1. MOOD DISORDERS
BY
Ahmed albehairy, md.
Psychiatry consultant, moh.

2. Mood Disorders , Types
- Affective disorders.
- Include:
major depressive disorders.
bipolar disorders , I, II, III.
Dysthymic disorder.
Cyclothymic.
mood disorder due to GMC.
substance induced mood disorders.
NOS, depression & bipolar

3. Epidemiology
Life time prevalence
MDD 10-25% W, 5-12%M
Dysthymic disorders 6%
BAD 6%
BAD I 0.4 -1.6%
BAD II 0.5%
Rapid cycling 5-15% of BAD
Cyclothymic 0.4-1 %

4. Epidemiology
Sex :
MDD, W < M, BAD W=M
manic ---W, DEP.--- M
Age :
BAD onset 30, + all ages
MDD ALL ages
Sociocultural:
MDD--- Single, divorced

5. Etiology
Biological:
- Biogenic amines :
dopamine, serotonin, noradrenaline.
( HVA) , ( 5-HIAA), ( MHPG)
in urine , blood and CSF.
MDD --- DEC 5-HIAA
VIOLENCE, SUICIDE--- DEC 5-HIAA
DEP---- DEC DOPAMINE
MANIA --- INC DOPAMINE

6. Etiology
Biological:
- Neuroendocrine abnormalities
HTPA axis, dec TSH, GH, FSH, LH
AND nocturnal secretion of
melatonin.
- Immunity , dec in both dep, mania.

7. Etiology
Biological:
- Sleep : in depression
delayed sleep onset, multiple
awakening, short REM latency with
inc. 1st REM .
Sleep deprivation--- AD
- KINDLING
- GENETIC.
- Neuroanatomical.

8. Etiology
Psychosocial:
- psychoanalytical.
- Cognitive.
- Learned helplessness.
- Stressful life events.

9. INVSTIGATION
- DST.
- CT, MRI
- RATING SCALES
- Bech, zung, MADRS.
- RORSCHACH.
- TAT

10. Clinical Pictures
Depressive episode.
Manic episode.
Hypomanic
Bipolar I,II,III
Rapid cycler
Ultra rapid cycler
Melncholic depression
Seasonal or recurrent dep

11. Clinical Pictures
Postpartum onset .
Atypical dep. Hysterical dysphoria
Catatonia
Pseudodementia
Depression in children.
Dysthymia
Double depression.
Cyclothymic.
Psychotic depression
chronic
NOS ( recurrent brief, premenstrual).

12. Differential diagnosis
Organic br. ( tumor, myxedema
madness, mercury)
SIM
SCHIZOPHRENIA
GRIEF
PD
SCHIZOAFFECTIVE
SLEEP DISORDERS
ANXIETY, SOMATOFORM,

13. Course & Prognosis
MDD --- 15% SUICIDE
MDD --- NATURAL HISTORY 10 MS.
75% of have 2nd episode of
depression, in 6ms.
Average no of dep episodes is 5.
50%recover,30%partial recover, 20%
chronic.
45%manic recurs, last 3 m , average
10 in life .

14. Treatment
MDD BAD
AD MOOD STAB.
ECT AD
PSYCHOLOGICAL ECT
PSYCHOLOGICAL

15. When should ECT be considered?
- Suicidality, dangerousness.
- Failure to respond to several Ads
- Threatening acute symptoms.
- Agitation, psychotic.
- Intolerable S E OF AD
- History of +ve response to ECT.
- Medical condition precluding the use of
Ads.

