Mood Disorders for the USMLE Step 2 CK

by / Tuesday, 08 June 2010 / Published in Psychiatry


Major Depressive Disorder

Major depressive disorder is characterized by a depressed mood or anhedonia (cannot enjoy things that they once enjoyed), and depressive symptoms lasting at least 2 weeks.

  • Look for other possible causes such as hypothyroidism, drug use/substance use.

The classic mnemonic for depression is SIG E CAPS

S: sleep disturbances (too much or too little)

I: interest changes (loss of interst)

G: guilty feelings

E: energy loss

C: concentration disturbances

A: appetite changes (causes weight changes too)

P: psychomotor changes

S: suicidal thoughs/death

  • If patient is suicidal or dangerous to others always admit



  • 1st line treatment is SSRI such as fluoxetine, paroxetine, sertraline (possible side effect is sexual dysfunction)
  • Can include benzodiazepine if patient is agitated
  • Therapy is also indicated along with SSRI treatment


Dysthymic Disorder

Same symptoms as major depressive disorder except is more low-level in nature, and is present on most days for at least 2 years. 


  • SSRI (similar treatment as Major Depression)


  • Bereavement is commonly seen after death of a family member (most commonly seen in older people after death of a spouse).


  • Key to the diagnosis is the time that has elapsed since the onset of the bereavement period. 
  • Symptoms > 2 months makes the diagnosis major depressive disorder instead of normal bereavement.


  • Therapy (grief management) is recommended in such conditions


Bipolar Disorder

  • A condition with episodes of mania, depression, as well as normal periods.
  • Seen in approximately 1% of the population
  • Affects males = females
  • More common in the younger population
  • A mix of mania, depression, or mixed symptoms for at least 1 week


Signs and Symptoms:

  • Acute onset of increased energy
  • Decreased need to sleep
  • Pressured speech
  • Decreased attention span
  • Hypersexuality
  • Reckless behavior (excessive gambling, shopping, spending money)


Differential diagnosis:

  • Schizophrenia
  • Intoxication (cocaine, amphetamine)
  • Certain personality disorders


  • Episode should last more than 1 week and should be abrupt/cause significant disability
  • Bipolar 1 – a manic episode with or without depressive episode
  • Bipolar 2 – depressive episodes with hypomanic episodes
  • Rapid cycling – > 4 episodes in a one-year period


  • Hospitalization (is often involuntary because patient is manic)
  • Mood stabilizers – Lithium is DOC, can also use valproate or carbamazepine
  • Antipsychotics can be used until acute mania is controlled
  • If recurrent episodes of depression are present, can give antidepressants only in conjunction with mood stabilizers
  • Lithium levels should be checked to prevent toxicity



  • Is a recurrence of depressive episodes and hypomania for at least 2 years
  • Is a milder form of bipolar disorder



  • 1st is psychotherapy because many patients can function without medication
  • If functioning becomes impaired start patient on valproic acid, which is more effective in cyclothymia than lithium


Drug-Induced Mania

  • The most common causes are cocaine and amphetamines


Signs and Symptoms:

  • Findings similar to mania
  • Mydriasis
  • Hypertension
  • MI in young people (highly suggestive of cocaine overdose)


  • For acute symptoms give CCB’s
  • Drug treatment programs for long-term management


Post-partum Depression

  Post-partum blues “Baby blues” Postpartum Depression Postpartum Psychosis
Onset After any birth MC after 2nd birth Usually after 1st birth
Mother’s emotions toward the baby Mother still cares about the baby Thoughts about harming the baby are common Thoughts about harming baby are common
Symptoms Mild Depression Severe Depression Depressive symptoms + psychotic symptoms
Treatment No treatment necessary Antidepressants If patient not breastfeeding give Mood stabilizers OR antipsychotics + antidepressant 

If patient is breastfeeding do ECT

7 Responses to “Mood Disorders for the USMLE Step 2 CK”

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