MOOD DISORDERS

MOOD DISORDERS
Mood disorder is a group of conditions where mood of
person is not stable and affect to daily life for example feeling
sad all day, hopeless, useless, don’t have enough energy, bad
decision and have a problem with concentration. We can define
all symptom to three basic groups

Mania & Hypomania

Major depressive disorder
Bipolar
 Major depressive
disorder

Bipolar disorder

MOOD Substance-induced

DISORDERS Due to another

medical condition
Not otherwise
specified
 Mood disorder not otherwise
specified (MD-NOS)

Symptoms of mood disorder that do not

really meet the criteria of any specific mood disorder

Generally, this group used as statistical concept for

filing purposes
 Mood disorder not otherwise
specified (MD-NOS)

TREATMENT
Generally, treatment for MD-NOS is like
treatment for other groups of mood disorders.
Patient maybe receive medical or therapy or
maybe both strong or weak depend on what
symptom they got.
 Major depressive disorder (MDD)

1 >= 1
Major Depressive Major Depressive
Disorder Disorder (Recurrent)
(single episode)
Depression without periods of mania is sometimes referred to
as unipolar depression
The mood remains at the bottom "pole" and does not climb to the
higher, manic "pole" as in bipolar disorder.
Major depressive Atypical disorder
disorder Melancholic depression
Psychotic major depression
(MDD) Catatonic depression
Postpartum depression
Seasonal affective disorders
Dysthymia
Double depression
Depressive disorder Not Otherwise Specified (DD-NOS)
Depressive personality disorders (DPD)
Recurrent brief depression (RBD)
Minor depressive disorder
 Atypical disorder

Atypical depression is a type of depression

which does not follow what was thought to be the
"typical" presentation of the disorder. In general,
people with atypical experience similar symptoms
as those with major depressive disorder (MMD) but
with one crucial difference: mood reactivity. In
other words, a person's mood is able to improve if
something positive happens.
 Symptom Atypical disorder
A mood that temporarily
brightens after a positive event Body aches
or happy news

Increased appetite and Sleeping for long periods at night

weight gain or during the day (hypersomnia)

A heavy feeling in the arms Extreme sensitivity to rejection

or legs or perceived criticism
 Diagnosis Atypical disorder
Diagnosed with depressive Excessive eating or weight gain
disorder with atypical symptoms Excessive sleep
a person has to exhibit the Fatigue, weakness, and feeling
ability to feel better temporarily "weighed down"
in response to a positive life
Intense sensitivity to rejection
event (mood reactivity), plus any
two of the following criteria for a Strongly reactive moods
period of two or more weeks
 Melancholic depression
Melancholic depression is a form of
major depressive disorder (MDD) which
presents with melancholic features.
Although melancholic depression used
to be seen as a distinct disorder. MDD is
a significant mental health condition
characterized by persistent and intense
feelings of sadness and hopelessness.
 Symptom
Melancholic depression
• persistent feelings of extreme sadness for a long period of time
• loss of interest in activities that were once enjoyable
• having a lack of energy or feeling fatigued
• feeling anxious or irritable
• eating too much or too little

• sleeping too much or too little

• experiencing changes in body movement (for example,
jiggling your leg when you didn’t before)
• difficulty concentrating, making decisions, and
remembering things
• thinking or talking about death or suicide
• suicide attempt
Diagnosis
Melancholic depression
In order to be diagnosed with melancholic
depression, an individual must exhibit symptoms of
major depressive. To be diagnosed with melancholic
features, you must have at least
three of these symptoms

• Depression that is different from grief

• Weight loss or loss of appetite
• Slowed activity or restlessness
• Excessive guilt
• Waking much earlier than normal
• More severe depressive symptoms in the morning
Psychotic major depression

Prevalence of this depression in Thai is 0.38% and this

is the most worst of depression it’s related to some
biological markers such as low level of dopamine -β-
hydroxylase in blood, in cerebrospinal fluid has low level
of 3-methoxy-4-hydroxyphenylglycol (MHPG). It’s relate to
metabolism of dopamine and norepinephrine in neuron
system and include no react to dexamethasone
suppression test.
 Psychotic major depression

Symptom Treatment
Can be found in 1/1000 of Divide to two phase
1. Critical – using mood stabilizer,
mother after giving birth and antidepressant, antipsychotic
usually from 1st month having 2. Maintenance – using mood stabilizer at
such as astray, dramatically least 6 months and take fewer should take
drug at least 2 years for prevent recurrence.
crying, felt guilty, give up life
and psychedelic.
 Catatonic depression
Type of depression that cause to motionless and
speechless from dopamine, gamma-aminobutyric acid (GABA)
and glutamate neurotransmitter systems disorder.

