Depression & Bipolar Disorders

Depressive, Bipolar & Other Mood Disorders

Of all psychiatric illnesses, mood disorders are the most common. The process of treating mood disorders in primary care settings has become more common, and it is in these settings that clients usually first present due to the high amount of somatic symptomatology that comes with these disorders. Sadness is a common, normal human emotion.

Sadness, one of the most common human emotions, lies on a spectrum that could extend from the absence of depression at one end to pathological levels that produce significant symptoms of major depression at the other.

Behavioral manifestations of depression are affected by cultural differences. Mild depression can be considered a healthy reaction to life stressors that acts as a motivator to deal with events and emotions.

Sadness can be pathological if:

  • It is disproportionate to events and sustained over a significant period
  • It greatly hinders normal social functioning such as occupational, social, school, relational functioning.
  • It greatly hinders normal somatic functioning, for example, loss of appetite, altered sleep, altered self-care activities, and altered sexual functioning.
  • It is supposedly unrelated to any identifiable event or situation in a person’s life.
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MAJOR DEPRESSIVE DISORDER (MDD)

  • One of the most common psychiatric disorders; the primary unipolar affective disorder
  • A complex brain-based illness with a primary characteristic of a persistent disturbance in mood
  • Manifestations of behavioral, affective, cognitive, and somatic symptoms due to an excessive or distorted degree of sadness
  • Significantly interferes with daily functioning and goal attainment X Has complex genetic, biochemical, and environmental etiological factors

PERSISTENT DEPRESSIVE DISORDER (DYSTHYMIA)

  • A disorder like MDD but with less acute symptoms; with a more protracted, chronic disease course; and without any manifestations of psychotic symptoms
  • Less discrete episodes of illness than MDD
  • Symptoms often go undetected and therefore untreated for years
  • Vegetative symptoms which includes sleep, appetite, weight changes are much less common in dysthymic disorder than in MD

GRIEF AND BEREAVEMENT

  • Consist of a wide range of normal responses that can become abnormal and excessive
  • Involve normative emotional, cognitive, and behavioral reactions to death or loss of a significant person or object
  • Unlike in major depression, self-esteem is usually maintained in the grieving person
  • Involve nonnormative psychological responses to an identifiable stressor that can result in the development of clinically significant emotional or behavioral symptoms
  • Stressor encompassing elements of perceived loss
  • Develops within 3 months of stressor
  • Single event
  • End of relationship
  • Death of relative or partner
  • Recurring event: Living with person with terminal illness
  • Developmental event: Leaving home to go away to school. Getting married. Becoming a parent. Retiring from work

BIPOLAR (BP) DISORDER

Complex brain-based illness with a primary characteristic of disturbance in mood.

Mood disturbance frequently of both polarities: Depressive and Expansive or Manic

Several Patterns:

  • Single-polarity symptoms only including mania.
  • Distinct symptom patterns of alternating polarity. It includes manic symptoms alternating with depressive symptoms
  • Mixed, co-occurring symptoms
  • Excessive or distorted amount of sadness or elation, possibly both
  • Presents with behavioral, affective, cognitive, and somatic symptoms
  • May have precipitating event, situation, or concern yet often occurs without an identified

Precipitating Stressor

  • Has complex genetic, biochemical, and environmental etiological factors

Diagnostic Criteria

  • Period of abnormally or persistently elevated, expansive, or irritable mood, lasting for at least 1 week
  • Mood episode with rapid development and escalation of symptoms over a few days
  • Often precipitated by significant environmental stressor
  • Mood disturbance may result in brief psychotic symptoms may present after mood disturbance
  • Manic episodes may persist for days to several months
  • Briefer duration and concludes more abruptly than major depressive episodes
  • For 60% of people, a major depressive episode will immediately precede or follow the manic episode
  • Persistence of other suggestive symptoms: Lessened need for sleep, Feels rested after 3 hours sleep on average, Typically a discernible difference from normal baseline sleep pattern, Inflated self-esteem, Feeling of grandiosity, Increased goal-directed activities, Excessive involvement in pleasurable activities with a high potential for painful consequences, Unrestrained shopping sprees, Sexual indiscretions, Unsound business ventures, Excessive substance use or abuse, Highly recurrent depressive episodes

Recurrent shifts in polarity

  • Major depressive episode shifting to a manic episode
  • Manic episode shifting to a major depressive episode
  • Major depressive episode shifting to a mixed episode.
  • Expansive or elated mood symptoms known as Manic symptoms as described above
  • Hypomanic: Like mania but briefer in duration. Episode less severe than mania. No hospitalization required. Does not cause significant functional

CYCLOTHYMIC DISORDER

  • Chronic, fluctuating mood disorder with symptoms similar to but less severe than BP disorder
  • Numerous periods of hypomanic and dysthymic symptoms.
  • Etiology is like BP disorder

If you are struggling with depression, bipolar, or other mood disorders, give our office a call! (855) 208-0890

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