AFFECTIVE SPECTRUM DISORDER

MOOD DISORDERS

It involves much more severe alteration in mood for much long period of time. Mania is characterized by
intense and unrealistic feelings of excitement; it is opposite of depression. Depression usually involves
the feelings of extraordinary sadness and rejection. Sometimes the individual may have symptoms of
mania and depression during the same time period, mixed episode case.

The two types of mood disorder are; depressive disorder and bipolar disorder. The depressive disorder
suffers only from depression often called as unipolar disorder. They’ve no history of mania and return to a
normal or nearly normal mood when the depression lefts. The bipolar disorder is experienced through a
period of maniac that alternate with the period of depression. The differentiation among the mood
disorder is in terms of: severity, the number of dysfunctions experienced is in relative of the degree of
impairment evidenced in those areas; duration, whether the disorder is acute, chronic and intermitted.

UNIPOLAR DEPRESSION/ CLINICAL DEPRESSION/ DEPRESSION

Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. Also called
major depressive disorder or clinical depression, it affects how the person feels, think and behave and can
lead to a variety of emotional and physical problems. People may have trouble doing normal day-to-day
activities, and sometimes you may feel as if life isn't worth living. Major depressive episode is a period of
2 more weeks marked by at least 5 symptoms of depression including sad mode and/ or loss of pleasure.
In extreme cases, the episode may include the psychotic symptoms (hallucination). The DSM-V lists
several types of depressive disorder. People also experience a major depressive episode without having
any history of mania receive a diagnosis of major depressive disorder.

Prevalence, age of onset, and gender differences, around 19% of all adults experience an episode of
severe unipolar depression at some point in their lives. The rate of depression can be mild or severe, and
is higher among poor people. Women are at least twice likely as men. 26% of women have an episode at
somewhat in their lives compared to 12% of men. For children, the prevalence of unipolar depression is
similar for girls and boys. Approximately, 85% of people with unipolar depression recover, some without
treatment. Around the 40% of them have at least one other episode of depression later in their lives.

Symptoms, the symptoms are spanning in 5 areas of functioning;

• Emotional symptoms, feel sad, miserable, empty, humiliated, loss of sense of humor, little
pressure from anything such as anxiety, anger, and agitation.
• Motivational symptoms lose the desire to pursue their usual activities, lack of desire, and
initiative. They’ve uninterested in life or wish to die. About 7-15% of depressed people commit
suicide.
• Behavioral symptoms, less active, less productive, wants to be alone, move or slow in speaking.
• Cognitive symptoms, have negative views of them, consider them as undesirable, inferior, and
blame themselves for the unfortunate events. They’ve negative mental attitudes. The sense of
hopelessness and helplessness make them vulnerable to suicidal thinking.
 • Physical symptoms have physical ailment such as headache, indigestion, constipation, and
general pain. They’ve disturbance in sleep and appetite.

Diagnosing the Unipolar Disorder

Major depressive disorder (MDD), is a condition diagnosed if someone (without a history of

hypomania/mania) experiences a depressive episode involving severe depressive symptoms that have
negatively affected functioning most of the day, nearly every day, for at least 2 full weeks. According to
DSM-V, major depressive episode is a period involving severe depressive symptoms that have impaired
functioning for at least 2 full weeks. MDE is characterized by the combination of depressed mood or loss
of interest or pleasure lasting for most of the day, nearly every day for 2 weeks or more. The primary
symptom (depressed mood or loss of interest/pleasure) must be accompanied by four or more additional
symptoms and must cause clinically significant distress or impairment. The primary difference between
MDE and MDD is that MDD includes all of the criteria for MDE as well as MDE exclusionary criteria
for mania and hypomania.

DSM-V Diagnostic 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 one of the symptoms is either (1) depressed mood
or (2) loss of interest or pleasure: depressed mood most of the day, nearly every day, as indicated by
either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears
tearful); markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly
every day (as indicated by either subjective account or observation); significant weight loss when not
dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or
increase in appetite nearly every day; insomnia or hypersomnia nearly every day; psychomotor agitation
or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or
being slowed down); fatigue or loss of energy nearly every day; feelings of worthlessness or excessive or
inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about
being sick); diminished ability to think or concentrate, or indecisiveness, nearly every day (either by
subjective account or as observed by others); recurrent thoughts of death (not just fear of dying); recurrent
suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

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 to 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 and unspecified
schizophrenia spectrum and other psychotic disorders.

E. There has never been a manic episode or a hypomanic episode.

DSM-V Diagnostic Criteria for Major Depressive Episode

A. Major depressive episode involves a change in functioning that includes at least one of these
symptoms most of the day nearly every day over a period of 2 weeks (or longer): (a) depressed mood,
feelings of sadness, or emptiness, and/or (b) loss of interest or pleasure in previously enjoyed activities.
The person must also experience at least four of these symptoms during the same period: (a) significant
weight gain or weight loss (without dieting) or increases or decreases in appetite, (b) persistent changes in
sleep patterns, involving increased sleep or inability to sleep, (c) observable restlessness or slowing of
activity, (d) persistent fatigue or loss of energy, (e) excessive feelings of guilt or worthlessness, (f)
persistent difficulty with concentration or decision making, or (g) suicidal behaviors or recurrent thoughts
of death or suicide.

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.

The symptoms cause significant impairment and are not due to the physiological effects of a medical
condition, a prescribed medication, or drug or alcohol abuse.