Symptom Treatment
Always felt sad, suddenly gain Benzodiazepines – drug cause GABA
or lose weight, hard to sleep, hard work well
to wake, restless, felt guilty , Electroconvulsive therapy – best way
always fatigue, think of suicide, to cure Catatonic depression by using
attend to suicide. electrode to activate brain. Nowadays it’s
safe but not famous because it leave
stigma.
 Postpartum Major Depression (PMD)

Postpartum Major Depression (PMD), which occurs in

approximately 10 percent of childbearing women, may begin
anywhere from 24 hours to several months after delivery. When
its onset is abrupt and symptoms are severe, women are more
likely to seek help early in the illness. In cases with an insidious
onset, treatment is often delayed, if it is ever sought.
Untreated, PMD may resolve within several months but can
linger into the second year postpartum. After the initial
episode, women who have had PMD are at risk for both
nonpuerperal and puerperal relapses.
Postpartum Major Depression (PMD)
Symptom
Postpartum depression may be mistaken
for baby blues at first but the signs and
symptoms are more intense and last longer,
and may eventually interfere with your ability
to care for your baby and handle other daily
tasks. Symptoms usually develop within the
first few weeks after giving birth, but may
begin earlier during pregnancy or later up to
a year after birth
Postpartum Major Depression (PMD)

• Depressed mood or severe mood swings

Sign
• Excessive crying
• Difficulty bonding with your baby
• Withdrawing from family and friends
• Loss of appetite or eating much more than usual
• Inability to sleep (insomnia) or sleeping too much

- Overwhelming fatigue or loss of energy

- Fear that you're not a good mother
- Restlessness
- Severe anxiety and panic attacks
- Diminished ability to think clearly, concentrate or make decisions
Seasonal Affective Disorders (SAD)

Seasonal Affective Disorders (SAD) is

a type of depression that's related to
changes in seasons. SAD begins and ends at
about the same times every year. If you're
like most people with SAD, your symptoms
start in the fall and continue into the winter
months, sapping your energy and making you
feel moody. Less often, SAD causes
depression in the spring or early summer.
Seasonal Affective Disorders (SAD)

In most cases, seasonal affective

disorder symptoms appear during late fall
or early winter and go away during
the sunnier days of spring and summer.
Symptom Less commonly, people with the opposite
pattern have symptoms that begin in spring
or summer. In either case, symptoms
may start out mild and become more severe
as the season progresses.
Seasonal Affective Disorders (SAD)

• Feeling sluggish or agitated

Sign • Having difficulty concentrating

• Feeling hopeless, worthless or guilty
• Having frequent thoughts of death or suicide
• Feeling depressed most of the day, nearly every day
• Losing interest in activities you once enjoyed
• Having low energy
• Having problems with sleeping
• Experiencing changes in your appetite or weight
Dysthymia Depression

Persistent depressive disorder,also called dysthymia

(dis-THIE-me-uh), is a continuous long-term (chronic) form of
depression. You may lose interest in normal daily activities,
feel hopeless, lack productivity, and have low self -esteem and
an overall feeling of inadequacy.
These feelings last for years and may significantly
interfere with your relationships, school, work and daily
activities.
Dysthymia Depression

• Loss of interest in daily activities Symptom

• Sadness, emptiness or feeling down
• Hopelessness
• Irritability or excessive anger
• Decreased activity, effectiveness and productivity
• Avoidance of social activities
• Feelings of guilt and worries over the past
• Poor appetite or overeating
• Sleep problems
Double Depression

