MOOD DISORDERS

Dr. AMJAD HAKRO

MBBS, FCPS (Psych)
Consultant Psychiatrist,
Senior Registrar
ATMCH, Karachi
 DEPRESSIVE DISORDER
• Depressive disorder is a common psychiatric disorder
characterized by the symptoms of low mood, loss of interest
and enjoyment, and reduced energy leading to increased
fatigability lasting for 2 weeks or more.

• Life time prevalence is 10-20%.

• One year prevalence is 2-5%.
Screening Depression in Suspected cases
Use following 2 screening questions in suspected cases:

• 1. Over the past 2 weeks, have you felt down, depressed, or hopeless?

• 2. Over the past 2 weeks, have you felt little interest or pleasure in doing
things?

If either of these is present , then ask additional questions

Ref: David Goldberg , Prescribing anti-depressants in primary care and hospital practice ;
Depression in medical secularities ; WPA Bulletin on Depression “ Facing, understanding and managing
Depression Vol.7 No 26 ,2003
 Criteria for Depressive Disorder
Common symptoms / Typical symptoms
1. Depressed mood: most of the day, nearly every day
2. Anhedonia: diminished interest/ lack of pleasure
3. Fatigue: loss of energy
4. Weight change: more than 5% per month
5. Disturbed sleep: insomnia, hypersomnia (atypical depression
6. Agitation: psychomotor
7. Reduced libido
8. Inappropriate guilt
9. Indecisiveness: diminished ability to think
10. Suicide: thoughts of death
 What are the defining symptoms of anxiety
and depression? The tables below show the
differences and the similarities.
Anxiety & Anxiety Disorder Depression
Feeling of fear, apprehension and excessive anxiety Feeling of emptiness, deep sadness or misery, loss of
energy hope
Physical feelings of agitation, muscle tension and Slowing down of physical movement and lack of physical
symptoms of anxiety eg. heart symptoms, nausea, energy
dissociation, diarrhoea, breathing difficulties etc

General sense of being tense and rigid Physical body slumped

May be a perfectionist and is concerned about the results Loss of interest and ambition (can lead to poor
of activities (can lead to poor performance) performance)

May fear death but not focused on suicide (Suicide Suicidal thoughts present in severe depression
thoughts come only when Depression is a secondary
effect of anxiety disorder)
 THE BIPOLAR ILLNESSES

Wide range of syndromes with manic features,

Mania
associated with episodes of depression

Hypomania

Normal

Depression

Severe
depression
Normal Cyclothymic Cyclothymic Bipolar II Unipolar Bipolar I
mood personality disorder disorder mania disorder
variation

Goodwin FK and Jamison KR. Manic-depressive illness. New York: Oxford University Press, 1990
 BIPOLAR DISORDER:
A common disorder of mood or affect, characterized by
discrete periods of mania and depression separated by an
interval of remission (euthymia)
• More common than schizophrenia
• Men and women equally affected regardless of race, education,
occupation or income
• Most common first presenting episode
• women: depression
• men: mania
MANIA:
PRESISTENT ELATION OR IRRITABILITY
OF MOOD FOR AT LEAST ONE WEEK
(MOST OF THE DAY EVERYDAY)

Just opposite to the depressive disorder

HYPOMANIA:
LESSER DEGREE OF MANIA

HIGH MENTAL & PHYSICAL EFFICIENCY

MILD ELATION OF MOOD
BIPOLAR DISORDER: AGE OF ONSET
1,2
• Peak age of onset: 15–19 and 20–24 years
• Earlier onset and more
3 severe course in
substance abusers
• In early-onset patients, typical time-lag is
3–10 years between first presentation 4 and
initiation of treatment/hospitalization
• Later onset in association with other conditions
e.g., endocrinopathy

1
Burke KC et al. Arch Gen Psychiatry 1990;47(6):511–18;
2
Weismann MM et al. Psychol Med 1998;18:14–53;
3
Brady KT et al. J Clin Psychiatry 1995;56(Suppl. 3):19–24;
4
Egeland JA. Compr Psychiatry 1983;24(4):337–44
ETIOLOGY
BIOLOGICAL
GENETIC
TWIN – MONOZYGOTIC (IDENTICAL)
– DIZYGOTIC FRATERNAL

NEUROTRANSMITTERS
5HT
NORADRENALINE
DOPAMINE

ENVIROMENTAL
PSYCHOLOGICAL FACTORS (STRESS)

SOCIAL FACTORS (RECENT LIFE EVENTS)

Bipolar Disorder:
• Abnormally and persistently elevated, expansive,
or irritable mood > 1 week
• 3* or more activation symptoms:
• Distractibility, Increased risk-taking, Grandiosity,
Fast/racing thoughts, Activity increased, Sleep
decreased, Talkativeness (“DIG FAST”)
• Marked social/occupational impairment
• Not due to drugs or medical condition
Bipolar Disorder:
• 5 or more of following present > 2 weeks:
• depressed mood most of day, nearly every day
• decreased interest or pleasure in activities most of day, nearly every day
• increased/decreased appetite & weight
• increased/decreased sleep
• psychomotor agitation/retardation
• decreased energy
• guilt/worthlessness
• poor concentration
• recurrent thoughts of death/suicide
Psychotherapeutic Interventions
• Education
• Challenging irrational beliefs
• Self-monitoring (mood, sleep, stress
charts) and social rhythms
• Manage interpersonal relationships and
family coping
• Medication adherence
• Manage alcohol and substances
Pharmacotherapy in Bipolar Disorder

MOOD
STABILZERS

ATYPICAL
ANTI-
LITHIUM ANTI-
CONVULSANTS
PSYCHOTICS
 Pharmacotherapy for Bipolar illness
mnemonic
Mood Stabilizer – lithium, divalproex sodium,
M Carbamazepine, topiramate,
Anxiolytic – clonazepam, lorazepam
A Antidepressant – bupropion, SSRI, other
Neuroleptic – olanzapine, risperidone (clozapine,
N ziprasidone)
Indications for Inpatient treatment – suicide, severe
I psychosis, substance abuse
Consultation – Compliance
C Counseling – depression, family therapy
Thank you