MOOD DISORDERS

What is a mood disorder?

A mood disorder is a mental health problem that primarily affects a person’s emotional state. It is a disorder in
which a person experiences long periods of extreme happiness, extreme sadness, or both.

It is normal for someone’s mood to change, depending on the situation. However, to be diagnosed with a mood
disorder, symptoms must be present for several weeks or longer. Mood disorders can cause changes in your
behavior and can affect your ability to deal with routine activities, such as work or school.

Two of the most common mood disorders are depression and bipolar disorder. This article will review these
disorders and some of their many subtypes.

DEPRESSION:
Depression is a common mental disorder. Grief or sadness is a typical response to a traumatic life event
or crisis, such as the death of a spouse or family member, loss of a job, or a major illness. However, when
the depression continues to be present even when stressful events are over or there is no apparent
cause, physicians would then classify the depression as clinical or major depression. For a person to be
diagnosed with clinical depression, symptoms must last for at least two weeks.

TYPE OF DEPRESSION:

• Postpartum depression (peripartum depression) - This type of depression occurs during

pregnancy or after delivery
• Persistent depressive disorder (dysthymia) - This is a chronic form of depression that can last
for at least two years. Symptoms may occasionally lessen in severity during this time.
• Seasonal affective disorder (SAD) - This is another type of depression that occurs during
certain seasons of the year. It typically starts in the late autumn or early winter and lasts until
spring or summer. Less commonly, SAD episodes may also begin during the late spring or
summer. Symptoms of winter seasonal affective disorder may resemble those of a major
depression. They tend to disappear or lessen during spring and summer.
• Psychotic depression - This is a type of severe depression combined with psychotic episodes,
such as hallucinations (seeing or hearing things that others do not) or delusions (having fixed
but false beliefs). The episodes may be upsetting or disturbing and often have a theme.
• Depression related to a medical condition, medication, or substance abuse

BIPOLAR DISORDERS: (manic-depressive disorder)

Bipolar disorder is defined by swings in mood from periods of depression to mania. When someone
experiences a low mood, symptoms may resemble those of a clinical depression. Depressive episodes
alternate with manic episodes or mania. During a manic episode, a person may feel elated or can also
feel irritable or have increased levels of activity.

TYPES OF BIPOLAR DISORDER:

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There are four basic types of bipolar disorder.

• Bipolar I - This is the most severe form. Manic episodes last at least seven days or may be severe
enough to require hospitalization. Depressive episodes will also occur, often lasting for at least
two weeks. Sometimes symptoms of both mania and depression are present at the same time.
• Bipolar II disorder - This disorder causes cycles of depression similar to those of bipolar I. A
person with this illness also experiences hypomania, which is a less severe form of mania.
Hypomanic periods are not as intense or disruptive as manic episodes. Someone with bipolar II
disorder is usually able to handle daily responsibilities and does not require hospitalization.
• cyclothymia - This type of bipolar disorder has sometimes been defined as a milder form of
bipolar disorder. People with cyclothymia experience continuous irregular mood swings – from
mild to moderate emotional “highs” to mild to moderate “lows” – for extended periods of time.
In addition, changes in mood can occur quickly and at any time. There are only short periods of
normal mood. For an adult to be diagnosed with cyclothymic, symptoms have to be
experienced for at least 2 years. For children and adolescents, the, symptoms must persist for
at least one year.
• “Other” or “unspecified” bipolar disorder - Symptoms of this type of bipolar disorder do not
meet the criteria for one of the other types but people still have significant, abnormal changes
in mood.

What causes mood disorders?

There may be several underlying factors, depending on the type of the disorder. Various genetic,
biological, environmental, and other factors have been associated with mood disorders.

Risk factors include:

• Family history
• Previous diagnosis of a mood disorder
• Trauma, stress or major life changes in the case of depression
• Physical illness or use of certain medications. Depression has been linked to major diseases
such as cancer, diabetes, Parkinson’s disease and heart disease.
• Brain structure and function in the case of bipolar disorder

What are the symptoms of common mood disorders?

Symptoms depend on the type of mood disorder that is present.

