MOOD DISORDERS it is very important to consider the temporal course patterns of recurrence and remittance of depressive and or manic episodes clinicians have a goal of preventing further episodes as well as treating the current episode the 2 factors that most importantly describe mood disorders are severity and chronicity absence of manic or hypomanic episodes before or after the disorder major features extremely depressed mood lasting at least 2 weeks anhedonia when things that used to be pleasurable fun aren t fun anymore Depressive Disorders major depressive disorder cognitive symptoms disturbed physical functioning normal vs abnormal sadness single vs recurrent episodes depressed mood anhedonia insomnia hypersomnia in order to diagnose you have to identify a major depressive episode can be a single episode but for most people episodes are recurrent DSM criteria for major depressive episode five or more symptoms during the same 2 week period at least one of the symptoms is either depressed mood or anhedonia weight loss gain depression leads them to stop eating or food is their only comfort psychomotor agitation retardation i e walking slowly speaking slowly fatigue or loss of energy feelings of worthlessness or excessive guilt difficulty concentrating or making decisions suicidal thoughts MDD vs grief differences in affect for ppl w grief predominant feelings are emptiness loss and loneliness for ppl w MDD predominant feelings are persistent depressed mood and anhedonia thought content for ppl w grief thoughts are reminders of the dead thinking about the dead waves of grief MDD isn t tied to a specific event it s linked to everyday life self critical thoughts self esteem self esteem can be preserved in grief but for ppl w MDD they have self loathing thoughts of death there is normal grief and abnormal grief normal grief includes acute grief following a loved one s death and its transition into integrated grief a few months to a year following the death which involves adjusting to the loss and the restoration of functioning abnormal grief would be when your acute grief develops into complicated grief in which your acute grief persists for more than a normal period of time and you can t stop thinking about the death and have trouble with emotion regulation and have activation of the dopamine neurotransmitter system you don t have to be depressed to develop complicated grief but there is a common association complicated grief might become its own disorder in future versions of the DSM treatment for complicated grief is similar to treatment for PTSD which involves re experiencing the death under close supervision and dealing with the emotions surrounding it and incorporating positive emotions associated with the person and arriving at the position that you can cope and life will go on thus achieving a state of integrated grief MDD prevalence 7 high correlation btwn depression and anxiety the same genetic factors contribute to a biological vulnerability to both anxiety and depression an overactive neurobiological response to stressful life events and social and psychological factors account for these genetic factors developing into different disorders most common in Native Americans then whites then blacks proportionally depression symptoms can manifest as somatic physical symptoms across cultures however the subjective feelings people have towards depression can be influenced by the cultural view of the individual the role of the individual in society humiliation loss and social rejection are the most potent stressful life events likely to lead to depression can first appear at any age but onset goes up a lot after puberty peak onset is in your 20s you start to experience this at a young age although it may not be seen as a major depressive episode until your 20s often goes undiagnosed in the elderly assume that what they re going through is related to their body their decreasing social support etc but MDD is less common in the elderly than in younger people those w Alzheimer s often have depression suicide rates are higher in older adults than in any other age group more common in boys in early childhood then a surge of depression in teen girls tips the gender balance and women are 1 5 3x more likely to have MDD all the way until late adulthood when the gender ratio balances out women tend to ruminate more than men maybe why it s more common in women more social support can buffer you against depression less social support is related to depression when diagnosing MDD clinicians also specify the features of the overall disorder or of the most recent major depressive episode to help them determine the most effective treatment or likely course there are 8 main specifiers that may accompany depressive episodes MDD in general with psychotic features mood congruent or mood incongruent with anxious distress mild to severe most important specifier indicates a more severe condition w higher chance of suicide and predicts a poorer outcome from treatment mixed features melancholic features severe physical symptoms catatonic features catalepsy in which muscles are waxy and semirigid and the patient s arms and legs will stay in any position you place them in end state reaction to feelings of imminent doom atypical features sleeping more and eating more instead of sleeping less and eating less peripartum onset during pregnancy and right after birth can affect both mothers and fathers seasonal pattern only have depressive episodes during a specific time of year usually winter this is called seasonal affective disorder or SAD SAD might be related to increased melatonin production or changes in circadian rhythm more common in places with less winter sunlight i e extreme northern and southern latitudes treatment for SAD includes phototherapy which exposes these people to morning light which is 2 hours of bright light exposure immediately after waking up light therapy is especially helpful when combined w CBT persistent depressive disorder either MDD criteria is met continuously for at least 2 years and the person is not symptom free for more than a 2 month period at a time OR dysthymia which means depressed mood for most of the day for more days than not for at least 2 years and 2 or more of the following poor appetite or overeating insomnia hypersomnia low energy or fatigue low self esteem poor concentration or difficulty making decisions feelings of hopelessness so it differs from MDD in the