti-psychotic drugs such as lithium,
carbamazepine, and valproic acid, psychotherapy.
Bipolar I & II