Mood Disorders

Mood Disorder

By: Kendra Canham, Emily Chen, and Karla

Kendra Canham, Emily
Juarez Chen and Karla
Cortez
Juarez Cortez
Overview of Mood Disorders
● Mood disorders are chronic disorders that affect people’s emotions to the point that it
starts to interfere with various aspects of their lives such as: social, physical, and mental.

● Majority of these disorders have to last for an extended amount of time and the symptoms
have to appear consecutively.

● The main change on the DSM-V in regards to mood disorders is that these disorders are
separated into two categories: Bipolar Disorders and Depressive Disorders.
What is
depression?
● Depression is a
common and serious
mood disorder that
negatively affects the
way that an individual
thinks, feels, and acts.

https://www.youtube.com/w
atch?v=GOK1tKFFIQI
Depressive Disorders (Unipolar)
● Disruptive Mood Dysregulation Disorder
(DMDD)
● Major Depressive Disorder (MDD)
○ Single Episode or Recurrent
● Persistent Depressive Disorder (Dysthymia)
● Premenstrual Dysphoric Disorder
● Substance/Medication-Induced Depressive
Disorder
● Depressive Disorder Due to Another
Medical Condition
Prevalence
•An estimated 17.3 million adults
in the US have had at least one
major depressive episode (this
represent 7.1% of the population)

•Higher rates among individuals

between the ages of 18-25

•Higher rates in adult females

(8.7%) than in males (5.3%)
Etiology of Depressive Disorders
● We currently do not know exactly what causes depression
● Possible causes include a combination of biological,
psychological, and social sources of distress
● Thus, can be attributed to both exogenous stress along with an
endogenous genetic predisposition
● A study conducted at Duke University in 2015 found that
early life stress is a major risk factor for later episodes of
depression. Specifically, adults who are neglected or abused as
children are almost twice as likely to experience depression at
some point in their lives. (Hanson et. al, 2015).
Characteristics & Symptoms
•Depressed mood, most of the day, nearly
every day
•Diminished interest or pleasure in activities *Symptoms cause clinically significant distress or
impairment in social, occupational, or other
(anhedonia)
important areas of functioning
•Significant weight loss or weight gain
•Insomnia or hypersomnia *If symptoms are present, they must occur nearly
•Fatigue or loss of energy every day for 2+ weeks in order to receive a diagnosis
•Feelings of worthlessness or excessive or
*May first appear at any age, but much more likely
inappropriate guilt
after puberty
•Diminished ability to think or concentrate
(or indecisiveness)
•Recurrent thoughts of death
SSRIs & SNRIs
Selective Serotonin Reuptake Inhibitors (SSRIs) Serotonin Norepinephrine Reuptake Inhibitors
(SNRIs)
•Block the reuptake of serotonin into the presynaptic
neuron •Inhibit serotonin and norepinephrine reuptake

•Safer than older antidepressants and have less side •Typically prescribed if SSRIs have not proven effective

effects •Includes Effexor, Pristiq, Cymbalta, and Strattera

•Includes Prozac, Zoloft, Paxil, Luvox, Celexa, and •Side effects: Headaches, dizziness, high blood pressure,

Lexapro excessive sweating, coughing, chills, fatigue, loss of

•Side effect: Headaches, nausea, dry mouth, excessive appetite, nervousness, abnormal dreams

sweating, weight changes, loss of sex drive, irritability •More Extreme: Panic attacks, hallucinations, suicidal

•More Extreme: Suicidal ideation, new/worsening thoughts

anxiety, depression, or irritability, aggressive behavior,

panic attacks, insomnia, mania, extreme mood changes
MAOIs & TCAs
Monoamine Oxidase Inhibitors (MAOIs)
•Originally used to treat tuberculosis, then it was
noticed that the drug had the power to stimulate the
CNS, which led it to be used for treating depression
•Includes Marplan, Nardil, Emsam, and Parnate
•Side effects: Headache, muscle cramps, weight gain,
difficulty urinating
•More extreme: can cause cell death in the liver,
nighttime insomnia paired with daytime sedation,
tyramine intolerance, orthostatic hypotension (a drop in
blood pressure that results in dizziness on standing)
Tricyclic Antidepressants (TCAs)
•Appear to inhibit the reuptake of serotonin and
norepinephrine (Research is relatively strong, but results
can often be ambiguous)
•Includes Tofranil, Pamelor, Asendin, and Anafranil
•Side effects: Dry mouth, dizziness, constipation, blurred
vision, excessive sweating, weight gain, difficulty
urinating
•More extreme: Sedation, sexual dysfunction,
orthostatic hypotension
Therapeutic Treatments
•Cognitive Behavioral Therapy (CBT)- focuses on assessing and changing
the negative thought patterns that are associated with depression, along with
teaching coping strategies (often limited to 8-16 sessions)
*Has a strong research base