Causal factors

I. Biological causal factors, medical researchers have been aware for years that certain
diseases and drugs produce mood changes. Evidence from genetic, biochemical, anatomical,
and immune system studies suggests that often it does.
• Genetic Factors, in four kinds of research—family pedigree, twin, and molecular
biology gene studies—suggest that some people inherit a predisposition to unipolar
depression. In family pedigree studies, 20 percent of those relatives are depressed
compared with fewer than 10 percent of the general population. In twin studies,
when an identical twin had unipolar depression, there was a 46 percent chance that
the other twin would have the same disorder, in contrast, when a fraternal twin had
unipolar depression, the other twin had only a 20 percent chance of developing the
disorder. In molecular biology gene studies, researchers have found evidence that
unipolar depression may be tied to genes on chromosomes 1, 4, 9, 10, 11, 12, 13, 14,
17, 18, 20, 21, 22, and X. For example, individuals who are depressed often have an
abnormality of their 5-HTT gene, a gene located on chromosome 17 that is
responsible for activity of the neurotransmitter serotonin, low activity of serotonin is
closely tied to depression.
• Biochemical factors, low activity of two neurotransmitter chemicals, norepinephrine
and serotonin, has been strongly linked to unipolar depression. The body’s endocrine
system may play a role in unipolar depression. i.e., people with unipolar depression
have been found to have abnormally high levels of cortisol, one of the hormones
released by the adrenal glands during times of stress. Another hormone that has been
tied to depression is melatonin, sometimes called the “Dracula hormone” because it is
released only in the dark. People who experience a recurrence of depression each
winter (a pattern called seasonal affective disorder) may secrete more melatonin
 during the winter’s long nights than other individuals do. The researchers believe that
activity by key neurotransmitters or hormones ultimately leads to deficiencies of
certain proteins and other chemicals within neurons, deficiencies that may impair the
health of the neurons and lead, in turn, to depression.
• Brain anatomy and Brain circuits, many biological researchers now believe that
emotional reactions of various kinds are tied to brain circuits, networks of brain
structures that work together, triggering each other into action and producing a
particular kind of emotional reaction. Although research is far from complete, a brain
circuit, particularly the prefrontal cortex, the hippocampus, the amygdala, and
Bradman Area 25 (an area located just under the brain part called the cingulate
cortex), responsible for unipolar depression has also begun to emerge.
• Immune system, the immune system is the body’s network of activities and body
cells that fight off bacteria, viruses, and other foreign invaders. When people are
under intense stress for a while, their immune systems may become dysregulated,
leading to lower functioning of important white blood cells called lymphocytes and
to increased production of C-reactive protein (CRP), a protein that spreads
throughout the body and causes inflammation and various illnesses. Some studies
suggest that immune system dysregulation of this kind may help produce depression.
II. Psychological causal factors, the psychological models that have been most widely applied
to unipolar depression are the psychodynamic, behavioral, and cognitive models. The
psychodynamic model has not been strongly supported by research, and the behavioral model
has received moderate support. In contrast, the cognitive model of unipolar depression has
received considerable research support and gained a large following.
• Psychodynamic model, the first psychodynamic explanation and treatment for
depression was developed by Freud and Karl Abraham. It began by noting the
similarity between clinical depression and grief in people who lose loved ones:
constant weeping, loss of appetite, difficulty sleeping, loss of pleasure in life, and
general withdrawal. According to the two theorists, a series of unconscious processes
is set in motion when a loved one dies. Unable to accept the loss, mourners at first
regress to the oral stage of development, the period of total dependency when infants
cannot distinguish themselves from their parents. Studies have offered general
support for the psychodynamic idea that major losses, particularly ones suffered early
in life, may set the stage for later depression. At the same time, research does not
indicate that loss always is at the core of depression. In fact, it is estimated that less
than 10 percent of all people who experience major losses in life actually become
depressed. Moreover, research into the loss-depression link has provided inconsistent
findings. Though some studies find evidence of a relationship between childhood loss
and later depression, others do not.
• Behavioral model, clinical researcher Peter Lewinsohn was one of the first clinical
theorists to develop a behavioral explanation and treatment for unipolar depression.
Lewinsohn suggested that the positive rewards in life dwindle for some persons,
leading them to perform fewer and fewer constructive behaviors. The rewards of
campus life, for example, disappear when a young woman graduates from college
and takes a job, and an aging baseball player loses the rewards of high salary and
 adulation when his skills deteriorate. Although many people manage to fill their lives
with other forms of gratification, some become particularly disheartened. The
positive features of their lives decrease even more, and the decline in rewards leads
them to perform still fewer constructive behaviors. In this manner, the individuals
spiral toward depression. Lewinsohn and other behaviorists have further proposed
that social rewards are particularly important in the downward spiral of depression.
This claim has been supported by research showing that depressed persons
experience fewer social rewards than non-depressed persons and that as their mood
improves, their social rewards increase. Although depressed people are sometimes
the victims of social circumstances, it may also be that their dark mood and flat
behaviors help produce a decline in social rewards.
• Cognitive model, cognitive theorists believe that people with unipolar depression
persistently view events in negative ways and that such perceptions lead to their
depression. The two most influential cognitive explanations are the theory of learned
helplessness and the theory of negative thinking. According to psychologist Martin
Seligman (1975), such feelings of helplessness are at the center of her depression.
Seligman has developed the learned helplessness theory of depression. It holds that
people become depressed when they think: that they no longer have control over the
reinforcements (the rewards and punishments) in their lives and; and that they
themselves are responsible for this helpless state. According to a newer version of the
theory, the attribution-helplessness theory, when people view events as beyond their
control, they ask themselves why this is so. If they attribute their present lack of
control to some internal cause that is both global and stable (“I am inadequate at
everything and I always will be”), they may well feel helpless to prevent future
negative outcomes and may experience depression.
Negative Thinking, like Seligman, Aaron Beck believes that negative thinking lies at
the heart of unipolar depression. According to Beck, maladaptive attitudes, a
cognitive triad, errors in thinking and automatic thoughts combine to produce the
clinical syndrome. Beck believes that some people develop maladaptive attitudes as
children. The negative thinking typically takes three forms, which he calls the
cognitive triad: the individuals repeatedly interpret: their experiences; themselves;
and their futures in negative ways that lead them to feel depressed. According to
Beck, depressed people also make errors in their thinking. In one common error o
logic, they draw arbitrary inferences—negative conclusions based on little evidence.
Similarly, depressed people often minimize the significance of positive experiences
or magnify that of negative ones. Finally, depressed people experience automatic
thoughts, a steady train of unpleasant thoughts that keep suggesting to them that they
are inadequate and that their situation is hopeless.
III. Sociocultural causal factors, sociocultural theorists propose that unipolar depression is
greatly influenced by the social context that surrounds people. Their belief is supported in
part by the finding that this disorder is often triggered by outside stressors. There are two
kinds of sociocultural views; the family-social perspective and the multicultural perspective.
• Family-social perspective, a decline in social rewards is particularly important in the
development of depression. Depression has been tried repeatedly to the unavailability
 of social support such as that found in a happy marriage. People who are separated or
divorced display at least three times the depression rate of married or widowed
persons and double the rate of people who have never been married. In some cases,
the spouse’s depression may contribute to marital discord, a separation, or divorce,
but often the interpersonal conflicts and low social support found in troubled
relationships seem to lead to depression.
• The Multicultural Perspective, two issues have captured the interest of multicultural
theorists: links between gender and depression and ties between cultural and ethnic
background and depression.
Gender and Depression, the artifact theory holds that women and men are equally
prone to depression but that clinicians often fail to detect depression in men. Perhaps
depressed women display more emotional symptoms, such as sadness and crying,
which are readily diagnosed, while depressed men mask their depression behind
traditionally “masculine” symptoms such as anger. Although a popular explanation,
this view has failed to receive consistent research support. It turns out that women are
actually no more willing or able than men to identify their depressive symptoms and
to seek treatment. The hormone explanation holds that hormone changes trigger
depression in many women. A woman’s biological life from her early teens to middle
age is marked by frequent changes in hormone levels. Gender differences in rates of
depression also span these same years. Research suggests, however, that hormone
changes alone are not responsible for the high levels of depression in women.
Important social and life events that occur at puberty, pregnancy, and menopause
could likewise have an effect. The life stress theory suggests that women in our
society experience more stress than men. On average they face more poverty, more
menial jobs, less adequate housing, and more discrimination than men—all factors
that have been linked to depression. And in many homes, women bear a
disproportionate share of responsibility for child care and housework. The body
dissatisfaction explanation states that females in Western society are taught, almost
from birth, to seek a low body weight and very slender body shape—goals that are
unreasonable, unhealthy, and often unattainable. The cultural standard for males is
much more lenient. As girls approach adolescence, peer pressure may produce
greater and greater dissatisfaction with their weight and body, increasing the
likelihood of depression. Consistent with this theory, gender difference in depression
do indeed first appear during adolescence, and persons with eating disorders often
experience high levels of depression. However, it is not clear that eating and weight
concerns actually cause depression; they may instead be the result of depression. The
lack-of-control theory picks up on the learned helplessness research and argues that
women may be more prone to depression because they feel less control than men
over their lives. It has been found that victimization of any kind, from burglary to
rape, often produces a general sense of helplessness and increases the symptoms of
depression. Women in our society are more likely than men to be victims,
particularly of sexual assault and child abuse. A final explanation for the gender
differences found in depression is the rumination theory. Rumination is the tendency
 to keep focusing on one’s feelings when depressed and to consider repeatedly the
causes and consequences of that depression.
Cultural background and Depression, Depression is a worldwide phenomenon,
and certain symptoms of this disorder seem to be constant across all countries.
Researchers found that the great majority of depressed people in very different
countries reported symptoms of sadness, joylessness, tension, lack of energy, loss of
interest, loss of concentration, ideas of insufficiency, and thoughts of suicide. Beyond
such core symptoms, however, research suggests that the precise picture of
depression varies from country to country. Depressed people in non-Western
countries are more likely to be troubled by physical symptoms such as fatigue,
weakness, sleep disturbances, and weight loss. Depression in those countries is less
often marked by cognitive symptoms such as self-blame, low self-esteem, and guilt.
Researchers have found few differences in the symptoms of depression among
members of different ethnic or racial groups.

