MOOD DISORDERS

Major Depression and Bipolar Disorder

• A group of disorders in which the clinical

picture is dominated by the pathological mood
and related disorders (≈ Affective Disorders)
• Other signs and symptoms of mood disorders
include change in activity level, cognitive
abilities, speech, and vegetative function
(sleep, appetite, sexual activity, and other
biological rhythms) 🡪 periodic weeks-months
 EPIDEMIOLOGY
• Sex
-Bipolar I, prevalence ♂ = ♀.
-Manic episode > ♂, depression episode > ♀
-Manic episode ♀ > with mixed features, ♀ >
rapid cycling
-Episode bipolar I ♂ > like picture manic
episode but ♀ > like picture MDD
• Age
⮚ Onset bipolar I disorders > earlier than MDD
(as early age 5 or 6 years until 50 years, with
means age of 30 years)
⮚ Related to be increased use of alcohol and
drugs of abuse in this age group
• Marital Status
⮚ Bipolar I disorder is more common in divorced
and single person than among married person,
but this differences may reflect the early onset
and the resulting marital discord characteristic
of the disorder
▪ Social economic and cultural factor
⮚ No correlation 🡪 MDD
⮚ Bipolar I disorder 🡪 not graduate , Bipolar II
disorder 🡪 in college graduate
 Classification DSM-5
• Major Depressive Disorder (MDD) / unipolar
depression :
– No history of manic episodes / hypomanic / mixed
– ≥ 2 weeks
– ≥ 4 symptoms : changes in appetite and weight,
changes in sleep and activity, loss energy, guilty
feeling, problem in thinking and decision,
recurrent thoughts of death/ suicide
• Manic episode
– A distinct period of an abnormally & persistently
elevated, expansive, or irritable mood
– ≥ 1 weeks (or less if a patient must be hospitalized)
• Hippomanic episode :
– ≥4 consecutive days
– = manic episode, No occupational functioning
– No psychotic features
– Manic & hypomanic : inflated self-esteem,
decreased need for sleep, more talkative than
usual, over involvement in activities that have a
high potential in unrestrained buying
• Bipolar I : 1/> manic episode ± depression
• Mixed episode: ≥ 1 weeks manic episodes +
MDD usually every day
• Bipolar II : hypomania + MDD
• Dysthymia : ≥ 2 years, depressed mood <
MDD
• Cyclothymia: ≥ 2 years, frequently occurring
hypomania symptoms (< manic episode) &
depressive symptoms (< MDD)
 ETIOLOGI
• Biological Factors (monoamine neurotransmitters:
norepinephrine, dopamine, serotonin, and histamin)
• Biogenic amines:
– Activation receptor adrenergic ß2 pre-sinaptic 🡪
norepinefrin decrease & serotonine release 🡪depresi
– Depletion serotonin may precipitate depression and
suicidal impulses 🡪 low CSF concentration of serotonin
metabolites and uptake sites on platelets
– Dopamin : decreased activity (disfungsi mesolimbic
dopamin pathway & D1 Rec hipoactive ) reduced in
depression & increased in mania
 Faktor Genetik
▪ Significant (but the pattern of genetic inheritance
is complex ) particularly in bipolar I
- Family studies : likelihood of having a mood
disorder as the degree of relationship widened
- Adoption studies : biological relatives of bipolar
probands
- Twin studies : monozygotic concordance rate
bipolar I : 33-90 %, MDD : 50 %
- Linkage studies no genetic association has
been consistently replicated
 Psychosocial Factors
• Live events & Environmental stress
– Stress accompanying the first episode results in long-
lasting changes in the brain’s biology 🡪 a high risk of
undergoing subsequent episodes of mood disorder, even
without an external stressor
– Examples: losing a parent before age 11 years, loss of a
spouse, unemployment
• Personality Factors:
- No single personality trait 🡪 predisposes depression
- Personality disorders: OCD, histrionic and bordeline 🡪
greater risk depression than antisocial and paranoid
because can use projection & eksternalizing defense
mechanism
- Dysthymia & Cyclothimia risk factor 🡪MDD/ bipolar I
 DIAGNOSIS
• MDD = Unipolar = Single episode
⮚ Single / recurent
⮚ Differentiation between these patients and
those who have two or more episodes of MDD
is justified because of the uncertain course of
the former patients’ disorder
 BIPOLAR I
• Abnormal mood lasting at least 1 week
• Include separate bipolar I disorders (single
manic episode and a recurrent episode based
on the symptoms of the most recent episode)
• Manic episodes clearly precipitated by
antidepressant treatment
• Bipolar I disorders, single manic episode :
episode manic I
• Bipolar I disorders , recurrent : at least 2
months without significant symptoms mania or
hypomania
 BIPOLAR II
• Specify the particular severity, frequency
and duration of the hypomanic symptoms
• Sometime to over diagnosis of hypomanic
episodes and the incorrect classification of
patients with MDD
• Bipolar II with psychotic features
• Bipolar II no psychotic features
 Clinical Pictures Disordersipolar (GB)

Mania Subsyndromal Mania

(Hypomania) Mania

Maintenance

Subsyndromal Depression
(Dysthymia) Depression

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 Rekomendasi Farmakoterapi Untuk GB

Pilihan Jenis Obat

Lini I Litium, divalproat, olanzapin, risperidon, quetiapin, quetiapin XR,

aripiprazol, ziprasidon, litium atau divalproat + risperidon, litium atau
divalproat + quetiapin, litium atau divalproat + olanzapin, litium atau
divalproat + aripiprazol

Lini II Karbamazepin, ECT, litium + divalproat, Asenapin, litium atau

divalproat + Asenepin, paliperidon monoterapi

Lini III Haloperidol, klorpromazin, litium atau divalproat + haloperidol, litium +

karbamazepin, klozapin, oksakarbazepin, tamoksifen

Tidak Monoterapi gabapentin, topiramat, lamotrigin, verapamil, tiagabin,

direkomendasi risperidon + karbamazepin, olanzapin + karbamazepin
kan

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Diagnosis GB
5/3/2021
o Tuntunan/panduan disesuaikan secara individual
o Gunakan obat yang sudah terbukti efektif selama ini
o Pilih obat terbaik, misalnya:
✔Aman dan ditoleransi dengan baik
✔Penggunaan paling mudah (untuk pasien)
✔Pengelolaan paling mudah (untuk dokter)
o Tujuan → remisi simtom, bukan hanya
berespons
o Nilai luaran simtomatik

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o Tidak satu pun obat yang benar-benar mujarab untuk
menyembuhkan sehingga pengobatan ditujukan
untuk mengurangi/menghilangkan tanda dan gejala
yang mengganggu.
o Tidak boleh menyerah.
o Restorasi psikososial.
o Gunakan keluarga, edukasi, psikoterapi.
o Semakin kronik penyakit → respons terapi semakin
lambat.

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TERIMA KASIH