What can be the definition of mood?
Temporary mindset that can influence how we understand and process situations
What are the symptoms that must be present for Major Depressive Disorder and how long should they persist?
Needed:
- Severely low mood AND/OR characterized by anhedonia
- must persist for minimum of two weeks
What was the change in DSM 5 in regards to major depressive disorder?
Elimination of “bereavement exclusion”
- previous depressive symptoms stemming from grief wouldn’t have been deemed MDD
- Controversy - including grief may medicalize mourning and lead to over treatment
What are several important diagnoses related to mood?
- depressive disorders
- disruptive mood dysregulation disorder
-BP
What are the symptoms of Persistent Depressive Disorder?
- severely low mood AND/OR anhedonia
- diagnosis requires presence of fewer symptoms than MDD
- must last at least two years
- less intense than MDD but longer term
What is Premenstrual Dysphoric Disorder and its critiques?
- new to DSM5
- changes in mood, irritability, appetite change during luteal phase of menstrual cycle
- distinguished from PMS by severity of symptoms and increased impact of daily functioning
- critique - over medicalizing a natural biological process and stigmatizing female bodies/minds
- coincides with extension of a patent for existing med for new use intended to treat PMDD
What is Disruptive Mood Dysregulation Disorder and its controversy?
- new to DSM 5
- exclusively applied to children 6-18
- extreme anger or irritability that seems disproportional to the triggering situation
- critique - medicalizes normal phases of emotional development
- majority diagnosed also match symptoms of oppositional defiant disorder
- children likely to be treated with antipsychotic meds
- labelling children with mental illness affects how they see the would and themselves
What is Bipolar Disorder?
- Episodes of mania and depression
- mania - distinct periods of abnormally and persistently elevated, expansive or irritable mood and abnormal and persistent increased goal directed activity or energy at least a week
- …. may engage in compulsive and potentially harmful activities
What is hypomania and how it differs from mania?
Milder form of mania - elevated mood with lesser degrees of functional impairment
- less need for sleep, higher energy, self-confidence, overly optimistic
- mania = more severe, may involve psychosis, more likely to lead to incarceration or hospitalization, treatment may differ
What are the 3 subtypes of Bipolar?
Bipolar 1 - Mania and depression (depression not necessary for diagnosis)
Bipolar 2 - Hypomania and more severe depression (stronger depressive symptoms, less intense mania)
Cyclothymic disorder - most mild form with swings between mild depression and hypomania
What is Euthymia
periods without mania or depression
What are the different treatments for mood disorders?
- psychotherapy (CBT)
-Psychopharmaceuticals - ECT when other treatments fail
What did Kirsch find about antidepressants and the placebo effect
- using SSRIs for the treatment of MDD… 50% was genuine placebo effect
- Analysis of all available data suggests placebo effect accounts for 80% of patient response
- drug manufacturers bury negative findings and bias…
- insufficient evidence in favour of prescribing SSRIs
- recommend psychotherapy, exercise, acupuncture for same benefit with lower risk of side effects
- relapse rates higher in ADMs than other treatments
What does Iatrogenic mean?
they cause side effects that could lead to disease
What is the continuation phase?
the period of time between when meds would be effective and the depressive episode would have resolved on its own -> suggesting “better” to stay on meds
What does spontaneously remit mean?
Even without treatment, it may go away on its own
What was case study two?
Put patients on either placebo, ADM, or CBT…after treatment ended people who did well on CBT were less likely to relapse than those who did well on ADM
- CBT had more enduring positive results, reduced risk of relapse
- use of meds -> reduces enduring effectiveness of CBT
In case study two how do antidepressants work?
- do not increase overall level of serotonin in the brain, short term reallocation within the brain happens (more in cells, less out cells) but total level stays the same
- cause long term overall decline in pool of serotonin, full consequences not yet completely known
Why would a psychiatrist treat depression with ADM when psychotherapy works well?
- need to invest a lot of time in psychotherapy
- access problem with health insurance for psychotherapy
- long waitlists for psychotherapy
- ADMS cost less than psychotherapy
- RCT results = CBT outcomes similar no matter who provides the therapy
What are the concerns about ADM and psychotherapy?
- concerns about side effects (increased suicide risk) for ADM
- may be side effects with psychotherapy, but less known
What Biases have falsely inflated the efficacy of ADMs?
- publication bias
- outcome reporting bias
- citation bias
What are some reasons people with depression are more likely to be given ADMs than psychotherapy?
- high demand
- lack of access to psychiatrists/therapists
- ADMs easily prescribed/highrate, at low cost
What does a drug have to do to be FDA approved?
out perform a placebo
What are the benefits and cons of having diagnostics….
pros - certainty or relief for some
cons - may not reflect individual experience of person experiencing, may limit understanding of mental illness
- understanding mental illness beyond medical can expand understanding of diversity of lived experience and individual meaning