Treatments

The biological treatment includes usually antidepressant drug, but for severely the depressed individual,
who do not respond to other forms of treatment are given electroconvulsive therapy or brain stimulation.

In psychological treatments: the psychodynamic therapists use the same basic procedures with depressed
clients as they use with others: they encourage the client to associate freely during therapy; suggest
interpretations of the client’s associations, dreams, and displays of resistance and transference; and help
the person review past events and feelings. The long-term psychodynamic therapy is only occasionally
helpful in cases of unipolar depression. Short-term psychodynamic therapies have performed better than
the traditional approaches. The behavioral therapists use a variety of strategies to help increase the
number of rewards experienced by their depressed clients. The cognitive treatments are CBT, and ACT
(Acceptance and Commitment Therapy).

In sociocultural treatment; the family-social therapists, who use family and social approaches help
depressed clients change their approach to close relationships in their lives. The most effective family-
social approaches are interpersonal psychotherapy (IPT) and couple therapy. The multicultural treatment
includes culturally sensitive therapies.

BIPOLAR DISORDER

Bipolar disorder is a brain disorder that causes changes in person’s mood, energy, and in the ability to
function. People with bipolar disorder experience intense emotional states that typically occur during
periods of days to weeks, called the mood episodes. APA defines bipolar disorder as a group of brain
disorders that cause extreme fluctuations in a person’s mood, energy, and in the ability to function. People
with this disorder experience both depression and mania. These moos episodes are categorized as
manic/hypomanic (abnormally happy or irritable mood) or depressive (sad mood). People with bipolar
disorder generally have periods of neutral moods as well. When treated, people with bipolar disorder can
lead a full and productive life. The bipolar disorder is distinguished from unipolar disorders by the
presence of manic/hypomanic episodes, which are nearly always preceded or followed by the periods of
depression. Mania and hypomania are two distant types of episodes. A person who experiences manic
episodes has a markedly elevated, euphoric, and expansive mood, often interrupted by occupational
outbursts of intense irritability or even violence, particularly, when others refuse to go along with the
manic person’s wishes and schemas. These extreme moods persist for at least a week for diagnosis to
occur with additional or more symptoms, which are extremely severe. There will be significant
impairment of occupational and social functioning, thus might lead to hospitalization. Mania can be a
symptom of bipolar disorder II. Hypomanic episodes can also occur; these involve the milder versions of
the same symptoms. Although the symptoms listed are the same for manic and hypomanic episodes,
there’s much less impairment in hypomania, and the hospitalization isn’t required. It involves an episode
that lasts at least 4 days to diagnose. Hypomania can be the symptom of bipolar disorder I.

Bipolar Disorder I, it is a manic-depressive disorder that can exist both with and without psychotic
episodes. It is distinguished from MDD, Major Depressive Disorder, by the presence of mania. A mixed
episode is characterized by the symptoms of both full-blown manic and major depressive episodes for at
least 1 week, either intermixed or alternating rapidly every few days.

