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Mood Disorders (Major Depressive (Patients with depression usually have…
Mood Disorders
Major Depressive
Episodes characterized by atleast 5 of the 9 diagnostic symptoms lasting > = 2 weeks
SIG E CAPS
Sleep Disturbance depressed mood
Loss of Interest
Guilt or feelings of worthlessness
Energy loss and fatigue
Concentration problems
Appetite/weight changes
Psychomotor ret or agitation
suicidal ideations
Screen for history of manic episodes to rule out bipolar
Treatment
CBT and SSRI are first line
SNRI, mirtazapine, and bupropion can also be considered
ECT in treatment resistant patients
Persistent depressive disorder
often milder >2= depressive symptoms lasting >2 years w no more that 2 months without depressive symptoms
MDD with seasonal pattern
Lasting >=2 years with >= 2 major depressive episodes associated with seasonal pattern (usually winter) and absence of nonseasonal depressive episodes
atypical symptoms common
Patients with depression usually have the following changes in their sleep stages
dec slow wave sleep
dec REM latency
inc REM early in sleep cycle
inc total REM sleep
repeated nighttime awakenings
early morning awakening: terminal insomnia
Depression with atypical features
mood reactivity: able to experience improved mood in response to positive events
reversed vegetative symptoms: hypersomnia, hyperphagia
leaden paralysis: heavy feelings in arms and legs
long standing interpersonal rejection sensitivity
Most common subtype of depression
Treatment:
CBT and SSRI are first line
MAO inhibitors are effective, but high risk profile
Bipolar
Bipolar I
presence of atleast 1 manic episode +/- hypomanic or depressive episode
Bipolar II
presence of a hypomanic and depressive episode
no history of manic episode
Patients mood and functioning usually normalize between episodes
use of antidepressants can destabilize mood
high suicide risk
Treatment
Mood stabilizers
lithium
valproic acid
carbamazepine
atypical antipsychotics
Cyclothymic disorder
milder form of bipolar disorder lasting > 2 years
fluctuating between depressive and hypomanic symptoms