Definition:

• Mood disorders: emotional disturbance involving episodes of depression, mania, or both.

• Depressive disorders: Sadness severe enough or prolonged enough to impair function.

• Bipolar disorders: Episodes of mania and depression, which may alternate, although many patients have a predominance of one or the other.

  • Mania is abnormal periods (≥1 week) of great excitement, euphoria, delusions, and overactivity .

  • Hypomania a mild form of mania thar does not cause functional impairment.

  • Mixed episode is having both a manic episode and a major depressive episode nearly every day for ≥ 1 week.​​

• Dysthymia: mild depressive symptoms lasting for ≥ 2 years without remission.

• Cyclothymic disorder: hypomania and dysthymia (≥ than half the days of ≥ 2 years)

​ Etiology: ​

Types:

• Depressive disorders:

• Bipolar disorder:

  • Bipolar I: manic or mixed episodes.

  • Bipolar II: depressive episode with at least one episode of hypomania.

  • Bipolar III*: depressive episodes with hypomania only when on antidepressant.

Diagnosis:

• Major depressive disorder (Clinical criteria (DSM-V):

  • Symptoms (≥ 2 weeks):

    1. ​At least one of: depressed mood and/or anhedonia.  

    2. And some of these to total 5 symptoms or more: ​

       • Changes in appetite/weight.

       •  Altered sleep pattern

       • (increase or decrease).

       • Lack of energy.

       • Difficulty concentrating.

       • Agitation.

       • Reduced self-esteem.

       • Suicidal thoughts.

  • ​​Impairment in social, occupational or other important areas of functioning.

  • Exclusion of medical conditions, medication, or drug abuse.

  • CBC, electrolytes, and TSH, vitamin B12, and folate levels to rule out physical disorders.

• ​Bipolar disorders (Clinical criteria (DSM-V):

  • Bipolar-I:

    • Current or recent major depressive episode.

    • At least one previous manic episode or mixed episode.

    • Exclusion of psychotic disorder.

  • Bipolar-II

    • Current or recent major depressive episode.

    • At least one previous hypomanic episode.

    • No history of manic or mixed episode.

    • Exclusion of psychotic disorder.

    • Impairment in social, occupational or other important areas of functioning.

    • Current episode meets criteria for hypomania or depression.

• ​​CBC, electrolytes, and TSH, vitamin B12, and folate levels to rule out physical disorders.

• Exclusion of stimulant drug abuse clinically or by urine testing.

​

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Management:

• Assess the risk of suicide, homicide, and drug and alcohol abuse.

• Depressive disorder:

  • Psychological treatment:

    1. Cognitive-behavioral therapy (CBT).

    2. Interpersonal therapy (IPT).

  • Plus Antidepressants if the depression is moderate or severe.

  • Electroconvulsive therapy considered in pregnant women, refractory to other
    medications, catatonic patients, strong suicidal ideations, psychotic features or
    stupor.

    • Produce painless seizure in anesthetized patients.

    • SE: headache, partial amnesia (resolves in 6 months).

• Bipolar disorder: 

  • Treatment of acute mania or hypomania: 

    • Discontinuation of antidepressants.

    • Benzodiazepines for short term. 

      • MOA: binds to a regulatory site on the GABAA receptor to augment the inhibitory effect of GABA → reducing anxiety, sedation, and muscle relaxation.

      • SE: dependence & prolonged alcohol hangover.

    • Antipsychotic medication (2nd generation). *Please refer to Schizophrenia file. 

  • Treatment of acute depression (moderate-severe): 􏰁

    • SSRIs are first line.

    • Benzodiazepines for short term.

  • Maintenance treatment (for prevention of relapse): 

    • Mood stabilizers (Lithium, Valproate, Carbamazepine, and lamotrigine)