Bipolar Disorder II consists of depressive and manic episodes, which alternate and typically less severe
and do not inhibit. The person doesn’t experience full-blown manic (or mixed) episodes but has
experienced clear cut hypomanic episodes as well as major depressive episodes.

The main difference between the bipolar I and bipolar II disorders lie in the severity of the manic episodes
caused by each type.

• A person with bipolar I will experience a full manic episode, while a person with bipolar II will
experience periods of hypomania, but the symptoms are below the threshold for full-blown
mania.
• Person experiences episodes of mania and periods of depression. Even if the periods of
depression do not reach the threshold for a major depressive episode, the diagnosis of bipolar I
disorder is still given. Whereas in bipolar II disorder, the person experiences periods of depressed
mood that meet the criteria for major depression.

Prevalence, age of onset and gender differences, the 12-month prevalence estimate in the continental
United States was 0.6% for bipolar I disorder as defined in DSM-IV. Twelve-month prevalence of bipolar
I disorder across 11 countries ranged from 0.0% to 0.6%. The 12-month prevalence of bipolar II disorder,
internationally, is 0.3%. In the United States, 12-month prevalence is 0.8%. The prevalence rate of
pediatric bipolar II disorder is difficult to establish. Bipolar II are more common than bipolar I disorder.
The bipolar disorder occurs equally in male and females, which usually starts in adolescent and young
adulthood, for which the average age is18-22 years. The bipolar II disorder has an average age of onset
approximately 5 years later than bipolar I.

Symptoms, inflated self-esteem or grandiosity, decreased need for sleep, increased talkativeness, racing
thoughts, distracted easily, increase in goal-directed activity or psychomotor agitation, engaging in
activities that hold the potential for painful consequences, e.g., unrestrained buying sprees, depressed
mood most of the day or nearly every day, loss of interest or pleasure in all or almost all activities,
significant weight loss or decrease or increase in appetite, engaging in purposeless movements; such as
pacing the room, fatigue or loss of energy, feelings of worthlessness or guilt, diminished ability to think
or concentrate or indecisiveness, recurrent thoughts of death, recurrent suicidal ideation without a specific
plan, or a suicide attempt.

DSM-V Diagnostic Criteria for Bipolar I Disorder

Manic Episode

A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally
and persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the
day, nearly every day (or any duration if hospitalization is necessary).

B. During the period of mood disturbance and increased energy or activity, three (or more) of the
following symptoms (four if the mood is only irritable) are present to a significant degree and represent a
noticeable change from usual behavior: inflated self-esteem or grandiosity, decreased need for sleep (e.g.,
feels rested after only 3 hours of sleep), more talkative than usual or pressure to keep talking, flight of
ideas or subjective experience that thoughts are racing, distractibility (i.e., attention too easily drawn to
unimportant or irrelevant external stimuli) as reported or observed, increase in goal-directed activity
(either socially, at work or school, or sexually) or psychomotor agitation (i.e., purposeless non-goal-
directed activity), excessive involvement in activities that have a high potential for painful consequences
(e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).

C. The mood disturbance is sufficiently severe to cause marked impairment in social or occupational
functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic
features.

D. The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a
medication, other treatment) or to another medical condition.

Hypomanic Episode

A. A distinct period of abnormally and persistently elevated, expansive, irritable mood and abnormally
and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the
day, nearly every day.

B. During the period of mood disturbance and increased energy and activity, three (or more) of the
following symptoms (four if the mood is only irritable) have persisted, represent a noticeable change from
usual behavior, and have been present to a significant degree: similar to the manic episode.

C. The episode is associated with an unequivocal change in functioning that is uncharac-teristic of the
individual when not symptomatic.

D. The disturbance in mood and the change in functioning are observable by others.

E. The episode is not severe enough to cause marked impairment in social or occupational functioning or
to necessitate hospitalization. If there are psychotic features, the episode is, by definition, manic.

F. The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a
medication, other treatment)
Major Depressive Episode

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 one of the symptoms is either (1) depressed mood
or (2) loss of interest or pleasure: depressed mood most of the day, nearly every day, as indicated by
either subjective report (e.g., feels sad, empty, or hopeless) or observation made by others (e.g., appears
tearful); markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly
every day (as indicated by either subjective account or observation); significant weight loss when not
dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or
increase in appetite nearly every day; insomnia or hypersomnia nearly every day; psychomotor agitation
or retardation nearly every day (observable by others; not merely subjective feelings of restlessness or
being slowed down); fatigue or loss of energy nearly every day; feelings of worthlessness or excessive or
inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about
being sick); diminished ability to think or concentrate, or indecisiveness, nearly every day (either by
subjective account or as observed by others); recurrent thoughts of death (not just fear of dying), recurrent
suicidal ideation with-out a specific plan, or a suicide attempt or a specific plan for committing suicide.

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.

For Bipolar I Disorder, the criteria have been met for at least one manic episode (Criteria A-D, under
manic episode), and the occurrence of the manic and major depressive episode(s) is not better explained
by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional dis- order, or other
specified or unspecified schizophrenia spectrum and other psychotic disorder.

DSM-V Diagnostic Criteria for Bipolar II Disorder

Hypomanic Episode

A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally
and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the
day, nearly every day.

B. During the period of mood disturbance and increased energy and activity, three (or more) of the
following symptoms have persisted (four if the mood is only irritable), represent a noticeable change from
usual behavior, and have been present to a significant degree: similar to the manic/hypomanic episode in
Bipolar I Disorder.

C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the
individual when not symptomatic.

D. The disturbance in mood and the change in functioning are observable by others.

E. The episode is not severe enough to cause marked impairment in social or occupational functioning or
to necessitate hospitalization. If there are psychotic features, the episode is, by definition, manic.
F. The episode isn’t attributable to the physiological effects of a substance (e.g., a drug of abuse, a
medication or other treatment).

