Mood Disorders

• Depressive disorders are among the most common psychiatric disorders that occur in both younger and older adults
• With the start of the new millennium, mood disorders were second only to heart disease as the illness most responsible for poor quality of life and disability
• Mood disorder increases your chance of suicide between 3.4-5.9 times compared to others- even when controlling for other variables
• Lifetime risk of suicide completion between 2.2% and 4.2% for individuals with depressive disorders
• Mood Disorders

  • Major Depressive Disorder
  • Bipolar Disorder (BD I vs BD II)
  • Persistent Depressive Disorder (formerly Dysthymic Disorder)
  • Cyclothymic Disorder
  • Disruptive Mood Dysregulation Disorder
• Criteria for Major Depressive Disorder

  • Depressed mood
  • Diminished interest or pleasure in nearly all activities
  • Significant weight loss/gain without trying
  • Insomnia/hypersomnia
  • Psychomotor agitation or retardation
  • Fatigue or loss of energy
  • Feelings of worthlessness or inappropriate guilt
  • Diminished ability to concentrate
  • Recurrent thoughts of death, suicidal ideation without a specific plan, or suicide attempt/specific plan
• Major Depressive Disorder

  • Impairment
  • Not substance or medical condition
  • Not better explained by course of another disorder
  • There has never been a manic or hypomanic episode
• Specifiers for Major Depressive Disorder

  • with anxious distress
  • with mixed features
  • with melancholic features
  • with atypical features
  • with mood-congruent psychotic features
  • with mood-incongruent psychotic features
  • with catatonia
  • with peripartum onset
  • with season pattern
• Prevalence of Major Depressive Disorder: 12 month- 7%, Lifetime- ~16%, females 1.5-3X higher than males starting in adolescence
• Suicidal behaviors are a major concern with depressive disorders
• Interpersonal Theory of Suicide

  • Thwarted belongingness
  • Perceived burdensomeness
  • Acquired capability for suicide
• Thwarted belongingness


  Fundamental human psychological need to belong is unmet
• Perceived burdensomeness


  Perception that one is a burden on family/friends
• Acquired capability for suicide

  Based on the idea that suicide is not easy to do...wanting to do it is not enough, there must be some ability to follow through
• When in a manic episode, individuals will often resist treatment
• Prevalence of Bipolar I Disorder: 12 month = .6%, Mean AoO = 18 y/o
• About 60% of manic episodes occur immediately before an MDE
• Those who have 4+ mood episodes in a year may be designated "rapid cycling"
• Bipolar II Disorder


  • Characterized by experiencing at least one major depressive episode PLUS hypomania
  • Symptoms of hypomania are the same as mania BUT do not cause significant impairment, do not require hospitalization, and do not involve a break from reality
  • Symptoms last at least 4 days
  • Must never have been diagnosed with a manic episode or it would be Bipolar I
• Prevalence of Bipolar II Disorder: 12- month- .8%, Mean AoO - mid 20's
• Persistent Depressive Disorder


  • Depressed mood for most of the day, for more days than not, for at least 2 years
  • Presence of 2+ symptoms like poor appetite, insomnia, low energy, low self-esteem, poor concentration, feelings of hopelessness
  • During the 2-year period, the individual has never been without the symptoms for more than 2 months at a time
  • No manic or hypomanic episodes; no cyclothymia
• Prevalence of Persistent Depressive Disorder: 12-month .5% for PDD and 1.5% for chronic MDD
• Comorbidity is higher for Persistent Depressive Disorder than Major Depressive Disorder, especially with early onset and personality disorders
• Cyclothymic Disorder


  • For at least 2 years (1 for kids and adolescents) there have been numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic episode and numerous periods with depressive symptoms that do not meet criteria for a major depressive episode
• Persistent Depressive Disorder


  • Same specifiers as Major Depressive Disorder
  • Early onset: before age 21
  • Late onset: before age 21
  • With pure dysthymic syndrome: no Major Depressive Episodes
  • With persistent Major Depressive Episode: full criteria for Major Depressive Episode met during the last 2 years
  • Other specifiers
• Prevalence of Persistent Depressive Disorder is 12-month .5% and 1.5% for chronic Major Depressive Disorder
• Persistent Depressive Disorder has a higher risk of comorbidity than Major Depressive Disorder
• Early onset Persistent Depressive Disorder is associated with personality disorders
• Cyclothymic Disorder


  • For at least 2 years (1 for kids and adolescents) there have been numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic episode and numerous periods with depressive symptoms that do not meet criteria for a major depressive episode
  • During 2 years, the mood periods have been present for at least ½ the time and they have never been without them for more than 2 months at a time
  • Criteria for a major depressive, manic, or hypomanic episode have never been met
  • Not another disorder
  • Not substance or medical condition
  • Impairment
• Lifetime prevalence of Cyclothymic Disorder is .4% - 1% and prevalence is 3%- 5% in mood clinics
• Substance and sleep disorders are common comorbidities with Cyclothymic Disorder
• Disruptive Mood Dysregulation Disorder

  • Severe recurrent temper tantrums manifested verbally and/or behaviorally that are grossly out of proportion in intensity or duration to the situation or provocation
  • The temper outbursts are inconsistent with developmental level
  • Temper outbursts occur, on average, three or more time per week
  • The mood between temper outbursts is persistently irritable or angry most of the day, nearly every day, and is observable by others
  • A-D have been present for at 12 months+. During that time, the individual has not has a period of 3 months or more without all the symptoms of A-D
  • A-D are present in at least 3+ settings and are severe in at least one of these
  • Diagnosis should not be made before 6 y/o or after 18
  • Age of onset is before 10
  • Never met criteria for manic/hypomanic episode
  • Not another disorder
  • Not substance or medical condition
• Prevalence of Disruptive Mood Dysregulation Disorder is 2-5%
• Behavioral Activation (BA) for Major Depressive Disorder

  • Psychoeducation (explaining how depression may be related to low behavioral engagement in positive and rewarding experiences)
  • Setting of goals and homework (getting the client on board with doing things despite not feeling like it and increasing the likelihood that the things they engage in are going to be positive)
  • BA targets inactivation and avoidance
  • BA is short-term
• If you don't do anything different

  Nothing is going to change
• Cognitive-Behavior Therapy (CBT) and Acceptance and Commitment Therapy (ACT) for Major Depressive Disorder


  • Empirically supported treatments
• Cognitive-Behavior Therapy (CBT) for Bipolar Disorder


  • Targeting depressive symptoms with behavioral activation, cognitive restructuring, and coping strategies
  • Target manic or hypomanic symptoms mainly with psychoeducation
  • Focus is to recognize early signs of manic/hypomanic episodes in order to preemptively treat it
• Psychoeducation for Bipolar Disorder


  • Providing patients with information about bipolar disorder and its treatment, with a primary goal being to improve adherence to pharmacological treatment by helping patients understand the biological roots of the disorder and the rationale for pharmacological treatments
  • Patients are also taught the early warning signs for episodes, and common triggers for symptoms
  • Psychoeducation interventions are typically—but not always—held in group format
• Medication has strong research support for treating depression and bipolar disorder
• CBT/CT is also effective in the treatment of depression alone and somewhat effective in treating manic/hypomanic symptoms