Mood Disorders
Dr Joanna Bennett
Mood Disorders
Pervasive alterations in emotions that are
manifested by depression, mania, or both,
and interfere with the person’s ability to
function normally
Mood Disorders
 Major depression: 2 or more weeks of sad
mood, lack of interest in life activities, and
other symptoms
 Bipolar disorder (formerly called “manic-
depressive illness”): mood cycles of mania
and/or depression and normalcy and other
symptoms
Some related disorders
 Seasonal affective disorder (SAD)
 Postpartum depression
 Postpartum psychosis
Prevalence
 International studies
Major depression - 3-16%
 Bipolar disorder 0.3-1.5%
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 Caribbean
4.9% (PAHO 2005)
 Community prevalence and risk factors for
mood disorders are generally unknown

DSM Diagnostic criteria – Major
depressive disorder
 At least one of the following three abnormal
moods
 significantly interferes with the person's life:
 Depressed mood
 Loss of interest & pleasure
 Irritable mood (under 18 yrs)
Occurring most of the day, nearly every day,
for at least 2 weeks
Diagnostic criteria: Depression
 At least five of the following symptoms should
have been present during the same 2 week
depressed period:
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Depressed or irritable mood
Loss of interest & pleasure
Appetite/weight disturbance (gain/loss)
Sleep disturbances
Fatigue/loss of energy
Guilt
Poor concentration
Morbid thoughts of death
Diagnostic criteria: Depression
 The symptoms are not due to
Physical illness, alcohol, medication, or
street drug use.
 Normal bereavement.
 Bipolar Disorder
 Delusional or Psychotic Disorders

Mania: Signs and symptoms
 Grandiose delusions, inflated sense of self-
importance
 Racing speech, racing thoughts, flight of
ideas
 Impulsiveness, poor judgment, distractibility
 Reckless behavior
 In the most severe cases, delusions and
hallucinations
Mania: Signs and symptoms
 Increased physical and mental activity and
energy
 Heightened mood, exaggerated optimism and
self-confidence
 Excessive irritability, aggressive behavior
 Decreased need for sleep without
experiencing fatigue
Types of Bipolar disorder
Diagnostic criteria: Mania
 Persistently elevated, expansive or irritable
mood, lasting at least 1 week (or any duration
if hospitalization is necessary)
 3 (or more) of the symptoms have persisted
(4 if the mood is only irritable) and have been
present to a significant degree:
Diagnostic criteria: Mania
 inflated self-esteem or grandiosity
 decreased need for sleep
 more talkative than usual or pressure to keep
talking
 flight of ideas or subjective experience that
thoughts are racing
 distractibility
 excessive involvement in pleasurable
activities
Nursing diagnosis
 Psychiatrists have formulated clear guidelines
for categorizing mental disorders (DSM-1V,
ICD-10) – determines interventions
 Nursing diagnosis provides basis for nursing
intervention
 Systematic collection & integration of data to
formulate Nursing Diagnosis
 The Nurse combines nursing diagnoses and
DSM/ICD classifications to develop the
treatment plan
Nursing Diagnosis
 Assessment/psychiatric interview/MSE
 Example nursing diagnosis
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Risk for Suicide
Ineffective Coping
Hopelessness
Self-Care Deficit
Aetiology
 Depression often triggered by stressful life
events
 Contributing factors:
 Intensity and duration of these events
 individual’s genetic endowment
 coping skills
 social support network - depression and
many other mental disorders are broadly
described as the product of a complex
interaction between biological and
psychosocial factors
Biological factors
 Focus on alterations in brain function

Abnormal concentrations of many
neurotransmitters and their metabolites in
urine, plasma, and cerebrospinal fluid

Overactivity of the HPA (hypothalamuspituitary-adrenal) axis - stress
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dysfunction in serotonin (5-HT(1A) receptor
activity could be due to a hypersecretion of
cortisol
Monoamine Hypothesis
 Prevailing hypothesis - depression is caused
by an absolute or relative deficiency of
monoamine transmitters in the brain
 Evidence that reserpine, a medication for
hypertension, caused depression by
depleting the brain of both serotonin and
the three principal catecholamines
(dopamine, norepinephrine, and
epinephrine).
Monoamine Hypothesis
 monoamine hypothesis remains important for
treatment purposes.
 Many currently available pharmacotherapies
that relieve depression or mania, or both,
enhance monoamine activity.
 One of the foremost classes of drugs for
depression, SSRIs, increase the level of
serotonin in the brain.
Psychosocial and Genetic Factors in
Depression
 Social, psychological, and genetic factors act
together to predispose to, or protect against,
depression.
 many episodes of depression are
associated with some sort of acute or
chronic adversity
 past parental neglect, physical and sexual
abuse, and other forms of maltreatment
impact on both adult emotional well-being
and brain function
Psychosocial and Genetic Factors in
Depression

early disruption of attachment bonds can
lead to enduring problems in developing
and maintaining interpersonal relationships
and problems with depression and anxiety.
Cognitive factors
 how individuals view and interpret stressful
events contributes to whether or not they
become depressed.
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 the impact of a stressor is moderated by the
personal meaning of the event or situation
 Increased vulnerability to depression is linked
to cognitive patterns that predispose to
distorted interpretations of a stressful event
Genetic factors in depression &
Bipolar
 Susceptibility to a depressive disorder 2-4
times greater among the first-degree relatives
of patients with mood disorder
 The risk among first-degree relatives of
people with bipolar disorder 6-8 times
greater.
Genetic factors in depression &
Bipolar
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Does not prove a genetic connection.
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First-degree relatives typically live in the
same environment, share similar values
and beliefs, and are subject to similar
stressors, the vulnerability to depression
could be due to nurture rather than nature
Treatment
 50 to 70 % of depressed patients who
complete treatment respond to either
antidepressants or psychotherapies
 Surveys consistently show that a majority of
individuals with depression receive no
treatment
Treatment
 The acute phase - 6 to 8 weeks medication

patients should be seen weekly or biweekly
for monitoring of symptoms, side effects,
dosage adjustments, and support
 Psychotherapies during the acute phase for
depression typically consist of 6 to 20 weekly
sessions
Treatment - ECT
 60 to 70 % response rate seen with ECT
Proposed to be useful with poor response
to medication
 depression is accompanied by potentially
uncontrollable suicidal ideas and actions

 The most common adverse effects are
confusion and memory loss for events
surrounding the period of ECT treatment.
Management- Maintenance
 Medication

acute phase treatment and at least 6
months of continued treatment
 TCA’s, SSRI’s, NARIs, MAOIs,
 St John Wort (Herbal) as effective as
antidepressants
Psychosocial interventions :
depression
 NICE Guidelines (2009)
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Mild depression – psychological
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Moderate depression – Medication or
Psychological
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Severe depression – CBT & medication
Drug Treatment - Bipolar
 Lithium – Long-term
 Anticonvulsants – carbamazipine (not shown
to be effective in acute treatment)
 Antidepressants – SSRIs (inaequate
evidence of effectiveness)
 Antipsychotics – olanzapine, rispiridone
(effective short-term)
Psychosocial interventions Bipolar
 CBT - group /individual
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12-14 sessions < depressive episodes
 Family therapy
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psychoeducation, communication skills
training, and problem-solving skills training.