Major Depressive Episode

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 one of the symptoms is either (1 ) depressed mood
or (2) loss of interest or pleasure: depressed mood most of the day, nearly every day, as indicated by
either subjective report (e.g., feels sad, empty, or hopeless) or observation made by others (e.g., appears
tearful); markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly
every day (as indicated by either subjective account or observation); significant weight loss when not
dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or
increase in appetite nearly every day; insomnia or hypersomnia nearly every day; psychomotor agitation
or retardation nearly every day (observable by others; not merely subjective feelings of restlessness or
being slowed down); fatigue or loss of energy nearly every day; feelings of worthlessness or excessive or
inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about
being sick); diminished ability to think or concentrate, or indecisiveness, nearly every day (either by
subjective account or as observed by others); recurrent thoughts of death (not just fear of dying), recurrent
suicidal ideation with- out a specific plan, a suicide attempt, or a specific plan for committing suicide.

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.

The criteria have been met for at least one hypomanic episode (Criteria A-F, under the hypomanic
episode) and at least one major depressive episode (Criteria A-C under the major depressive episode).
There’s no manic episode. The occurrence of the hypomanic episode(s) and major depressive episode(s)
is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional
disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder. The
symptoms of depression or the unpredictability caused by frequent alternation between periods of
depression and hypomania causes clinically significant distress or impairment in social, occupational, or
other important areas of functioning.

Causal factors

A host of causal factors for bipolar disorder have been posited during the past century. However,
biological causal factors are clearly dominant, and the role of psychological causal factors has received
significantly less attention.

I. Biological causal factors, a number of biological factors are thought to play a causal role in
the onset of bipolar disorder. These factors include genetic, neurochemical, hormonal,
neurophysiological, neuroanatomical, and biological rhythm influences.
• Genetic influences, there is a greater genetic contribution to bipolar I disorder than
to unipolar disorder. Approximately 8 to 10 percent of the first-degree relatives of a
person with bipolar I illness can be expected to have bipolar disorder, compared to 1
percent in the general population.
 • Neurochemical factors, the early monoamine hypothesis for unipolar disorder was
extended to bipolar disorder, the hypothesis being that if depression is caused by
deficiencies of norepinephrine or serotonin, then perhaps mania is caused by excesses
of these neurotransmitters. Thus, disturbances in the balance of these
neurotransmitters seem to be one of the keys to understanding this debilitating illness.
• Abnormalities of hormonal regulatory systems, some neurological-hormonal
research on bipolar disorder has focused on the HPA axis. Cortisol levels are elevated
in bipolar depression (as they are in unipolar depression), but they are usually not
elevated during manic episodes.
• Neurophysiological and neuroanatomical influences, with PET scans, it is possible
to visualize variations in brain glucose metabolic rates in depressed and manic states,
although there is far less evidence regarding manic states because of the great
difficulties studying patients who are actively manic. Several summaries of the
evidence from studies using PET and other neuroimaging techniques show that,
whereas blood flow to the left prefrontal cortex is reduced during depression, during
mania it is increased in certain other parts of the prefrontal cortex. Thus, there are
shifting patterns of brain activity during mania and during depressed and normal
moods.
• Sleep and other biological rhythms, there is considerable evidence regarding
disturbances in biological rhythms such as circadian rhythms in bipolar disorder,
even after symptoms have mostly remitted. During manic episodes, patients with
bipolar disorder tend to sleep very little (seemingly by choice, not because of
insomnia), and this is the most common symptom to occur prior to the onset of a
manic episode. During depressive episodes, they tend toward hypersomnia (too much
sleep). Even between episodes people with bipolar disorder show substantial sleep
difficulties, including high rates of insomnia.
II. Psychological causal factors, although biological factors play a prominent role in the onset
of bipolar disorder, psychosocial factors have also been found to be involved in the etiology
of the disorder. In particular, stressful life events, poor social support, and certain personality
traits and cognitive styles have been.
• Stressful life events, stressful life events appear to be as important in precipitating
bipolar depressive episodes as they are in triggering unipolar depressive episodes.
Both stressful life events during childhood (e.g., physical and sexual abuse) and
recent life stressors during adulthood (e.g., problems with friends. and partners,
financial hardship) increase the likelihood of ever developing bipolar disorder as well
as having recurrences.
• Other psychological factors in bipolar disorder, other social environmental
variables may also affect the course of bipolar disorder. For example, one study
found that people with bipolar disorder who reported low social support showed
more depressive recurrences over a 1-year follow-up, independent of the effects of
stressful life events, which also predicted more recurrences.
III. Sociocultural factors, research on the association of sociocultural factors with both unipolar
and bipolar mood disorders is discussed together because much of the research conducted in
this area has not made clear-cut diagnostic distinctions between the two types of disorders.
 Cross-Cultural Differences in Depressive Symptoms, depression occurs in all cultures that
have been studied. However, the form that it takes differs widely, as does its prevalence. For
example, in Western cultures the "psychological" symptoms of depression (e.g., guilt,
worthlessness, and suicidal ideation) are prominent, whereas they are not prominently
reported in non-Western cultures such as China and Japan, where rates of depression are
relatively low. Cross-Cultural Differences in Prevalence: prevalence rates for mood disorders
vary a great deal across countries, as revealed by large-scale epidemiological studies. For
example, the WHO World Mental Health Survey, which assesses the prevalence and
characteristics of psychological disorders across more than 20 countries, reveals that the 12-
month prevalence of mood disorders varies from 0.8 percent in Nigeria to 9.6 percent in the
United States.

Treatments

Pharmacotherapy: Antidepressant, mood-stabilizing, and antipsychotic drugs are all used in the treatment
of unipolar and bipolar disorders. Antidepressant drugs usually require at least 3 to 5 weeks to take effect.
Generally, if there are no signs of improvement after about 6 weeks, physicians try a new medication
because about 50 percent of those who do not respond to the first drug prescribed do respond to a second
one.

Alternative Biological Treatments: In addition to the use of pharmacotherapy, there are several other
biologically oriented approaches to the treatment of mood disorders. These approaches have been the
subject of empirical study in recent years, and they appear to be promising treatment options. It includes,
electroconvulsive therapy, trans-cranial magnetic stimulation, deep brain stimulation and bright light
therapy.

