Major depressive disorder (unipolar depression)

• ~20% prevalence , 15% commit suicide, ♀ > ♂ , RF: 1st° relative

• Major depressive episode

  • DX: At least 5 sx for at least 2 weeks (DICESGAPS)

    • Depressed mood most days (must be present)

    • Interest ↓ in activities (must be present)

    • Concentration ↓ (indecisive)

    • Energy ↓ or fatigue

    • Sleep ∆ (insomnia or hypersomnia)

    • Guilt or feelings of worthlessness

    • Appetite or weight ∆

    • Psychomotor agitation or retardation

    • Suicidal ideation or thoughts of death

  • Distress impacts work or school

  • Not due to substance use or disease

• Major depressive disorder DX:

  • SX NOT DUE to other psychiatric disorder

  • NO HX of manic/hypomanic episode (that would make the dx BIPOLAR)

Persistent depressive disorder (dysthymia)

• Chronic (2years) of depressed mood for most of day, more days than not

  • Can't be asx for > 2 consecutive months

• DX criteria: At least 2 sx present while depressed

  • • Weight or appetite ∆

    • Insomnia or hypersomnia

    • Low energy/fatigue

    • ↓ concentration (indecisive)

    • Low self-esteem

    • Feelings of hopelessness

Bipolar I

• One manic episode = Bipolar 1 dx

  • ± major depressive and/or hypomanic episode (not required for dx)

Manic episode

• At least 1 week (unless manic episode ➔ hospitalization) of:

  • Abnormally and persistently elevated or irritable mood

    • AND

  • Abnormally and persistently increased activity or energy

  • With noticeable change from usual behavior seen by at least 3 (4 if only irritable)

    • Distractibility

    • Irresponsible (shopping, gambling)

    • Grandiosity

    • Flight of ideas (racing thoughts)

    • Activity↑ (goal-directed)/psychomotor Agitation

    • Sleep not needed

    • Talkative/pressured speech

• Manic episodes can have psychotic features (distorted perception of reality)

  • Delusions, hallucinations, disorganized behavior

• Catatonia is MC in mood disorders

Bipolar II

• At least one episode of hypomania (a full manic episode ➔ Bipolar I dx)

  • Hypomania AND one major depressive episode

    • Hypomania DOES NOT affect work/school

    • Hypomania DOES NOT result in hospitalization

    • Hypomania DOES NOT have psychotic features

Cyclothymic disorder

• Persistent (2 years) of depression and periods of hypomania