Week 1 Topic 2 Part 2

• It is unclear if major depressive episodes are part of a major depressive disorder or bipolar disorder, as the criteria is the same.
• Depending on the definition used, the percentage of people with depression who are bipolar varies:
• Narrow definition (old DSM-IV): 16%
• Slightly broader definition (closer to current DSM-V): 31%
• Very broad definition: Over half
• Bipolarity is likely under-recognized in people with depressive episodes.
• Unrecognized bipolar disorder is overrepresented in the treatment-resistant depressive group.
• A study in Taiwan showed that 26% of difficult-to-treat patients switched to bipolar, compared to 6% to 9% of early treatment responders.
• It is important to look for signs of bipolar disorder in the treatment resistant depressive group.
• Optimized treatment for people recently hospitalized for mania, which includes optimized treatment regimes, British guidelines, and psychoeducational strategies, shows better results than standard care.
• This translates to a 3,100 euro per-head saving in the mood disorder clinic.
• Better treatment of depression is the number one request from patients in recent surveys.
• Patients also want reduced risk of weight gain, prevention of relapse into depression, and improved quality of life.
• Treatment of depression is a great unmet need, especially in bipolar disorder.
• There are many trials of antidepressants for major depressive disorder, but few studies on bipolar depression.
• There is no clear separation for aripiprazole, marginal separation for lamotrigine, and suggestion of separation for lithium.
• Paroxetine did not clearly separate from placebo.
• Most positive data is for quetiapine or olanzapine, and fluoxetine with an SSRI.
• There is a lack of evidence-based trials for treatments in bipolar depression.
• Practical considerations for mood disorder diagnosis and treatment: Recurrent mood disorder, Severity, Major Depressive Episode, Mania or Hypomania, Mixed State, Psychiatric co-morbidity, and physical health.
• Mania is more reliable as a diagnosis than hypomania, as hypomania is often normalized and difficult to find on history.
• 30% of people with mania will have three or more depressive symptoms and the contrary, with manic or hypomanic symptoms being present in depression, is also common.
• Depression and bipolar disorder can cause people to die 15 years earlier due to suicide risk and common physical health problems like ischemic heart disease and diabetes.
• Physical ill health needs to be addressed correctly in people with mood disorders.
• Age of onset may give a clue as to the disorder's nature, with bipolar disorder commonly onsetting slightly younger than depressive disorders.
• Also consider family history, treatment history, and functional and neurocognitive status.
• Treatment should be individualised or personalised with an accurate diagnosis including all co-morbidities.
• Balance efficacy or benefits with adverse effects or harms, which vary for each patient.
• Factors like social support, psychoeducation, and treatment adherence are important.
• The goal is meaningful remission, which means optimal functioning and quality of life.
• Affective or mood disorders are common, complex, and costly.
• The two main forms of mood disorder are MDD (Major Depressive Disorder), also known as unipolar disorder, and bipolar disorders.
• Treatment approaches include psychological treatments, lifestyle changes, neurostimulation, and pharmacotherapy.
• Treatment resistance and poor outcome is an important problem for both types of mood disorder.

Explore bipolar I and II disorders and their diagnosis. Delve into mixed states, reduced life expectancy, and age of onset. Understand individualized treatment approaches and cost savings in mood disorder clinics.