Double depression is a complication of a psychiatric

illness called dysthymic disorder, or dysthymia. Dysthymia is a
chronic, depressed mood accompanied by just one or two
other symptoms of clinical depression (such as low energy or
low self-esteem) that lasts at least two years in adults (or one
year in kids). This low, dark mood – sometimes described as
a "veil of sadness" -- occurs nearly every day and can
sometimes persist for many years. Some people may have this
mood disorder for 10 to 20 years or even more
before seeking treatment
 Depressive disorder Not Otherwise
Specified (DD-NOS)

Depressive disorder that Symptom

does not meet the criteria for a •Ability to enjoy the things that used
specific disorder. to make them happy is decrease.
•Lose interest in some activities.
•Distress due to medical conditions.
Examples
• Recurrent Brief Depressive disorder
Derive from
• Minor Depressive disorder Environmental effects and situations.
Depressive Personality disorder (DPD)

Personality disorder with depressive features.

Symptom
• dejection,gloominess, cheerlessness, joylessness and unhappiness.
• Self-concept centers on beliefs of inadequacy, worthlessness and
low self-esteem.
• Is critical, blaming and derogatory towards the self.
• Is brooding and given to worry.
• Is negativistic, critical and judgmental toward others.
• Is prone to feeling guilty or remorseful.
Recurrent brief depression (RBD)

Diagnosis
Recurrent brief depression (RBD) is an affective disorder with
periodic episodes occurring almost every month that are unrelated
to the menstruation cycle and last only a few days. The diagnostic
criteria for RBD requires the presence of at least five out of nine
depressive symptoms analogous to the symptoms of major
depression, yet a duration of less than two weeks, according to
DSM-IV and ICD-10 diagnostic criteria.
Recurrent brief depression (RBD)

Symptom
Recurrent Brief Depressive Disorder (RBD) is a well-defined and
prevalent mood disorder with an increased risk of suicidal behavior and
significant clinical impairment in the community and general practice.
Occurring at least monthly with depressive episodes lasting
only a few days defines recurrent Brief Depressive Disorder. The lifetime co -
occurrence of both RBD and Major Depressive Disorder (MDD), called
Combined Depression (CD), substantially increases the risk for attempted
suicide, even more than that known for 'pure' MDD.
Recurrent brief depression (RBD)

Treatment
Both psychotherapy as well as different
drugs have been suggested as treatments.
However, no randomized controlled treatment
trial of RBD has been conducted.
 Minor depressive disorder

Symptom
A person is considered to have minor depressive disorder if they
experience 2 to 4 depressive symptoms during a 2-week period.
The Diagnostic and Statistical Manual of Mental Disorders lists the major
depressive symptoms. Depressed mood most of the day and/or loss of
interest or pleasure in normal activities must be experienced by the
individual to be considered to have minor depressive disorder. Without
either of these two symptoms, the disorder is not classified as minor
depressive disorder. Other depressive symptoms include significant weight
loss or weight gain without trying to diet (an increase/decrease in appetite
can provide clues as well), insomnia or hypersomnia, psychomotor
agitation or psychomotor retardation, fatigue or loss of energy, and feelings
of worthlessness or excessive guilt.
 Minor depressive disorder

Treatment
Treatment of minor depressive disorder has not been studied as
extensively as major depressive disorder. Although there are often
similarities in the treatments used, there are also differences in what may
work better for the treatment of minor depressive disorder. Some third -
party payers do not pay to cover treatment for minor depressive disorder.
The leading treatment techniques for minor depressive disorder are
the use of antidepressants and therapy. Typically, patients with minor
depression were treated by watchful waiting, prescribed antidepressants,
and given brief supportive counseling, but Problem-Solving Treatment for
Primary Care (PST-PC) is a Cognitive-Behavioral Therapy that has gained
popularity. In one study, Problem-Solving Treatment for Primary Care (PST-
PC) and Paroxetine, an antidepressant, were shown to be equally effective
in significantly reducing symptoms.
 Bipolar disorder

Bipolar disorder, formerly called manic depression, is

a mental health condition that causes extreme mood swings
that include emotional highs (mania or hypomania) and lows
(depression).
 Bipolar disorder

