Week 4-7

1. Major depressive disorder: 1 or more major depressive episodes that are at least 2 weeks long. This is a disorder of severity.

2. Dysthymic disorder: at least 2 years of depressed mood for more days than not. This is a disorder of chronicity

• Must have at least 5 of the criteria, one of which MUST be (1) or (2):
• 1. Depressed mood
• 2. Anhedonia (apathy)
• 3. Significant change in weight
• 4. Insomnia/hypersomnia
• 5. Increased/decreased psychomotor 
• 6. fatigue/energy loss
• 7. feelings of worthlessness/guilt
• 8. diminished concentration/indecisiveness
• 9. recurrent death/suicidal thoughts

Atypical, melancholic, catatonic, postpartum, psychotic, seasonal

• - generally occurs in younger women
• - characterized by increased appetite/weight gain, hypersomnia (10+hrs/day), leaded paralysis, extreme sensitivity to interpersonal rejection, and mood reactivity in which the mood brightens considerably with positive events.

• - most often occurs in older adults
• - characterized by anhedonia/inability to be cheered up
• - following symptoms: depression worse in the am, early am awakening, psychomotor retardation/agitation, significant anorexia/weight loss, excessive and inappropriate guilt.

Significant psychomotor alterations (immobility, excessive motor activity, mutism, echolaila [repetition of words], inappropriate posturing)

• - When a person has hallucinations and delusions with the mood disturbance.
• - Tend to be mood-congruent

• A. Depressed mood for 2 years, with a depressed mood for most of the day, for more days than not
• B. 2 or more of the following:
• 1.poor appetite/overeating
• 2. insomnia/hypesomnia
• 3. low energy/fatigue
• 4. low self-esteem
• 5. poor concentration/difficulty making a decision
• 6. feelings of hopelessness

• Neurochemical: norepinephrine, serotonin, dopamine, dysregulation of GABA. The cells that the monoamines activate have lost the ability to respond
• Genetic: 
• Endocrine: Hypothalamic-pituitary-adrenal (HPA), which mediates the stress response, malfunctions and creates cortisol, thyroid, and hormonal abnormalities
• Circadian rhythm
• changes in brain anatomy: atrophy of white matter in frontal lobes, cerebellum, and basal ganglia
• psychological: Adverse early life experiences, intrapsychic conflicts, reactions to live events

• 1. Plan: people with a plan are more serious about suicide and have a higher risk
• 2. Method: Lethality-some methods are more lethal than others (some methods give person more time to think it through)
• 3. Rescue: the person who will deceive possible rescuers as to where he/she is is higher risk

Characterized by a patient who swings between manic episodes and major depression

Person swings between a hypomanic episode and major depression

Swing between hypomanic episode and dysthymia