Chapter 7:
Mood Disorders and Suicide
• The common feature of depressive disorders is the presence of sad, empty or irritable mood,
accompanied by somatic and cognitive changes that significantly affect the individual’s capacity
to function; depressed mood out of proportion to any cause.
• A few disorders included under Depressive Disorder
→ Major depressive disorder (incl. Major depressive episode)
→ Persistent depressive disorder (dysthymia)
→ SAD
→ Premenstrual dysphoric disorder
Symptoms of depression:
- Symptoms take over the whole person - emotions, bodily functions(somatic), behaviors, thoughts
- Depressed mood out of proportion to any cause
- Loss of interest in everything in life - anthedonia
- No emotions even when they do something enjoyable
- Activity level, sleep and appetite take on many forms - loss of
appetite/overeating; insomnia, early morning waking/excessive sleeping
- Behaviorally - slowed down i.e psychomotor retardation - walk, gestures, talk more slowly and
quietly OR
- Psychomotor agitation - physical agitation, can’t sit still, fidget and move
around aimlessly
- Chronic fatigue, lack of energy
- Cognitive - themes of worthlessness, hopelessness, guilt, suicide
- Inability to concentrate, indecisive
- Severe symptoms - hallucinations/delusions
DSM 5 Criteria for Major depressive disorder
A: Five or more of the following symptoms have been present during the same 2-week
period and represent a change from previous functioning: at least 1 of the symptoms is
either (1) depressed mood or (2) loss of interest or pleasure
1. Depressed most of the day nearly everyday
2. Diminished interest/pleasure in all/almost all activities. Loss of interest in everything
in life (anhedonia) most of the day nearly everyday
3. Weight loss/gain or decrease or increase in appetite nearly everyday
4. Insomnia/hypersomnia nearly everyday
5. Psychomotor retardation (slowed down) / agitation (restlessness, fidgety) nearly
everyday
6. Fatigue, loss of energy
7. Worthlessness/ excessive inappropriate guilt nearly everyday
8. Difficulty concentrating/ indecisiveness nearly everyday
9. Recurrent thoughts of death, suicidal ideation/suicide attempt/plan for suicide
Criteria
B: The symptoms cause clinically significant distress or impairment in social. Occupational or
other important areas of functioning.
C: The episode is not attributable to the physiological effects of a substance or another
medical condition.
D: The occurrence of the major depressive episode is not better explained by schizoaffective
disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or
unspecified schizophrenia spectrum and psychotic disorders.
E: There has NEVER been a manic or hypomanic episode.
, Diagnosing depressive disorders
1. Major depressive disorder:
! Depressive symptoms, chronically lasting 2 weeks or more
! Impair person's ability to function in everyday life
! Only 1 depressive episode - MDD, single episode
! 2 or more: MDD, recurrent episode (2 or more episodes separated by at least 2
consecutive months without symptoms)
! Cannot diagnose MDD - death - normal & expected - atypical features present e.g
worthlessness, psychomotor retardation, severe impairment
2. Persistent depressive disorder(dysthymia):
! Depressed mood, for most of the day, for more days than not, for at least 2 years;
plus 2/more (a) poor appetite (b) insomnia/hypersomnia (c) low energy/fatigue
(d) low self-esteem (e) poor concentration (f) hopelessness
! Patient must never have been without symptoms of depression for more than 2
months
! Show a higher risk for co-morbid disorders (e.g anxiety & substance use) than people
with MDD alone
! Experience worse functional consequences
DMS subtypes of major depressive symptoms
Different forms the disorder can take different subtypes:
Anxious distress: prominent anxiety symptoms.
Mixed features: presence of at least 3 manic/hypomanic symptoms, but does not meet
criteria for manic episode.
Melancholic features: inability to experience pleasure, distinct depressed mood, depression
regularly worse in the morning, early morning awakening, marked psychomotor retardation
or agitation, significant anorexia or weight loss, excessive guilt.
Psychotic features: presence of mood-congruent or mood incongruent delusions or
hallucinations.
Catatonic features: catatonic behaviors, not actively relating to environment, mutism,
agitation, mimicking another’s speech/movement.
Atypical features: positive mood reactions to some events, significant weight gain or
increase in appetite, hypersomnia, heavy or leaden feelings in arms or legs, long standing
sensitivity to interpersonal rejection.
Seasonal pattern: history of at least 2 years in which major depressive episodes occur
during 1 season of the year (usually the winter) and remit when the season is over.
Peripartum onset: onset of Major depressive episode during pregnancy or in the 4 weeks
following delivery
Seasonal Affective disorder
• History of experiencing and fully recovering from MDEs
Depressed when the daylight hours are short and recover when the daylight hours
are long
• Some can develop mild mania or full mania in the summer
• Diagnosis - when a person's mood change is not the result of psychosocial events
e.g. being unemployed during the winter
• The mood symptoms must seem to come on without reason or cause
Premenstrual Dysphoric disorder
• Experiences of increases in distress premenstrually
• Symptom is a mixture of depression, anxiety, tension, irritability, anger
• Occurs week before onset, improve once menses begun, become minimal or absent
in the week post menses
Mood Disorders and Suicide
• The common feature of depressive disorders is the presence of sad, empty or irritable mood,
accompanied by somatic and cognitive changes that significantly affect the individual’s capacity
to function; depressed mood out of proportion to any cause.