Psychotherapy: Several forms of specialized psychotherapy, developed since the 1970s, have proved
effective in the treatment of unipolar depression, and the magnitude of improvement of the best of these is
approximately equivalent to that observed with medications. The major psychotherapies are cognitive-
behavioral therapy (CBT) (also known as cognitive therapy), behavioral activation treatment,
interpersonal therapy (IPT) and family and marital therapy. It includes electroconvulsive therapy, trans-
cranial magnetic stimulation, deep brain stimulation and bright light therapy. Even without formal
therapy, the great majority of patients with mania and depression recover from a given episode in less
than a year.

PERSISTENT DEPRESSIVE DISORDER (DYSTHYMIA)

Persistent depressive disorder (dysthymia) is defined as depressed mood that continues at least 2 years,
during which the patient cannot be symptom free for more than 2 months at a time even though they may
not experience all of the symptoms of a major depressive episode. A person with persistent depressive
disorder (previously referred to as dysthymic disorder) has a depressed mood for most of the day, for
more days than not, for at least two years. The individuals who suffer from both major depressive
episodes and persistent depression with fewer symptoms are said to have double depression.
Prevalence, age of onset and gender differences, it is effectively an amalgam of DSM-IV dysthymic
disorder and chronic major depressive episode. The 12-month prevalence in the United States is
approximately 0.5% for persistent depressive disorder and 1.5% for chronic major depressive disorder.
The lifetime prevalence is 4%. The gender difference is that it is much higher in females, and the age of
onset is often childhood or adolescence.

DSM-V Diagnostic Criteria

A. Depressed mood for most of the day, for more days than not, as indicated by either subjective account
or observation by others, for at least 2 years.

B. Presence, while depressed, of two (or more) of the following: poor appetite or overeating; insomnia or
hypersomnia; low energy or fatigue; low self-esteem; poor concentration or difficulty making decisions;
and the feelings of hopelessness.

C. During the 2-year period (1 year for children or adolescents) of the disturbance, the individual has
never been without the symptoms in Criteria A and B for more than 2 months at a time.

D. Criteria for a major depressive disorder may be continuously present for 2 years.

E. There has never been a manic episode or a hypomanic episode, and criteria have never been met for
cyclothymic disorder.

F. The disturbance is not better explained by a persistent schizoaffective disorder, schizophrenia,

delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic
disorder.

G. The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a
medication) or another medical condition (e.g., hypothyroidism).

H. The symptoms cause clinically significant distress or impairment in social, occupational, or other
important areas of functioning.

Causal factors

I. Biological dimension, the genetic factor implies that the depressive disorder is often found
among same family. The low level of neurotransmitters such as serotonin, nor-epinephrine
and dopamine are associated with dysthymia. The irregularity in neurotransmitter produces
physiological symptoms. The over activity of HPA axis and overproduction of stress related
hormone (cortisol) also causes the development of dysthymia.
The functional and anatomical brain changes, people with depression have decreased
brain activity and other brain changes. It is also associated with the reduced plasticity and
reduced neurogenesis in hippocampus in synapse within center.
Circadian rhythm, the role in physiological disturbance is associated with depression
particularly seasonal depression.
II. Psychological dimension, the behavioral depression occurs when people receive insufficient
social reinforcement (social recognition, affection etc.). The loss of job, divorce, death etc.
can reduce the reinforcement. Stressful circumstances can produce dysthymia. The
 depressions tend to have a negative way of looking at themselves. For example, if people
aren’t talking to them, they think that people dislike them. Negative thinking effects their
emotion.
Learned helplessness and attributional style, they make erroneous assumptions about their
experiences. Self-criticism is associated with depression. They believe in depressive
symptoms.
III. Social dimension, lack of social support or resource could lead to depression. Distressing
social interaction is linked with depression. Early life neglect, maltreatment, parental loss etc.
are linked with the depression symptoms.
IV. Sociocultural dimension, the cultural influence implicates the discrimination based on race,
gender, and ethnicity, which are associated with depression. Gender, depression is more
common among women. Early physical maturation in girls, early traumatic experience such
as death, divorce, abuse etc. also increases the risk of depression.

Treatments

The biological treatment includes the medication, circadian related treatment, and brain stimulation
therapies. The psychological and behavioral treatment includes the behavioral activation therapy,
interpersonal psychotherapy, cognitive-behavioral therapy, and mindfulness-based cognitive therapy.

PRE-MENSTRUAL DYSPHORIC DISORDER (PMDD)

Pre-Menstrual Dysphoric Disorder (PMDD) is a controversial diagnostic category involving serious

distressing and disruption symptoms of depression, irritability, and tension that appear the week before
menstruation and disappear soon after menstruation begins. After years of study, PMDD was added to the
depressive disorder category in DSM-5. A combination of physical symptoms, severe mood swings and
anxiety are associated with incapacitation during the period of time - considered as mood disorder.
Diagnostic category assists the suffering women to receive treatment.

Prevalence, age of onset, and gender differences, twelve-month prevalence of PMDD is between 1.8%
and 5.8% of menstruating women. 1.8% for women whose symptoms meet the full criteria without
functional impairment and 1.3% for women whose symptoms meet the current criteria with functional
impairment and without co-occurring symptoms from another mental disorder. PMDD can arise at any
time during a woman's reproductive years although the average age of onset is 26 years. The onset of
PMDD may begin at any time after a woman's first period, although many individuals report a worsening
of symptoms as they approach menopause. After menopause and during pregnancy, symptoms do not
occur, though women with PMDD have a high risk of experiencing postpartum depression following the
birth of a child. Many individuals, as they approach menopause, report that symptoms worsen. Symptoms
cease after menopause, although cyclical hormone replacement can trigger the re-expression of
symptoms.

Risk and Prognostic Factors, the risk and prognostic factors included are;
 • Environmental factors, associated with the expression of PMDD include stress, history of
interpersonal trauma, seasonal changes, and sociocultural aspects of female sexual behavior in
general, and female gender role in particular.
• Genetic and physiological, heritability of PMDD is unknown. However, for PMS, estimates for
heritability range between 30% and 80%, with the most stable component of PMS estimated to be
about 50% heritable.
• Course modifiers, women who use oral contraceptives may have fewer premenstrual complaints
than do women who do not use oral contraceptives.

DSM-V Diagnostic Criteria

A. In the majority of menstrual cycles, at least five symptoms must be present in the final week before the
onset of menses, start to improve within a few days after the onset of menses, and become minimal or
absent in the week post-menses.

