Understanding Major Depressive and Manic Episodes: Causes and Treatment Options

1. major depressive episode (lasts 4-9 mo if left untreated) For 2 weeks, 5+: • depressed mood or loss of interest/pleasure • appetite or body weight change (5%+) • sleep problems • psychomotor agitation or retardation • fatigue • feelings of worthlessness or guilt • poor concentration • thoughts of death or suicide • (distress or impairment)

2. manic episode (lasts 3-6 mo if untreated) 1 week of elevated, expansive, or irritable mood and 3+: • inflated self-esteem/grandiosity • less need for sleep • excessively talkative • racing thoughts • too easily distracted • increased goal-directed activity/ psychomotor agitation • excessive pleasurable but risky activities

3. mixed manic episode Meets criteria for both major depressive episode & manic episode. hypomanic episode Less severe than mania & does not cause impairment (at least 4 days)

4. unipolar mood disorder Major Depressive Disorder, single episode (rare!) Major Depressive Disorder, recurrent dysthymic disorder 2+ years depressed mood, more days than not double depression dysthymic disorder + major depressive episode

5. bereavement Less than 2 mo of grief over death of loved one impacted grief reaction extreme bereavement w/psychosis

6. the following are all chronic w/ poor prognosis bipolar I disorder a manic episode bipolar II disorder hypomanic episode + major depressive episode cyclothymic disorder 2+ years alternating dysthymia & hypomania rapid cycling?

7. theories for cause BIOLOGICAL VULNERABILITY Genetic liability for emotional disorders (dep, anx) Low serotonin allows NE & DA to range widely. Which disorder? GENERAL PSYCHOLOGICAL VULNERABILITY Depends on experiences. Negative attributional style (uncontrollability). ANXIETY DEPRESSION Uncertain of control. Gives up hope. STRESSORS TRIGGER ONSET Kindling effect, reciprocal-gene environment

8. antidepressant meds TRICYCLICS – downregulates receptors MAO-Is (tyramine & the cheese effect) SSRIs

9. mood stabilizers LITHIUM (therapeutic vs. lethal dosage window) -kidney dysfunction & seizures ANTICONVULSANTS (valproate, carbamazepine) - Less effective than lithium for suicide

10. ECT 65-140 volts for half second produces seizure for 30 secs to few minutes. Applied 3x/week for 4 weeks. TMS Daily for 2-4 weeks to PFC. But produces seizures so not yet FDA approved.

11. CBT therapy behavior therapy • stop social avoidance behavior, confront & cope with feared social cues • increase exercise interpersonal psychotherapy Work on interpersonal disputes, loss of relationships, gain new relationships, & increase social skills