Bipolar I disorder
You've had at least one manic
episode that may be preceded or
followed by hypomanic or major
depressive episodes.
Bipolar II disorder
You've had at least one major depressive
episode and at least one hypomanic
episode, but you've never had a manic
episode
 Bipolar disorder
Symptom ;
Mania and hypomania episode
• Abnormally upbeat, jumpy or wired
• Increased activity, energy or agitation
• Exaggerated sense of well-being and self-confidence (euphoria)
• Decreased need for sleep
• Unusual talkativeness
• Racing thoughts
• Distractibility
• Poor decision-making — for example, going on buying sprees,
taking sexual risks or making foolish investments
 Bipolar disorder
Symptom ;
Major depressive episode
• Depressed mood, such as feeling sad, empty, hopeless or tearful
• Marked loss of interest or feeling no pleasure in all — or almost all — activities
• Significant weight loss when not dieting, weight gain, or decrease or increase in
appetite Either insomnia or sleeping too much
• Either restlessness or slowed behavior
• Fatigue or loss of energy
• Feelings of worthlessness or excessive or inappropriate guilt
• Decreased ability to think or concentrate, or indecisiveness
• Thinking about, planning or attempting suicide
 Cyclothymia

•Bipolar disorder or Cyclothymic disorder

•People with varying moods fluctuate
Symptom between periods of overly cheerful and
depressed mood, with short periods of
normal mood.

• There has been fluctuating of emotion for at least 2 years

• Symptoms affects to their work or relationships who be around you at
least 1 time in 2 years
• When you do not have symptoms or have a normal emotions that will
occur less than 3 consecutive months to you.
• It has just a mild symptoms that is not being a point of bipolar disease
 Cyclothymia

Different from Bipolar

Bipolar is more severe than Cyclothymia has less severe
Cyclothymia. symptoms than Bipolar as a mild
During the Mania period depression, mania and short duration.
which be an abnormal good emotion, This symptoms seem like normal time
the bipolar disorder patients will be that pass alternately through good
an overwhelmingly happy feeling and days and bad days. For example,
energetic mood with the most feeling there are less sleep, more talk,
in this world. Leading to be risk emotional instability, etc.
behavior, drive fast, use drugs and
drink alcohol is an example of
symptom.
 Cyclothymia

Treatment
• Many Cyclothymia patients can live without treatment but people
around you should observe their symptoms because 1/3 of patients
can develop into bipolar disorder disease.
• People in the family of patients who had ever been bipolar disease
are in the risk of developing into Bipolar disorder more than normal
people.
• Nowadays, there is definitely no the cure solution for Cyclothymia
disease, even bipolar disorder drugs such as mood controlling drugs.
It can not always relieve better as well.
• The popular treatment is a communication with a psychologist in
order to help the patient can manage their emotions and
understanding the factors that may cause the symptoms to worsen.
 Cyclothymia

Prevent for being patient

• Do not take the medicine regularly as recommended by the doctor.
• Pay attention to your symptoms as being better or worse. And see if the
worsening symptoms are caused by any provoking factors
• Avoid alcohol and substance abuse
• Before deciding to use any herbal medicines or supplements Always
consult a doctor first Because some drugs may interact with each other
to cause unwanted side effects or to cause the drugs that are
ineffective.
• Exercise and do activities to increase the movement of the body. Will
improve both strength and agility
• Get enough sleep
 Bipolar disorders not otherwise
specified (BD-NOS)
BD-NOS, sometimes called sub-threshold bipolar, referred to
symptoms that patient has some symptoms of bipolar
spectrum but does not qualify to any of formal bipolar DSM-IV* diagnoses.

Diagnosis
Typically, BD-NOS is indicated when there is a rapid change
between manic and
depressive symptoms.
BD-NOS maybe diagnosed when bipolar might not be the primary
disorder.
Substance-induced
 Alcohol induced

• High rates of major depressive disorder occur in

heavy drinkers and those with alcoholism.
• Alcohol misuse directly causes the development
of depression in a significant number of heavy
drinkers.
• Depression and other mental health problems
associated with alcohol misuse may be due to
distortion of brain chemistry, as they tend to
improve on their own after a period of
abstinence.
 Alcohol induced
There is a connection – self-harm and suicide are much
more common in people with alcohol problems. It can work
in two ways

