Chapter 6: Mood disorders

Table 6-2 Is it unipolar or bipolar depression? Questions to ask the monoamine neurotransmitter system. These three
Who’s your daddy?
monoamines often work in concert. Many of the symp-
toms of mood disorders are hypothesized to involve
What is your family history of: dysfunction of various combinations of these three
systems. Essentially all known treatments for mood dis-
 mood disorder?
 psychiatric hospitalizations? orders act upon one or more of these three systems.
 suicide? We have extensively discussed the dopamine
 anyone who took lithium, mood stabilizers, system in Chapter 4 and illustrated it in Figures 4-5
antipsychotics, antidepressants? through 4-11. We have extensively discussed the
 anyone who received ECT? serotonin system in Chapter 5 and illustrated it in
These can be indications of a unipolar or bipolar Figures 5-13, 5-14, 5-25, and 5-27. Here we introduce
spectrum disorder in relatives. the reader to the norepinephrine system, and also
show some interactions among these three monoami-
Where’s your mama?
nergic neurotransmitter systems.
I need to get additional history about you from
someone close to you, such as your mother or your
spouse. Noradrenergic neurons
Patients may especially lack insight about their manic The noradrenergic neuron utilizes norepinephrine (nor-
symptoms and under-report them. adrenaline) as its neurotransmitter. Norepinephrine
(NE) is synthesized, or produced, from the precursor

Identifying Bipolar Depression:

Hints From Current Symptoms

BIPOLAR DEPRESSION
HYPOMANIA
More:
Time sleeping
Overeating
Comorbid anxiety
Motor retardation
Mood lability during episode
DYSTHYMIA Psychotic symptoms
Suicidal thoughts

Figure 6-22. Bipolar depression symptoms. Although all symptoms of a major depressive episode can occur in either unipolar or bipolar
depression, some symptoms may present more often in bipolar versus unipolar depression, providing hints if not diagnostic certainty that the
patient has a bipolar spectrum disorder. These symptoms include increased time sleeping, overeating, comorbid anxiety, psychomotor
retardation, mood lability during episodes, psychotic symptoms, and suicidal thoughts.

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