Major Depressive Episode: loss of interest and pleasure for at least 2 weeks Manic Episode: elevated an expansive mood for at least 1 weekMixed Episode: alternating moods that last at least 1 week, must

meet criteria for both manic and depressive almost daily

Hypomanic Episode: expansive, irritable, and elevated mood that lasts

at least 4 days

Bipolar IBipolar IICyclothymia(We expect major changes in this criteria with regard to children in DSM-5)

Major Depressive DisorderDysthymia (different criteria for children)

Bipolar I Disorder: one or more manic episodes, usually with a history of depressive episodes (can have psychotic aspects)

Bipolar II Disorder: one or more depressive with at least one hypomanic episode, no psychosis

Cyclothymic Disorder: persistent mood disturbance lasting at least two years, must not be without for two months, less severity than bipolar

Bipolar Disorder NOS

Major Depressive Disorder: one or more major depressive episodes, episodes must last at least two weeks

Dysthymia: two-year history of depressed mood, must not be without for two months, less severity than major depression, constant for a period of two years (children one year agitated depression)

More information on co-morbidity of alcohol and substance abuse (Bipolar Disorders)

Major Depressive Disorder: now the symptoms must last two months after loss of a loved one (used to be two weeks) tried to separate from condition called Bereavement.

Dysthymia—in DSM-IV-TR—outcome is better with active treatment

New diagnosis proposed: mixed anxiety depression.

Each mood disorder diagnosis is accompanied by some type of anxiety dimension.

A rating of anxiety should be included from 0 (no anxiety) to 4 (severely anxious with 5 symptoms and motor agitation).

Tricyclics (TCA): Examples of TCAs include:• Tofranil (generic name Imipramine)• Elavil/Amitriptyline

MAO Inhibitors: Many dietary restrictions, no foods with the chemical tyramine (e.g., cheese, beef or chicken liver, pickled herring, red wine, chocolate, coffee, raisins, pineapple, bananas)

• Eldepryl (Selegiline)

Other Anti-Depressants: Selective Serotonin Re-uptake Inhibitors (SSRIs).

• Prozac/Fluoxetine • Paxil/Paroxetine hydrochloride • Zoloft

Side effect of the SSRIs: sexual disinterest and ORGASMIC DELAY

In 2004, the FDA ordered the strongest safety warning possible:Antidepressants increase the risk of suicidal thinking and behavior (suicidality) in children and adolescents with major depressive disorder (MDD) and other psychiatric disorders. Anyone considering the use of [Drug Name] or any other antidepressant in a child or adolescent must balance this risk with the clinical need. (Prozac is the exception.)In 2006 added “young adults.”