- Major depressive disorder is characterized by at least one major depressive episode involving depressed mood and/or loss of interest/pleasure plus at least 5 other symptoms lasting at least 2 weeks. - Bipolar disorder involves alternating periods of mania/hypomania and depression and includes bipolar I, bipolar II, and cyclothymia. - Treatment involves managing acute episodes with medications like lithium, SSRIs, or antipsychotics and long-term maintenance therapy to prevent future episodes.

1. Mood disorders

2. MAJOR DEPRESSIVE DISORDER
Diagnostic Criteria
• Major Depressive Episode
• A. During the 2-week period a change from
previous functioning is present; at least one of the
symptoms is either (1) depressed mood or (2) loss
of interest or pleasure.
Note: Do not include symptoms that are clearly due
to a general medical condition, or mood-incongruent
delusions and hallucinations.

3. Five (or more) of the following
symptoms have been present
• 1 depressed mood
• 2 loss of interest or pleasure
(anhedonia /ˌan.hɪˈdəʊ.nɪə/)
• 3 significant weight loss when not
dieting or weight gain, or decrease or
increase in appetite
• 4 insomnia or hypersomnia

4. • 5 psychomotor agitation or retardation
• 6 fatigue or loss of energy
• 7 feelings of worthlessness or
inappropriate/excessive guilt
• 8 diminished ability to think or concentrate,
or indecisiveness
• 9 recurrent thoughts of death or suicide

5. • B. The symptoms do not meet criteria for a
mixed episode (is not a bipolar disorder).
• C. The symptoms cause significant distress or
impairment in social, occupational, or other
important areas of functioning.
• D. The symptoms are not due to the direct
physiological effects of a substance (eg, drug
of abuse) or a general medical condition (eg,
hypothyroidism).
• E. The symptoms are not better accounted for
by bereavement (I e, depressive/grief
symptoms lasting less than 2 months).

6. BEHAVIORAL SYMPTOMS ASSOCIATED
WITH MEDICAL CONDITIONS
BEHAVIORAL
SYMPTOM
ASSOCIATED MEDICAL CONDITION
Anxiety Cardiac arrhythmia
Chronic infection with fever
Cushing’s disease, Hyperthyroidism
Hypoglycemia or hyperglycemia
Pheochromocytoma
Pulmonary disease
Anemia, Severe blood loss
Vitamin/mineral deficiency or toxicity
Depression AIDS
Brain lesions, particularly in the left frontal lobe
Collagen-vascular diseases
Chronic pain (e.g., headache)
Diabetes mellitus
Hypoadrenalism (Addison’s disease)
Hyperadrenalism (Cushing’s disease)
Hypothyroidism, Hypoparathyroidism, Hyperparathyroidism
Huntington’s disease
Immune system disorder

7. Hypomanic Episode
Diagnostic Criteria
A. A distinct period of abnormally and persistently el-
evated, expansive, or irritable mood lasting at least 1
week (or any duration if hospitalization is necessary).
B. During the period of mood disturbance, three (or
more) of the following symptoms have persisted (four if
the mood is only irritable) and have been present to a
significant degree:
1 inflated self-esteem or grandiosity
2 decreased need for sleep (eg, feels rested after only 3
hours of sleep)

8. 3 more talkative than usual or pressure to keep talking
4 flight of ideas or subjective experience that thoughts
are racing
5 distractibility (ie, attention too easily drawn to
unimportant or irrelevant external stimuli)
6 increase in goal-directed activity (either socially, at
work or school, or sexually) or psychomotor agitation
7 excessive involvement in pleasurable activities that
have a high potential for painful consequences (eg,
engaging in unrestrained buying sprees, sexual
indiscretions, or foolish business investments)

9. C. The symptoms do not meet the criteria for a mixed
episode.
D. The mood disturbance is sufficiently severe to
cause marked impairment in occupational functioning
or in usual social activities or relationships with others,
or to necessitate hospitalization to prevent harm to
self or others, or there are psychotic features.
E. The symptoms are not due to the direct
physiological effects of a substance (eg, a drug of
abuse, a medication, or other treatment) or a general
medical condition (eg, hyperthyroidism).
Note: Manic-like episodes that are clearly caused by
somatic antidepressant treatment (e g, medication,
electroconvulsive treatment, light therapy) should not
count toward a diagnosis of bipolar I disorder.