B. One (or more) of the following symptoms must be present: marked affective liability (e.g., mood
swings: feeling suddenly sad or tearful, or in- creased sensitivity to rejection); marked irritability or anger
or increased interpersonal conflicts; marked depressed mood, feelings of hopelessness, or self-deprecating
thoughts; and marked anxiety, tension, and/or feelings of being keyed up or on edge.

C. One (or more) of the following symptoms must additionally be present, to reach a total of five
symptoms when combined with symptoms from Criterion B above: decreased interest in usual activities
(e.g., work, school, friends, hobbies); subjective difficulty in concentration; lethargy, easy fatigability, or
marked lack of energy; marked change in appetite; overeating; or specific food cravings; hypersomnia or
insomnia; a sense of being overwhelmed or out of control; physical symptoms such as breast tenderness
or swelling, joint or muscle pain, a sensation of “bloating,” or weight gain.

D. The symptoms are associated with clinically significant distress or interference with work, school,
usual social activities, or relationships with others (e.g., avoidance of social activities; decreased
productivity and efficiency at work, school, or home).

E. The disturbance is not merely an exacerbation of the symptoms of another disorder, such as major
depressive disorder, panic disorder, persistent depressive disorder (dysthymia), or a personality disorder
(although it may co-occur with any of these disorders).

F. Criterion A should be confirmed by prospective daily ratings during at least two symptomatic cycles.

G. The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a
medication, other treatment) or another medical condition (e.g., hyperthyroidism).

Etiology, potential biological contributors include central nervous system (CNS) sensitivity to
reproductive hormones, genetic factors, and psychosocial factors such as stress. The timing of symptom
onset and offset in PMDD suggests that hormonal fluctuation is a key component in PMDD's
pathogenesis. Recent research suggests that women with PMDD have altered sensitivity to normal
hormonal fluctuations, particularly estrogen and progesterone, neuroactive steroids that influence CNS
function.
The exact cause of PMDD isn’t known. It may be an abnormal reaction to the normal hormonal change
that happen with each menstrual cycle.

Treatments

The medications include; antidepressants, anxiolytics, SSRIs etc. Psychotherapy and cognitive behavioral
therapy are other therapeutic treatments. There is hormonal treatment, intermittent dosing, symptom onset
therapy, birth control pills, and also surgical removal of ovaries. The alternative non-medical treatments
including yoga, aerobic exercise, or dietary supplementation are also used to treat PMDD.

CYCLOTHYMIA DISORDER

Cyclothymic disorder or cyclothymia is a rare mood disorder. It causes emotional up's and down's but not
as extreme as those in bipolar I and bipolar II disorder. The essential features of cyclothymia are the
disorder is a chronic, fluctuating mood disturbance involving numerous periods of hypomanic symptoms
and depressive symptoms. The hypomanic symptoms are insufficient numbers, severity, pervasiveness or
duration to meet full criteria for hypomanic episode. Depressive symptoms are insufficient numbers,
severity, pervasiveness or duration to meet full criteria for a major depressive episode. Or, is a mood
disorder characterized by people of hypomanic symptoms and periods of depressive symptoms that occur
even the course of at least 2 years. The number, duration, severity of symptoms doesn’t meet the full
criteria for major depressive episode or hypomanic episode. It is often considered to be mild disorder. It
lacks certain extreme symptoms and psychotic features such as delusion and marked impairment caused
by the major depressive episode. In depressed phase of cyclothymic disorder, the person’s mood is
dejected, loss of pleasure, in addition, other symptoms such as low energy, feelings of inadequacy, and
social withdrawal. The symptoms are similar to dysthymia without any duration criteria. The symptoms
of hypomanic phase of the cyclothymic are essentially the opposite of symptoms of dysthymia, such as
the person becomes creative and productive because of increased physical and mental energy. For
diagnosis of cyclothymic, there must be at least 2 years during when there are numerous periods with
hypomanic and depressed symptoms. The symptoms may cause clinically significant distress or
impairment in functioning because the individual with cyclothymic are at great at risk of later developing
the full blown bipolar I And bipolar II disorder.

Prevalence, age of onset, and gender differences, the lifetime prevalence of cyclothymic disorder is
approximately 0.4%-l%. Youth with cyclothymic disorder also reported an early age of symptom onset.
Three-quarters had symptom onset before they were aged 10 years, and the average age of onset for youth
with cyclothymic disorder was 6 years. Cyclothymic disorder is apparently equally common in males and
females. In clinical settings, females with cyclothymic disorder may be more likely to present for
treatment than males.

Development and course, it is equally common in males and females, and usually begins in adolescence
or early adulthood. The cyclothymia has an insidious onset and persistent course. There’s 15 - 50 % risk
that an individual with cyclothymia will subsequently develop bipolar I and bipolar II.

Risk and prognostic factors, the major depressive disorder, bipolar I and bipolar II are more common
among first degree biological relatives of individuals with cyclothymia than in general population. The
cyclothymia may be more common in first degree biological relatives with bipolar I disorder than in
general. The substance related disorders and sleep disorders may be present in individuals with
cyclothymia. Most children with cyclothymia are treated for more than one mental condition.

Symptoms, the signs and symptoms of the highs of cyclothymia may include: an exaggerated feeling of
happiness or well-being (euphoria); extreme optimism; inflated self-esteem; talking more than usual; poor
judgment that can result in risky behavior or unwise choices; racing thoughts; irritable or agitated
behavior; excessive physical activity; increased drive to perform or achieve goals (sexual, work related or
social); decreased need for sleep; tendency to be easily distracted; and inability to concentrate. The signs
and symptoms of the lows of cyclothymia may include: feeling sad, hopeless or empty; tearfulness;
irritability, especially in children and teenagers; loss of interest in activities once considered enjoyable;
changes in weight; feelings of worthlessness or guilt; sleep problems; restlessness; fatigue or feeling
slowed down; problems concentrating; and thinking of death or suicide.

DSM-V Diagnostic Criteria

A. For at least 2 years (at least 1 year in children and adolescents) there have been numerous periods with
hypomanic symptoms that do not meet criteria for a hypomanic episode and numerous periods with
depressive symptoms that do not meet criteria for a major depressive episode.