Symptoms of major depression may include:

• Feeling sad most of the time or nearly every day

• Lack of energy or feeling sluggish
• Feeling worthless or hopeless
• Loss of appetite or overeating
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• Gaining weight or losing weight

• Loss of interest in activities that formerly brought enjoyment
• Sleeping too much or not enough
• Frequent thoughts about death or suicide
• Difficulty concentrating or focusing

Symptoms of bipolar disorder may include both depression and mania. Symptoms of hypomanic or
manic episodes include:

• Feeling extremely energized or elated

• Rapid speech or movement
• Agitation, restlessness, or irritability
• Risk-taking behavior, such as spending too much money or driving recklessly
• Unusual increase in activity or trying to do too many things at once
• Racing thoughts
• Insomnia or trouble sleeping
• Feeling jumpy or on edge for no apparent reason

How are mood disorders treated?

Treatment will depend on the specific illness and symptoms that are present. Usually, therapy involves
a combination of medication and psychotherapy (also called “talk therapy”). Therapy sessions may be
conducted by a psychologist, psychiatrist, or other health professional.

Medications to treat depression and/or bipolar disorders

• Antidepressants - Many different medications are available to treat depression and depressive
episodes of bipolar disorder. Some of the most widely used drugs are selective serotonin
reuptake inhibitors (SSRIs). These include citalopram (Celexa®), escitalopram (Lexapro®),
sertraline (Zoloft®), fluoxetine (Prozac®), and paroxetine (Paxil®). Serotonin and norepinephrine
reuptake inhibitors (SNRIs) such as duloxetine (Cymbalta®) and venlafaxine (Effexor®) also are
commonly prescribed and are similar to SSRIs in their action. Bupropion (Wellbutrin®) is used
to treat depression and seasonal affective disorder. It works differently than SSRIs or SNRIs.
Older types of antidepressants include tricylic antidepressants, monoamine oxidase inhibitors,
and tetracyclic antidepressants. Although different types are found to work equally well, some
antidepressants may be more effective depending on the individual. It is important to take the
antidepressants as prescribed and continue taking them even if you feel better. Usually an
antidepressant must be taken as prescribed for 4 to 6 weeks before it begins to work.
• Mood stabilizers - These medications help to regulate the mood swings that occur with bipolar
disorder or other disorders. They reduce abnormal brain activity. Mood stabilizers may also be
prescribed along with antidepressants in some cases. Some of the most widely used mood
stabilizers include lithium and anticonvulsant drugs, such as valproic acid (Valproic®),
lamotrigine (Lamictal®), carbamazepine (Tegretol®), and oxecarbazepine (Trileptal®).
• Antipsychotics - Patients with bipolar disorder who experience mania or mixed episodes may
be treated with an atypical antipsychotic drug, such as aripiprazole (Abilify®). Atypical
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antipsychotics may also sometimes be used to treat depression, if symptoms are not controlled
with an antidepressant alone.

Psychotherapy (talk therapy)

Patients with depression and other mood disorders may benefit from various types of psychotherapy or
counseling sessions. Types of therapy include:

• Cognitive-behavioral therapy
• Interpersonal therapy
• Problem-solving therapy

Brain stimulation therapies

Brain stimulation therapies are thought to work by causing changes in the chemicals in the brain that
are known to be associated with symptoms of depression and bipolar disorders. There are several types
of brain stimulation therapies including:

• Electroconvulsive therapy (ECT) - ECT has long been used to treat severe depression or
bipolar disorder in cases when medication or psychotherapy have been unsuccessful. Before
having ECT, a patient is placed under general anesthesia and is given a muscle relaxant.
Electrodes are placed in certain locations on the scalp or forehead. An electric current is passed
through the brain to induce a seizure. The patient awakens after five to 10 minutes. The ECT
sessions can be performed on an outpatient basis. Usually, two or three sessions per week are
required, over a period of two weeks or more. Generally, six to 12 sessions are required.
• Repetitive Transcranial Magnetic Stimulation (rTMS) - This noninvasive procedure uses a
magnetic coil to apply short electromagnetic pulses to specific nerve cells in the brain. The
magnet is positioned against the forehead, while pulses are sent through the skull. The
procedure is used to treat major depression for patients who do not respond to at least one
antidepressant drug.

Treatments for seasonal depression

Antidepressant medications, such as SSRIs and bupropion, and psychotherapy are used to treat
seasonal affective disorder. In addition, patients may benefit from light therapy and vitamin D
supplements.

• Light therapy - This technique has long been used to treat SAD. It is based on the idea of
supplementing natural sunlight with bright artificial light during the fall and winter. Patients
may use a light box that provides cool-white fluorescent light. Each morning, the person is
exposed to the artificial light for about 20 to 60 minutes. The light is about 20 times more intense
than regular indoor lighting.