Overview
This lecture covers the full spectrum of psychiatric mood disorders, from depressive disorders to manic states, including diagnostic criteria, key differences, and treatment options.
Mood Disorder Spectrum
- Mood disorders range from low mood (depression) through neutral to high mood (mania).
- Many disorders fall between these poles, with varying criteria and severity.
Major Depressive Disorder (MDD)
- MDD requires 5+ symptoms (at least one: depressed mood or anhedonia) for ≥2 weeks.
- Symptoms: depressed mood, sleep changes, loss of interest (anhedonia), guilt/worthlessness, low energy, concentration problems, appetite changes, psychomotor changes, suicidal thoughts.
- Exclude substance/medical causes before diagnosing MDD.
- Treatment: psychotherapy, antidepressants (SSRIs, SNRIs, TCAs, MAOIs), ECT for refractory cases.
Mania, Hypomania, and Bipolar Disorders
- Mania: 3+ DIG FAST symptoms for ≥1 week, with marked social/functional impairment.
- Hypomania: Similar symptoms, lasting ≥4 days, without significant impairment.
- Bipolar I: At least one manic episode (depression or hypomania may also occur).
- Bipolar II: At least one hypomanic and one major depressive episode.
- Treatment: mood stabilizers (lithium, valproic acid, lamotrigine, quetiapine), antipsychotics for acute mania.
Cyclothymic and Persistent Depressive Disorders
- Cyclothymic Disorder: Fluctuating symptoms of hypomania and depression not meeting full criteria, lasting ≥2 years.
- Persistent Depressive Disorder (Dysthymia): Depressed mood and some MDD symptoms for ≥2 years, less severe than MDD.
- Cyclothymic treatment: CBT, lithium, antipsychotics.
- Persistent depressive disorder: CBT; antidepressants less commonly needed.
Adjustment Disorder
- Emotional or behavioral symptoms (depression/anxiety) within 3 months of stressor, resolving within 6 months after stress ends.
- Does not meet full MDD/anxiety disorder criteria.
- Treatment: supportive therapy, medications for specific symptoms if needed.
Key Terms & Definitions
- Anhedonia — loss of interest or pleasure.
- DIG FAST — distractibility, irresponsibility, grandiosity, flight of ideas, activity increase, sleep decrease, talkativeness (mania mnemonic).
- SIG E CAPS — sleep, interest, guilt, energy, concentration, appetite, psychomotor, suicidal ideation (depression mnemonic).
- Psychomotor changes — physical slowing or agitation linked to mood.
- Mood stabilizers — medications to control mood swings in bipolar disorder.
- ECT (Electroconvulsive therapy) — treatment for severe or refractory depression.
Action Items / Next Steps
- Review criteria mnemonics (SIG E CAPS, DIG FAST).
- Prepare for upcoming lecture on antidepressant medications.
- Read about distinguishing features of mood vs. adjustment disorders.