B. During the above 2-year period (1 year in children and adolescents), the hypomanic and depressive
periods have been present for at least half the time and the individual has not been without the symptoms
for more than 2 months at a time.

C. Criteria for a major depressive, manic, or hypomanic episode have never been met.

D. The symptoms in Criterion A are not better explained by schizoaffective disorder, schizophrenia,
schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum
and other psychotic disorder.

E. The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a
medication) or another medical condition (e.g., hyperthyroidism).

F. The symptoms cause clinically significant distress or impairment in social, occupational, or other
important areas of functioning.

Treatments

Treatments usually involve counseling and therapy. In rare cases, medications may be used. Therapies
include:

• Psychotherapy, a broad category of talk therapies that helps to overcome psychological

conditions.
• Cognitive behavioral therapy, talk therapy focused on modifying negative thoughts, behaviors
and emotional responses associated with psychological conditions.
• Family therapy, psychological counseling that helps families to resolve conflicts and
communicate more effectively
SUBSTANCE INDUCED AFFECTIVE DISORDER

Substance-induced mood disorder is a kind of depression that is caused by using alcohol, drugs or
medications. Substance/Medication-induced depressive disorder is diagnosed when a substance (alcohol,
illicit drugs, or prescribed medication) causes depressive symptoms while an individual is using the
substance or during a withdrawal syndrome associated with the substance. Substance/medication-induced
depressive disorder is characterized by a prominent and persistent change in mood, exhibiting clear signs
of depression or a marked decrease in interest or pleasure in daily activities and hobbies, and these
symptoms start during or soon after a certain substance/medication has been taken, or during withdrawal
from the substance/medication.

The higher risk medications/substances implicated in medication-induced depressive disorder, with

varying degrees of evidence, include: antiviral agents (efavirenz); cardiovascular agents (guanethidine,
clonidine); retinoic acid derivatives (isotretinoin), which has a warning by FDA for risk for suicide;
antidepressants, there is known risk for the use of antidepressants in youth aged 18-24 years, and the
increased risk for suicidal behaviors or ideation; and hormonal agents (corticosteroids, oral
contraceptives), have high estrogen/progesterone content in oral contraceptive is a particular risk factor
for depressive symptoms.

Substance/medication-induced depressive disorder is caused directly by a specific substance/medication

that is taken or during withdrawal from the substance/medication. There are a number of substances and
medications that could cause this, including: Alcohol, Phencyclidine, hallucinogens, inhalants, opioids,
and amphetamines. Some medications can cause depressive mood symptoms, such as, antibiotics,
particular steroids, stimulants, etc. Clinical judgment is used to assess whether the medication is
associated with inducing the depressive disorder or whether the primary depressive disorder would have
happened to have its onset while the person was receiving the treatment regardless.

Prevalence, age of onset, and gender differences, the lifetime prevalence of substance/medication-
induced depressive disorder is 0.26%. The age of onset is often in adolescence. The gender difference is
much higher in males than in females.

Symptoms, the symptoms of the depressive disorder must also be severe enough to cause impairment in
the day-to-day functionality of the individual. Withdrawal times for various substances from the body
vary, and so the depressive symptoms may continue for some time after the individual has ceased taking
the substance/medication. Common symptoms are: constantly feeling sad, hopeless or empty; constantly
feeling irritated or agitated; excessive weight gain or loss during a short period of time; sleeping too much
or too little; low energy levels or fatigue; low self-esteem; poor levels of concentration; decreased sex
drive; and increased thoughts of death and dying, including suicidal thoughts and behavior. The above
symptoms must all have manifested during or after a specific substance/medication was taken or during
withdrawal. Some symptoms are associated with the ingestion, injection, or inhalation of a substance, and
depressive symptoms persist beyond the expected length of physiological effects, intoxication or
withdrawal period.
DSM-V Diagnostic Criteria

A. A prominent and persistent disturbance in mood that predominates in the clinical picture and is
characterized by elevated, expansive, or irritable mood, with or without depressed mood, or markedly
diminished interest or pleasure in all, or almost all, activities.

B. There is evidence from the history, physical examination, or laboratory findings of both (1) and (2): the
symptoms in Criterion A developed during or soon after substance intoxication or withdrawal or after
exposure to a medication; and the involved substance/medication is capable of producing the symptoms in
Criterion A.

C. The disturbance isn’t better explained by a bipolar or related disorder that isn’t substance/medication-
induced. Such evidence of an independent bipolar or related disorder could include the following: the
symptoms precede the onset of the substance/medication use; the symptoms persist for a substantial
period of time (e.g., about 1 month) after the cessation of acute withdrawal or severe intoxication; or there
is other evidence suggesting the existence of an independent non-substance/medication-induced bipolar
and related disorder (e.g., a history of recurrent non-substance/medication-related episodes).

D. The disturbance does not occur exclusively during the course of a delirium.

E. The disturbance causes clinically significant distress or impairment in social, occupational, or other
important areas of functioning.

Differential Diagnosis, the differential diagnoses are;

• Substance intoxication and withdrawal, depressive symptoms are common in substance

intoxication and withdrawal, and the diagnosis of the substance specific intoxication or
withdrawal is usually enough to categorize the symptom presentation.
• Primary depressive disorder, a substance/medication-induced depressive disorder is distinguished
from a primary depressive disorder by the fact that a substance is judged to be etiologically
related to the symptoms.
• Depressive disorder due to another medical condition, because individuals with other medical
conditions often take medications for those conditions, the clinician must consider the possibility
that the mood d symptoms are caused by the physiological consequences of the medical condition
rather than the medication.

Once the substance or medication is discontinued, the depressive symptoms usually resolve within days to
several weeks, depending on the half-life and withdrawal syndrome. If symptoms persist 4 weeks beyond
the expected time course of withdrawal of a particular substance/medication, other causes for the
depressive symptoms should be explored.

Treatments

Treating substance-induced mood disorder requires a multi-faceted approach. For many people with
substance-induced mood disorder, combining psychotherapy and drug counseling has been more effective
than just one or the other. Cognitive-behavioral therapy (CBT) and motivational interviewing, or
Motivational Enhancement Therapy (MET), are both prudent treatment options for this condition.