• A few disorders included under Depressive Disorder
→ Major depressive disorder (incl. Major depressive episode)
→ Persistent depressive disorder (dysthymia)
→ SAD
→ Premenstrual dysphoric disorder
Symptoms of depression:
- Symptoms take over the whole person - emotions, bodily functions(somatic), behaviors, thoughts
- Depressed mood out of proportion to any cause
- Loss of interest in everything in life - anthedonia
- No emotions even when they do something enjoyable
- Activity level, sleep and appetite take on many forms - loss of
appetite/overeating; insomnia, early morning waking/excessive sleeping
- Behaviorally - slowed down i.e psychomotor retardation - walk, gestures, talk more slowly and
quietly OR
- Psychomotor agitation - physical agitation, can’t sit still, fidget and move
around aimlessly
- Chronic fatigue, lack of energy
- Cognitive - themes of worthlessness, hopelessness, guilt, suicide
- Inability to concentrate, indecisive
- Severe symptoms - hallucinations/delusions
DSM 5 Criteria for Major depressive disorder
A: Five or more of the following symptoms have been present during the same 2-week
period and represent a change from previous functioning: at least 1 of the symptoms is
either (1) depressed mood or (2) loss of interest or pleasure
1. Depressed most of the day nearly everyday
2. Diminished interest/pleasure in all/almost all activities. Loss of interest in everything
in life (anhedonia) most of the day nearly everyday
3. Weight loss/gain or decrease or increase in appetite nearly everyday
4. Insomnia/hypersomnia nearly everyday
5. Psychomotor retardation (slowed down) / agitation (restlessness, fidgety) nearly
everyday
6. Fatigue, loss of energy
7. Worthlessness/ excessive inappropriate guilt nearly everyday
8. Difficulty concentrating/ indecisiveness nearly everyday
9. Recurrent thoughts of death, suicidal ideation/suicide attempt/plan for suicide
Criteria
B: The symptoms cause clinically significant distress or impairment in social. Occupational or
other important areas of functioning.
C: The episode is not attributable to the physiological effects of a substance or another
medical condition.
D: The occurrence of the major depressive episode is not better explained by schizoaffective
disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or
unspecified schizophrenia spectrum and psychotic disorders.
E: There has NEVER been a manic or hypomanic episode.
, Diagnosing depressive disorders
1. Major depressive disorder:
! Depressive symptoms, chronically lasting 2 weeks or more
! Impair person's ability to function in everyday life
! Only 1 depressive episode - MDD, single episode
! 2 or more: MDD, recurrent episode (2 or more episodes separated by at least 2
consecutive months without symptoms)
! Cannot diagnose MDD - death - normal & expected - atypical features present e.g
worthlessness, psychomotor retardation, severe impairment
2. Persistent depressive disorder(dysthymia):
! Depressed mood, for most of the day, for more days than not, for at least 2 years;
plus 2/more (a) poor appetite (b) insomnia/hypersomnia (c) low energy/fatigue
(d) low self-esteem (e) poor concentration (f) hopelessness
! Patient must never have been without symptoms of depression for more than 2
months
! Show a higher risk for co-morbid disorders (e.g anxiety & substance use) than people
with MDD alone
! Experience worse functional consequences
DMS subtypes of major depressive symptoms
Different forms the disorder can take different subtypes:
Anxious distress: prominent anxiety symptoms.
Mixed features: presence of at least 3 manic/hypomanic symptoms, but does not meet
criteria for manic episode.
Melancholic features: inability to experience pleasure, distinct depressed mood, depression
regularly worse in the morning, early morning awakening, marked psychomotor retardation
or agitation, significant anorexia or weight loss, excessive guilt.
Psychotic features: presence of mood-congruent or mood incongruent delusions or
hallucinations.
Catatonic features: catatonic behaviors, not actively relating to environment, mutism,
agitation, mimicking another’s speech/movement.
Atypical features: positive mood reactions to some events, significant weight gain or
increase in appetite, hypersomnia, heavy or leaden feelings in arms or legs, long standing
sensitivity to interpersonal rejection.
Seasonal pattern: history of at least 2 years in which major depressive episodes occur
during 1 season of the year (usually the winter) and remit when the season is over.
Peripartum onset: onset of Major depressive episode during pregnancy or in the 4 weeks
following delivery
Seasonal Affective disorder
• History of experiencing and fully recovering from MDEs
Depressed when the daylight hours are short and recover when the daylight hours
are long
• Some can develop mild mania or full mania in the summer
• Diagnosis - when a person's mood change is not the result of psychosocial events
e.g. being unemployed during the winter
• The mood symptoms must seem to come on without reason or cause
Premenstrual Dysphoric disorder
• Experiences of increases in distress premenstrually
• Symptom is a mixture of depression, anxiety, tension, irritability, anger
• Occurs week before onset, improve once menses begun, become minimal or absent
in the week post menses