•Interpersonal Therapy (IPT)- focuses on improving problems in personal relationships and other life changes that may
be contributing to the depressive disorder, teaches individuals to increase their interactions while improving how they relate
to others (often time-limited in a way similar to CBT)

•Psychodynamic Therapy- focuses on recognizing and understanding negative patterns of behavior and feelings that are
rooted in past experiences while working to resolve them, looks at the unconscious processes (can be either short-term or
long-term)

•Other Interventions: Herbal Therapy, Art Therapy, Music Therapy, Forest Therapy, and Exercise
Deep Brain Stimulation (DBS)
•Patients suffering from severe,
treatment-resistant depression can benefit both
acutely and long-term from DBS

•This March at the University of Freiburg, a

study was conducted on 16 patients suffering
from severe depression. Researches used thin
electrodes to stimulate a deep-seated part of the
reward system, which led to a significant
reduction of depression severity in all patients by
half (on average). Most participants experienced
positive stimulation effects within the first week,
and they lasted throughout the course of the
one-year study. (Coenen et. al, 2019)
Depression in Children
https://www.youtube.com/watch?v=vi8SygnGaUk
Bipolar I & Bipolar II
Disorders
Prevalence (via DSM-V)
Bipolar I Disorder

● 12-month prevalence in the U.S. was 0.6%

● Average age of one’s first manic, hypomanic, or major depressive episode is 18.

Bipolar II Disorder

● 12-month prevalence in the U.S. is 0.8%.

● Can begin in late adolescence and throughout adulthood; average age is mid-20s.
Symptoms of Bipolar Disorders
Bipolar I Disorder Bipolar II Disorder

● Full manic episodes/mania ● Fluctuates between major depression

● Major depressive episodes
● Most experience an alternation of the
episodes. However, some have reported
to experience a mix of the episodes (e.g.
having racing thoughts while feeling
extremely sad).
● Also called “manic-depressive illness”
and hypomania
● Hypomania are episodes of mania that
are less severe and lasts for shorter
periods of time.
● Does not have a full-blown manic
episode
● A full-blown manic episode is enough to
be diagnosed with Bipolar Disorder I

*For both disorders, symptoms have to be present even after the substance(s) is no longer in the one’s
system and they cannot be explained by any psychotic/depressive disorders.
What Bipolar Disorders Looks Like
https://www.youtube.com/watch?v=krsrvyQ3HXI
What causes Bipolar Disorders?
● Currently, we do not know
what exactly causes Bipolar
Disorders.
● Genetic, Neurochemical and
Environmental factors are the
most prevalent theories. (Or a
combination of all three).
● Diathesis-Stress Model: stress
caused by life experiences reveal
a “predispositional
vulnerability”
Genetic Factors
Some fundamental statistics:

● About half of the people with bipolar disorder have a family member with a
mood disorder, such as depression.
● Research on identical twins shows that if one twin is diagnosed with bipolar
disorder, the other has a 40-70% chance of having the same diagnosis.
● People who have a sibling with Bipolar Disorder are 10 times more likely to
develop it themselves.
Recent Findings on Genetic Causes
● Last year, a multi-decade study focusing on children who had parents diagnosed with
bipolar disorder indicated that 24.5% of these children also will gradually develop bipolar
illness between the ages of 12 and 30. (Duffy et. al, 2018)
● Early signs were predominately depressive episodes, especially among children with parents
who were using lithium.
● Childhood symptoms such as sleep and anxiety disorders indicated a higher risk of
developing a mood disorder later on.
● None of the children met diagnostic criteria for bipolar disorder prior to age 12, regardless
of clinical assessment or high genetic risk.
Environmental Factors
● Childhood Trauma
○ More likely to show rapid cycling, psychotic features, higher number of mood episodes, greater
risk of suicide attempts.
● Life Events
○ Any substantial changes in surroundings causing extreme stress.
○ More than 60% of patients experienced at least on life event 6 months before a new episode
(simhandl et al.).
● Climate
○ Mania tends to peak in spring, summer and mid-winter. Depression spikes in winter and spring.
○ Disruption of our circadian rhythm due to the number of light/dark hours during the day.
● Maternal Health
○ Maternal smoking and infections, such as gestational influenza, may increase risk of Bipolar
Disorder in child.
● Other Drugs
○ Antidepressants, Opioids, Cocaine, Ecstasy, etc. (Aldinger and Schulze, 2017)
Neurochemical Factors
● Irregular function of neurotransmitters,
primarily norepinephrine, serotonin,
dopamine.
● GABA observed to be lower in the blood
and spinal fluids of bipolar patients.
● Poor connectivity with brain circuits
dedicated to processing sensory
information or generating appropriate
motor responses.
● Parts of the hippocampus are smaller in
people with BD than MDD or no mood
disorders (Cao, 2016).
Treatment
Lithium
● A naturally occuring, positively charged alkali metal ion that affects different parts of the
brain differently at various times when different doses are prescribed
● Affects multiple neurotransmitters and second-messenger systems in our body
● Increases serotonin levels, blocks the effects of highly sensitive dopamine receptors,
increases norepinephrine in depressed patients and lowers it in manic patients, stabilizes
neurons in the Central Nervous System.
● Approximately 60-80% of clients with mania respond to lithium.
● Problems with Lithium:
○ Treatment dosage is very close to toxic dosage.
○ Cannot be processed by kidneys leading to higher chances of kidney damage
○ 3/4 of users experience side effects, which is the primary reason why they stop taking
Lithium. Side effects also increase as dosage increases.
● Thus, we are still uncertain of Lithium’s effectiveness.
Other Medications
● Antidepressants
○ In conjunction with mood stabilizers, but there are heavy concerns that
antidepressants will induce mania.
○ Should only be used when mood stabilizers have failed due to the side effects and
exacerbation of rapid cycling/manic states. (McInerney and Kennedy, 2014).
● Anticonvulsants
○ Increase concentration of GABA by attaching to the enzyme that breaks down
GABA. Decreases electrical activity and less neurotransmission activity
○ Used often for mixed mood states, rapid cycling
● Atypical Antipsychotic Medications
○ Recently, researchers found that cariprazine, or vraylar, which was previously used for
mania has also been effective in treating depression in Bipolar Disorder, which may
help eliminate clients’ need for multiple types of medications. (Yatham, 2019)
Integrative Approach
● Medical Perspective: Mood disorders are “chemical imbalances” therefore, they must be treated with
medicine. These disorders, specially bipolar disorders, have a hereditary component that can make an
individual more vulnerable to being diagnosed later in life.
● Psychological Perspective: Mood disorders impair an individual’s interaction with the world and has to be
resolved with psychotherapy. Another issue involves a patient’s concern about their creativity being stifled by
the treatment.

- Kyaga et al. (2011) conducted a study in which he discovered that several individuals who are
diagnosed with Bipolar Disorder and Schizophrenia are involved in careers that have to do with
creativity such as visual arts, musicians, etc.
 Continued
● Social Perspective: The stress of various factors such as familial, financial and/or racial will impact the likelihood that one
will seek treatment. The cost of the treatment themselves can be too overbearing for some patients, specially those with
low-income and no health insurance.
https://www.ncbi.nlm.nih.gov/books/NBK43419/table/clindep.t1/?report=objectonly
● Cultural Perspective: Individuals differ in values and have different perspectives on what mental illness is; some cultures
are opposed to seeking help for mental health which in turn leads to the mood disorders to continue.
● In 2010, Carpenter-Song et al. conducted a study and some of his findings included:
● Non-minority (Euro-Americans) participants tended to seek treatment and their beliefs about their mental illness
were those of a medical model; in contrast, African Americans and Latino participants agreed more with a
non-biomedical explanation for mental illness.
● Unlike European Americans participants, African Americans participants expressed frustration over their
therapist’s overemphasis on medications and Latino participants did not like the diagnostic labels given to them.
New Research on Treatment
● In 2017, an 8 year Swedish study followed over
50,000 people with bipolar disorders. During
follow-up, there were 10,648 suicide attempts. The
rate of attempted or completed suicide dropped by
14% when patients were taking Lithium (Song, et. al).

