Why Separating Mood Disorders Into Categories is Pointless

If you work in psychiatry long enough then you will know exactly what I’m talking about here in this video. I see patients every day who do not fit neatly into the DSM-5 diagnostic categories of major depression or bipolar disorder. Some data suggest that 50% of people with major depression have 1 to 3 manic symptom present during depressive epsiodes. You are left to decide just how bipolar the patient is sitting across from you which is no simple task. This makes medication mangement decisions such as should we start lamotrigine, low dose lithium or dopamine blocking medication versus starting one of the SSRIs very difficult. The goal of todays discussion is to offer a dimensional approach to diagnosis, a so called mood spectrum that could eliminate the need to separate people into individual categories.
Time stamps
Introduction: 00:00 to 02:21
The mood spectrum: 02:22 to 03:45
DSM-5 missed the mark on mixed depression: 03:46 to 05:57
The Mood Spectrum explained: 05:58 to 09:26
Final thoughts on the mood spectrum: 09:27 to 11:55
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Disclaimer: This is not medical advice, and the information is provided for educational purposes only. Please consult your doctor for any specific medical questions. All content is created for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider. If you think you have a medical emergency, call your doctor, go to the emergency department, or call 911. We do not endorse any specific treatment, tests, or procedures. Reliance on this information is solely at your own risk.

[@butterboy5621]

Dang! You're up to almost 10,000 subscribers already? Last time I looked you only had a few hundred!

[@ShrinksInSneakers]

spread the word, every little bit counts. I appreciate the support

[@butterboy5621]

@@ShrinksInSneakers I'm a PMHNP. I tell colleagues about you all the time.

[@benzapp1]

This was really interesting and compelling.

[@catwww]

Great explanation! Ive heard about this idea from others like Tracy Marks (also on KZbin) but his is very well explained and this approach has been true in my own treatment.

[@ShrinksInSneakers]

Thank you for being a part of the community, my thinking is always evolving and many of these things discussed here are related to my direct interaction and treatment of real life patients. This is what I see and I want to share it. Hope it helped

[@t2000kw]

Your videos on California rocket fuel made my life bearable finally!!! It worked great for me, but not my wife, though my wife wasn't tried on the same dose of mirtazapine, so she might be trying that in time. She just got a genetic test of some sort to help the doctor figure out which medications may work for her since so many haven't. >>> How about a video on zuranolone soon? It appears about to be FDA approved soon?

[@ShrinksInSneakers]

It's out today 😁

[@t2000kw]

@@ShrinksInSneakers Thanks. I'm watching it now. Do you care to comment on adding Dexedrine to California rocket fuel to boost dopamine? My mental health care NP is letting me try it after adding Wellbutrin to do the same thing didn't work well at all. The Wellbutrin made me a bit crabby, like I was before I started taking the mirtazapine-venlafaxine combination. The Dex seems to be helping both with depression and motivation. Is Dex used much for depression, anxiety, etc.? Thanks for the new video, too!

[@ShrinksInSneakers]

@@t2000kw I have not used all these medications in combination and I'm not aware of a strong evidence base in the literature for it. There are cases where a stimulant can be added to an antidepressant treatment regimen, but that usually comes after a lot of other stuff has been tried.

[@user-ly2lv9nl5l]

What I want to say is that many mental patients have problems adjusting to the real world. I think better helping patients adjust to the real world can reduce their symptoms. Currently, I have decided to go to a so-called psychiatric day ward where I can adjust to a social life. In the future, I will be able to adapt step by step to this real society that I can hardly adapt to. Just the thought of doing this has reduced my symptoms a lot and I don't have as many emotional problems anymore. Perhaps the core problem of many mental patients is to adapt to reality! This is the so-called psychosocial factor in psychiatry!

[@NatureHeadSupreme]

Unresolved, generational trauma is more than likely "the cause".

