Update in the Treatment of Depressive Disorders

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Update in the Treatment of Depressive Disorders

• Renee Lamm MD
• ABPN, ABAM FAPA, FAAFP

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Objectives

• Review the DSM-5 changes to mood disorder
  diagnostic criteria
• Discuss differential diagnosis of depressive
  disorders
• Introduce new pharmacological agents for
  treatment of depressive disorders and strategies
  for their use
• Discuss the use of diagnostic testing in the
  treatment of mood disorders

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DSM- 5 Types of Mood Disorders

• Bipolar and Related Disorders
• Depressive Disorders
• Trauma and Stressor Related Disorders
• Substance Related and Addictive Disorders

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DSM-5 Associated Disorders

• Other disorders that may present with depression
• Schizoaffective Disorder
• Neurocognitive Disorders
• Adjustment Disorders
• Eating Disorders
• Obsessive Compulsive Disorders
• Possible with all disorders due to another
  medical condition

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DSM-5 Sub Types of Depression

• MDD mild, moderate, severe, psychotic features
• Single or recurrent
• THEN with anxious features, mixed features ,
  melancholic features, atypical features,
  catatonia, seasonal features, peripartum onset
• OR unspecified
• OR secondary to another medical condition

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What Percentage of Mood Disorders are Bipolar?
Stahl, S, Essential Psychopharm, Oxford Univ
Press, 2008
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Unipolar or BipolarDepression? What to Ask

• Whos Your Daddy?
• Family history of
• Psychiatric Hospitalizations
• Suicide
• ECT
• Anyone who took lithium, mood stabilizers,
  antipsychotics or antidepressants
• Postpartum mood episode, especially psychosis

• Whos Your Momma?
• Additional history is need from someone close to
  the patient such as a parent, spouse or child
• Patients lack insight to manic symptoms and under
  report them
• Stahl, S., Essential Psychopharmacology,
  Cambridge Univ Press, 2008

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Predictors of Relapse

• Number of past episodes
• Interval between episodes
• Stressful life events
• Medication management and compliance
• Demographic and psychosocial factors
• Clinical comorbidities and axis II disorders
• Substance abuse