From the Guidelines
Mood disorders are diagnosed using specific criteria that focus on persistent emotional disturbances, with major depressive disorder requiring at least five symptoms present during a two-week period, including depressed mood or loss of interest/pleasure, plus symptoms like significant weight changes, sleep disturbances, psychomotor agitation or retardation, fatigue, feelings of worthlessness, concentration problems, and recurrent thoughts of death, as outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) 1.
Key Criteria for Mood Disorders
- Major depressive disorder: at least five symptoms present during a two-week period, including depressed mood or loss of interest/pleasure, plus symptoms like significant weight changes, sleep disturbances, psychomotor agitation or retardation, fatigue, feelings of worthlessness, concentration problems, and recurrent thoughts of death.
- Bipolar disorders: episodes of mania or hypomania, characterized by elevated mood, grandiosity, decreased need for sleep, pressured speech, racing thoughts, distractibility, increased goal-directed activity, and risky behaviors.
- Persistent depressive disorder: depressed mood lasting at least two years.
- Cyclothymic disorder: numerous periods of hypomanic and depressive symptoms over at least two years.
Importance of Proper Diagnosis
Proper diagnosis is essential for developing appropriate treatment plans that may include psychotherapy, medication, lifestyle changes, or a combination of approaches, as highlighted in the guidelines for adolescent depression in primary care (GLAD-PC) 1.
Considerations for Diagnosis
The diagnostic assessment needs to incorporate both current and past history regarding symptomatic presentation, treatment response, psychosocial stressors, and family psychiatric history, as recommended in the practice parameter for the assessment and treatment of children and adolescents with bipolar disorder 1.
Recent Guidelines and Recommendations
Recent guidelines, such as those from the American College of Physicians 1 and the American Academy of Child and Adolescent Psychiatry 1, emphasize the importance of accurate diagnosis and treatment of mood disorders, with a focus on evidence-based approaches and consideration of individual patient needs and circumstances.
From the Research
Mood Disorder Criteria
The criteria for mood disorders, such as bipolar disorder, involve recurrent episodes of depression and mania or hypomania 2.
- Bipolar depressive episodes are similar to major depressive episodes.
- Manic and hypomanic episodes are characterized by a distinct change in mood and behavior during discrete time periods.
- The age of onset is usually between 15 and 25 years, and depression is the most frequent initial presentation.
Diagnosis and Treatment
Diagnosis and optimal treatment are often delayed by a mean of approximately 9 years following an initial depressive episode 2.
- Long-term treatment consists of mood stabilizers, such as lithium, valproate, and lamotrigine.
- Antipsychotic agents, such as quetiapine, aripiprazole, asenapine, lurasidone, and cariprazine, are recommended, but some are associated with weight gain.
- Antidepressants are not recommended as monotherapy, and a combination of antidepressants plus mood stabilizers or atypical antipsychotics is recommended instead 3.
Treatment Options
Different treatment options are available for bipolar disorder, including:
- Lithium, which may be effective in treating acute mania, and lithium efficacy is maximized when used to prevent both manic and depressive episodes 4.
- Valproate, which may be more effective as an antimanic rather than prophylactic agent 4.
- New antipsychotics and mood stabilizers, such as aripiprazole, lamotrigine, lurasidone, and cariprazine, which have strong potential to be beneficial and safe in cases of many comorbidities 5.