16. PHASES OF DEPRESSION
TREATMENT
 Acute Treatment (4 –6 weeks)
 Goal is to eliminate signs and symptoms of
depression;
 Select antidepressant based on target
symptoms, medical/psychiatric history, drug
interactions, side effects
 After 4-6 weeks reassess adequacy of response
 If no response or partial response, increase
dose of medication or switch to another
antidepressant

17. PHASES OF DEPRESSION
TREATMENT
 Acute Treatment (4 –6 weeks)
 Goal is to eliminate signs and symptoms of
depression;
 Select antidepressant based on target
symptoms, medical/psychiatric history, drug
interactions, side effects
 After 4-6 weeks reassess adequacy of response
 If no response or partial response, increase
dose of medication or switch to another
antidepressant

18. PHASES OF TREATMENT
Continuation Treatment (6 months)
 Goal is to prevent relapse following symptomatic
recovery/remission
 Continue full therapeutic antidepressant dose for 6
months after symptoms abate
 At the end of continuation phase, antidepressant
should be tapered gradually to avoid discontinuation
symptoms
 If symptoms recur, patient is likely to respond to
same antidepressant previously prescribed;
continue medication for 6 months at therapeutic
dose

19. Common Side Effect of
Antidepressants
TCA : dry mouth, constipation, drowsiness,
orthostatic hypotension, weight gain,,++ IOP.
Bupropion, seizure, agitation,insomnia.
Trazodone: sedation, priapism.
SSRI: insomnia, agitation, headache, nausea.
Fluxetine ( akathesia). Paroxetine , dry
mouth.
Venlafaxine: hypertension, nausea.
Mirtazepine: wt gain and sedation.
MAOI --- TYRMINE, SSRI,
LETHALITY : TCA OVERDOSE, serotenorgig
syndrome

20. Hot Items in Choosing
medications in Depression
Psychotic dep--- AP +AD, ECT
Melancholic ----- AD + ECT( REC)
Atypical ---------- SSRI
Seasonal -------- AD + phototherapy
Postpartum ------ ? BAD, in hospital

21. Hot Items in Choosing
medications in Depression
risk Lower moderate higher
Breast feeding TCA, Flupenthexol Amoxipen, MAOI,
mianserine, VENLAFAXINE
mirtazepine,
SSRI,
trazodone
CVS SSRI,Mianserine, MAOI, TCA,
mirtazepine, venlafaxine
trazodone
diabetus SSRI,TRAZODON FLUXETINE, MAOI
E, VENLAFAXINE MIANSERINE
,
MIRTAZEPIN
E, TCA

22. Hot Items in Choosing
medications in Depression
risk Lower moderate higher
OLD AGE VENLAFAXINE, MAOI, TCA
MIRTAZEPINE, SSRI, MIANSERINE,
VENLAFAXINE TRAZODONE
PREGNAN ?// TRYPTOPHAN TCA,MAOI,ME
CY RTIZAPINE,V
ENLAFAXINE,
MIANSERINE
RENAL MIANSERINE,TCA,TR SSRI,MIRTEZ VENLAFAXINE,
AZODONE,TRYPTOP APINE,MAOI, FLUXETINE
HAN DULEXTINE

23. Hot Items in Choosing
medications in Depression
risk Lower moderate higher
Epilepsy MAOI, SSRI, DULOXETINE, AMOXIPINE,
MIANSERINE, MAPROTILINE
MIRTAZEPINE, TCA,
VENLAFAXINE
GLAUCO MAOI, SSRI, DELUXTINE, TCA
MA TRAZODONE MIRTAZEPINE
VENLAFAXINE
LIVER MIANSERINE, DULOXETINE,MIRTAZ MAOI
PAROXETINE EPIMNE, SSRI,TCA,
VENLAFAXINE

24. Mood Stabilizers
lamotrigine/Lamictal
lithium
quetiapine/Seroquel
divalproex/Depakote
carbamazepine/Tegretol
olanzapine/Zyprexa
oxcarbazepine/Trileptal
omega-3 fatty acids /fish oil
clozapine
atypical (2nd generation)
antipsychotics

25. LTG LIT VPK CRB OXC OM3 OLZ QUTIP ARIP
H
experience
++ ++ ++ ++ + + +
Ad effect
++ + + + + + + ++ +
Short term se
++ + + +
Few long term
risk ++ + +++ ?
No wt
+ + + +
Low cost
++ ++ ++ + + +
Fast antimanic
+ ++ ++
maintenance
+ + + + ++ +
pregnancy
? ? ?
Breast feeding
usa usa ++

26. Thank you