[@ShrinksInSneakers]

I agree more focus should be placed on supervised work environments, social skills training, and other interventions to address the problems of life many people with serious mental illness face. This is more of a Societal issue where I as a physician addressing the symptoms of mental illness do not see the necessary investment of money and resources into programs like those mentioned above. Until we start valuing these interventions we are unlikely to see much change in a practical sense

[@thebeatles9]

it sounds like teh DSM can be useful but really it comes down to clinical experience. Is the DSM really even useful then aside from a learning aid for new clinicians?

[@user-ly2lv9nl5l]

I think psychiatry today does not do enough research on the social and psychological aspects, and most of it is on the biological aspects.

[@benzapp1]

A costly venture

[@user-ly2lv9nl5l]

I think you can talk about the clubhouse model.

[@Tatiana-zu1gf]

Is this possible to book an appointment with you ? (online - I live in MD)

[@user-ly2lv9nl5l]

I think I'm in what this topic calls an "in-between state". It's hard for me to be categorized under either diagnosis. Includes schizophrenia, bipolar disorder, and depression. The current doctor's diagnosis for me is mixed episode of bipolar disorder, and others include autism. Everyone is unique, and there is really no way to apply it to the diagnosis. The drug I am currently taking is Latuda, and I think I need more psychotherapy. I know that my problem is in the psychosocial aspect.

[@ShrinksInSneakers]

Personalization of treatment is very important and many people do not meet the criteria of any one specific DSM diagnosis yet still have symptoms and need help. We have to determine thing like how bipolar is the person sitting across from me and make treatment decisions based on the diagnosis that is most fitting

[@miguelsalabert7824]

Could you tell me about your view on agomelatine/Valdoxan. It was prescribed to me for depression and anxiety. Does it work?

[@ShrinksInSneakers]

This is an atypical antidepressant that stimulates melatonin receptors and blocks some serotonin receptors to improve mood and anxiety symptoms. I do not use it in my practice, but I did read the Coharane review on it which found it to be no more effective than other antidepressants. It did however have a lower risk of sexual side effects which is very important. Hope this helps

[@miguelsalabert7824]

Thank you very much, doctor! I'm from Brazil and your teachings have been of great value. All my treatment has been based on the information in your videos, I take them to my psychiatrist and we discuss the best option. God bless you!

[@grannyg8155]

What is your opinion on "Mixed anxiety and depressive disorder" and were does it fall on the depression spectrum..Also is depression caused By OCD a true clinical depression or is it more a low mood state caused by constant intrusive thoughts? If possible could you do a video explaining these two questions..many Thanks

[@ShrinksInSneakers]

High levels of anxiety and depressive symptoms that are moderate fall into the neurotic depression category. The difficult part is answering the question is the depression causing the anxiety. In my opinion you need to have a higher archery of diagnosis. I would start with treating depression to remission and then seeing if the anxiety persists. With OCD the same situation can be applied treat the OCD to remission and see if the depressive symptoms resolve. Many of the OCD medication treatments are the same as depression treatments so there will be a lot of overlap. The type of psychotherapy will be different in the case of OCD exposure and response prevention. Hope this helps

[@grannyg8155]

@@ShrinksInSneakers Thanks for your thought out reply..Ive been diagnosed with OCD and various depression labels...Reccurent/Mixed etc I think i probably fall on the neurotic depression although i have been tipped into major depression in the past..My last "Severe" episode was some years back and was very "Mixed"lack of sleep,Early waking,no appitite,agitated,angry suicidal etc but also i developed almost delusional /paranoid ideas...Ive been perscribed anti psychotic treatment in the past but always worried over side effects..I,m currently on antidepressants(10 years) and find i still have Symptoms (OCD ones mainly) Does what i described above respond well to antipsychotics ?? Thanks Again

[@reddbendd]

For OCD with derealization I recommend TCA or TeCA antidepressants. OCD alone can go away by itself

[@BigDaddyBostin]

❤😢😅😂😊