• you regularly drink too much

including (including ‘binge drinking’) Either ways
which makes you feel depressed. • Alcohol affects the chemistry of the
• you drink to relieve anxiety or brain, increasing the risk of epression.
depression. • Hangovers can create a cycle of waking
up feeling ill, anxious, jittery and guilty.
• Life gets depressing – arguments with
family or friends, trouble at work,
memory and sexual problems.
 Alcohol induced

Symptom
• drinking too much in any one episode
• drinking frequently, even daily
• continually craving alcohol
• sneaking alcohol so others won’t observe it
• continuing to drink despite negative consequences,
both to physical health and personal relationships
• continued drinking despite symptoms of depression or a
mood disorder
 Benzodiazepine-induced
depressive disorder
Benzodiazepines are a Example drugs
class of medication commonly
• Dizziness
used to treat anxiety, panic
attacks and insomnia. • Abnormal vision
Benzodiazepines Is • Severe breathing problems
categorized by the duration of • Depressive
action as criteria Which is a very
short acting group, short acting
group And the long-acting group.
 Benzodiazepine-induced
depressive disorder
Treatment
While benzodiazepine-induced depressive
disorder may be exacerbated immediately after
discontinuation of benzodiazepines, in a follow-up
study of patients suggests that mood significantly
improves after the acute withdrawal period to
levels better than during use. Depression resulting
from withdrawal from benzodiazepines usually
subsides after a few months but in some cases
may persist for 6–12 months.
 Due to another medical condition

Criteria
Depressed mood or markedly diminished interest or
pleasure in all, or
almost all, activities
There is evidence from the history, physical
examination, or laboratory findings that the disturbance is the
direct physiological consequence of
a general medical condition.
 Due to another medical condition

Associated Features
Etiology is the key variable in depressive disorder due to another
medical condition
The listing of the medical conditions that are said to be able to induce
major depression is never complete

Development and Course

The onset of depression can occur within a few days of cerebrovascular
accident (CVA)in the largest case series.
In some cases, onset of the depression is weeks to months following the
CVA.
 Refference
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• https://www.healthline.com/health/depression
• ธรณินท์ กองสุข (2547).สถานการณ์สุขภาพจิตของไทยจากผลการสารวจ
ระดับชาติ. หนังสือประกอ[การประชุมวิชาการสุขภาพจิตนานาชาติครั้งที่3. กรม
สุขภาพจิต: 56-71
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meta-analysis. American Journal of Psychiatry, 154: 1497–1503
• O’Hara MW, Swain AM (1996). Rates andrisk of postpartum
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 Refference
• Smith LA, CV, Warnock A, Tacchi MJ,Taylor D (2007). Pharmacological
interventions for acute bipolar mania: asystematic review of randomized
placebo-controlled trials. Bipolar Disord. Sep;9(6): 551-60.
• Harm J Gijsman, PD, MRC Psych et.al.(2004). Antidepressants for Bipolar
Depression: A Systematic Review of Randomized, Controlled Trials. Am J
Psychiatry (161): 1537-1547.
• https://www.aafp.org/afp
• https://courses.lumenlearning.com/abnormalpsychology
• American Psychiatric Association. (2013). Diagnostic and statistical manual of
mental disorders (5th ed.).https://doi.org/10.1176/appi.books.9780890425596
• https://med.mahidol.ac.th/ramamental/generalknowledge
• https://www.webmd.com
 Presented By
6013093 Piyangkun Trakulcharoensuk
6013110 Kantanat Naksomboon
6013115 Nattapol Mekcham
6013122 Ruttanapong Chunthaisong
6013124 Waristha Tanwongwarn
6013127 Supachet Arunsuksiri
6013130 Hanarint Chanekasit
6013285 Kan Boonnok
6013287 Jeeradet Swadiluks
6013288 Chanidapa Komsao
6013291 Thongchai Yaemsuk
 Presented By
6013291 Thongchai Yaemsuk
6013292 Tanin Limsiriwong
6013294 Teerapat Matoum
6013335 Wannapat Wannaprapa
6210008 Jaron Jattuwattana
6210075 Poomipat Yimthin
6210080 Wuttipat Sirisathit