10. Bipolar disorder
Episodes typically begin suddenly, a depressive
episode immediately precedes or follows a
manic episode.
Bipolar disorder includes
1. Bipolar I disorder
2. Bipolar II disorder
3. Cyclothymia:

11. Bipolar I disorder
1. At least one manic episode is necessary to make
the diagnosis;
2. depressive episodes are common in the vast
majority of cases with bipolar disorder I, but are
unnecessary for the diagnosis.
3. Pure (or monopolar) mania /ˈmeɪ.ni.ə/ is very
rare. The hallmark of a manic episode is
abnormally and persistently elevated, expansive,
or irritable mood.

12. Bipolar II disorder
1. No manic episodes and
2. One or more hypomanic episodes and one or more
major depressive episode.
3. Hypomanic episodes do not go to the full extremes of
mania (i.e., do not usually cause severe social or
occupational impairment, and are without psychosis),
and this can make bipolar II more difficult to
diagnose,
4. hypomanic episodes may simply appear as periods of
successful high productivity and are reported less
frequently than a distressing, crippling depression.

13. CYCLOTHYMIC DISORDER
Diagnostic Criteria
A. For at least 2 years, the presence of numerous periods with hypomanic
symptoms and numerous periods with depressive symptoms that do not
meet criteria for a major depressive episode.
Note: In children and adolescents, the duration must be at least 1 year.
B. During the above 2-year period (1 year in children and adolescents), the
person has not been without the symptoms in Criterion A for more than 2
months at a time.
C. No major depressive episode, manic episode, or mixed episode has been
present during the first 2 years of the disturbance.

14. • The elevated mood can be described as
euphoric /juːˈfɒr.ɪk/, cheerful, and with
indiscriminate enthusiasm and optimism;
therefore, others often perceive it as
infectious. Although the patient's mood may
be predominantly elevated, it may quickly
become irritable, especially after demands are
not satisfied.

15. DYSTHYMIC DISORDER
DYSTHYMIA /dɪsˈθaɪ.mi.ə/
DSM-IV Diagnostic Criteria
A. Depressed mood for most of the day, for more
days than not, as indicated either by subjective
account or observation made by others, for at least
2 years.
Note: In children and adolescents, mood can be
irritable and duration must be at least 1 year.

16. • B. Presence, while depressed, of two (or more)
of the following:
1 poor appetite or overeating
2 insomnia or hypersomnia
3 low energy or fatigue
4 low self-esteem
5 poor concentration or difficulty making decisions
6 feelings of hopelessness

17. C. During the 2-year period (1 year for children or
adolescents) of the disturbance, the person has never
been without the symptoms in Criteria A and B for
more than 2 months at a time.
D. No major depressive episode has been present
during the first 2 years of the disturbance (1 year for
children and adolescents); i.e., the disturbance is not
better accounted for by chronic major depressive
disorder, or major depressive disorder, in partial
remission.

18. Treatment
The clinical management of bipolar disorder involves:
1 Treatment of the acute episodes and
2 Maintenance therapy.
Acute depressive episodes are treated best with SSRIs or
bupropion, because these medications are less likely to
trigger the switch into mania or hypomania (frequently
caused by TCAs).
Acute manic episodes can be managed with lithium,
valproic acid, or carbamazepine.
If delusional symptoms and agitation are present,
antipsychotics (eg, haloperidol) or benzodiazepines (eg,
clonazepam) need to be added.
Maintenance treatment of bipolar disorder, aimed at
course stabilization and prevention of further episodes,
includes lithium, valproic acid, or carbamazepine.

19. Treatment
Lithium has been used to suppress the hypomanic
cycles, but most patients seek treatment for their
labile, irritable moods and their anxious, dysphoric
depressions.
Some of these patients may shift into acute manic
states or may develop rapid cycling if their
depressions are treated solely with TCAs.
In this case, bupropion, MAOIs, and low-dose SSRIs, in
conjunction with lithium or other mood stabilizers,
may be appropriate.