Mood Disorders: The Ups and the Downs

Transcription

1 Mood Disorders: The Ups and the Downs Melissa Goelitz, MD NAMI Wisconsin Conference April 30, 2016

2 What is a depressive episode? Mood Changes An overly long period of feeling sad or hopeless Loss of interest in activities once enjoyed, including sex Need to have 2 weeks of low mood and/or loss of interest along with behavior changes. Need at least 5 symptoms to qualify for depressive diagnosis. Needs to interfere with functioning. Behavioral Changes Feeling tired or "slowed down" Having problems concentrating, remembering, and making decisions Being restless or irritable Changing eating, sleeping, or other habits Thinking of death or suicide, or attempting suicide From NIMH website

3 What is mania? Mood Changes A long period of feeling "high," or an overly happy or outgoing mood Extreme irritability Need to have mood change for 1 week along with at least 3 behavior changes which are a change from baseline and are not due to drugs or other substances From NIMH website Behavioral Changes Talking very fast, jumping from one idea to another, having racing thoughts Being easily distracted Increasing activities, such as taking on new projects Being overly restless Sleeping little or not being tired Having an unrealistic belief in one's abilities Behaving impulsively and engaging in pleasurable, high-risk behaviors

4 What is hypomania? Similar to mania but less severe Does not result in functional impairment May last only a few days From NIMH website

5 So what is it?? Major depressive disorder Depressive episode(s) Bipolar disorder I Mania +/- depressive episode Bipolar disorder II Hypomania +/- depressive episode

6 Similarities Depressive episodes are common to both illnesses Psychotic thoughts can happen at extremes of either depression or mania Consequences can be quite significant on functional impairment (unable to work, maintain relationships, etc) Substance and/or alcohol use are common comorbidities ECT can be used for people whose symptoms are quite severe

7 Differences Medications available to treat bipolar disorder are more limited Treatment proposed is likely different

8 How We Diagnose No blood test available We do blood tests and brain imaging (when appropriate) to make sure it isn t a different medical illness that needs to be treated Collateral information is critical Based off of clinical interview and presentation

9 Present State of Understanding Multiple causes: Genetics May be genetic hot spots meaning higher risk for other disorders including depression and schizophrenia Environment Substance use Seasonal component Post-partum

10 Current Meds for Bipolar Disorder Mood Stabilizers Lithium Depakote Tegretol Atypical Antipsychotics Lamotrigine (for type II only) Often on for long-term treatment Antidepressants Use with caution as they can kindle or trigger a mania Sleep aids Important to ensure ongoing adequate sleep to prevent relapse of episodes

11 Current Meds for Depression Antidepressants SSRIs SNRIs Atypical ADs (mirtazapine and bupropion) TCAs MAOIs Treatment is often at least 1 year after episode resolves Augmentation Agents Lithium Atypical Antipsychotics Lamotrigine Thyroid hormone Buspirone Sleep Aids

12 Other Treatments Exercise Evidence in depression for getting at least 3 hours per week of hard exercise Therapy (IPT, CBT, ACT, Social Rhythms, etc) Can be helpful in mild depressive episodes as monotherapy Often augments in moderate-severe depressive episodes in conjunction with medication Can help in mania but not appropriate as monotherapy

13 Current Therapy for Bipolar Often therapy alone is not enough on its own if diagnosed with Bipolar, type I. Therapy does help to get remission faster and helps it last longer. Social Rhythms Therapy Family-Focused Therapy Cognitive Behavioral Therapy Interpersonal Psychotherapy

14 Current Therapy for Depression Interpersonal Psychotherapy (IPT) Cognitive Behavioral Therapy (CBT) Acceptance and Commitment Therapy (ACT) Psychoanalytic Therapy Less commonly used in acute episodes but can help with personal understanding when not in midst of mood episodes

15 Other Treatments Continued Meditative practice Evidence for its benefit in major depressive episodes Less effective in mania Homeopathy No evidence of any benefit

16 Relapse Prevention Ideas Diary or journaling Wellness Recovery Action Plans (WRAP) Staying engaged with provider, even when in remission from episode OR maintain easy access to provider in case of relapse of mood symptoms

17 Good Sources of Information National Alliance on Mental Illness (NAMI) National Institute of Mental Health (NIMH) Substance Abuse and Mental Health Services Administration (SAMHSA) Your doctor and therapist

18 Questions?

19 Thanks for Listening Info presented from Clinicaltrials.gov NIMH website Various textbooks