● High degrees of connectivity in brain’s default network during “wakeful rest”

(when the person is not focused on anything in particular or involved in any
tasks) can protect against Bipolar Disorder (Frangou, 2018).
● Deep Transcranial Magnetic Stimulation (dTMS), previously used to treat
severe depression has shown to increase better overall functioning in bipolar
patients after four weeks. Could be used as an “add-on” therapy or as
maintenance therapy (Brunoni, 2017).
Bipolar Disorder in Children
● Children and teens are 40 times more likely to be
diagnosed with Bipolar Disorder in the 21st
century.
● Mainly in the U.S., Bipolar Diagnosis in European
countries have remained low.
● Not actually a rise in disorder, but most likely a diagnostic inflation due to
redefinitions of symptoms in DSM-IV.
● Bipolar diagnosis may be “easier” to parents, teachers, physicians than ADHD,
anxiety, oppositional-defiant disorder, conduct disorder, etc., because it is seen as
a context-independent, genetic disorder, and therefore, there is no extra blame.
(Parens and Johnston, 2010)
Controversies on Pediatric Bipolar Disorder

● Criteria for Bipolar Disorder overlaps with criteria for many other developmental issues,
such as Neurodevelopmental Disorders, as well as other problems known to affect people
of all ages, such as depression, anxiety, etc.
● Currently, there are no pediatric diagnostic guidelines for Bipolar Disorders in children.
● Signs of “irritability” and “acting out” in children/adolescents are often inaccurately
correlated with the “bipolar spectrum,”
● Drugs used to treat Bipolar Disorder may cause intense harmful side effects in children.
● Authors of the treatment guidelines admit that DSM symptoms for adult mania are
problematic when used for children, but then recommended their continual use anyways...
The “Universal Agreement”
● While there is deep disagreement about the guidelines of diagnosing children with
bipolar disorder, psychiatrists do agree that “there is a group of children with
severe irritability or aggression or rages whose explosive behavior is significantly
impairing, that we have been chasing with different diagnoses over the years ... that
we haven’t had a great deal of success in treating” (Parens and Johnston, 2010).
● Regardless of what diagnostic label they receive, these children are experiencing
extreme and debilitating moods such as racing thoughts, periods of elation,
hypersexuality, extreme depression, and suicidality, and they should be helped
accordingly.
Where do we go from here?
● Research recommends psychiatrists who followed DSM IV’s criteria for Bipolar Disorder
when diagnosing children should revisit their diagnoses and treatment plan periodically to
eliminate potential life-threatening suffering for the child.
● Extensive clinician training and more thorough evaluations, rather than use of “checklists”
● Improving our understanding of how the impact of severe emotional trauma, such as
physical or sexual abuse, manifests during children’s development, leading to symptoms
that resemble bipolar disorder.
● Proposing Temper Dysregulation Disorder with Dysphoria for DSM-V
○ Less children diagnosed with Bipolar Disorder, which would lead to fewer children exposed to
antipsychotics and mood stabilizers
○ Did not actually go through due to complaints about vague guidelines.
● Finally, in 2013, the addition of Disruptive Mood Dysregulation Disorder to DSM-V
as an attempt to replace Bipolar Diagnosis in Children
Disruptive Mood Dysregulation Disorder
https://www.youtube.com/watch?v=UPzdAhTxGIc

● Symptoms include: severe recurrent temper outbursts (verbally or behaviorally) that are inconsistent
with developmental level, outbursts that occur 3+ times per week, persistently irritable or angry mood
between outbursts nearly most of the day, every day, and is observable by others (e.g., parents, teachers,
peers). This criteria must be present in at least 2 or 3 settings (at home, at school, with peers) and are
severe in at least one of these. Criteria must also be present for 12 or more months (throughout that
time, the individual has not had a period of 3 or more consecutive months without all of these
symptoms)
● Must receive diagnosis between ages 6-18, cannot also be diagnosed with ODD or IED

● Treatment options: Dialectical behavioral therapy for the child, along with parent management
training. If therapy is not available or not effective on its own, a combination of stimulant medications
and SSRIs may be prescribed. In extreme cases, an atypical antipsychotic such as Risperdal can be
prescribed to the child.
Questions?