Mood Disorders

Overview of Mood Disorders

Mood disorders are complex psychological disorders in which individuals exhibit  uncharacteristic alterations in mood. The symptoms and severity of mood disorders vary  from person to person, and they can affect individuals’ daily lives and inhibit their  ability to carry out routine tasks. Symptoms are manifested physiologically and  cognitively, and they include: racing thoughts, difficulty concentrating, difficulty sleeping  and/or needing to sleep less, emotional sensitivity, and changes in appetite amongst  others. When people exhibit a combination of symptoms, it can incite a mood episode;  which is an unusually intense emotional state that occurs for a distinct period of time.  Each mood episode represents a drastic change from a person’s usual mood or behavior,  and the cultivation of these episodes is what typifies a mood disorder. Mood disorders,  specifically depression and bipolar disorders, are fairly common and fortunately they  are treatable. Treatment options include medication, psychotherapy, or a combination of  medication and psychotherapy. Because mood disorders, their symptoms, and the  severity of symptoms are unique to each individual, treatment is highly personalized and  handled on a case by case basis. The goal of personalized treatment is to provide  individuals with the support and cognitive frameworks necessary to control their mood  episodes.

Classifying & Identifying a Mood Disorder

Classifying and accurately identifying mood disorders is difficult because they have a  number of neurobiological, behavioral, and psychological etiological pathways unique to each individual. Individuals’ varying pathways result in the development of different symptoms. Symptoms are manifested physiologically and cognitively, and they include:

Physiological Symptoms :

1.) Weight loss (expressed as failure to achieve expected weight gains in children)
2.) Insomnia/Hypersomnia
3.) Psychomotor agitation or deferral
4.) Fatigue or decreased energy levels on a daily basis

Cognitive Symptoms:

1.) Depressed mood (expressed as irritability in children)
2.) Decreased interest or pleasure in activities
3.) Excessive guilt or feelings of worthlessness
4.) Difficulty concentrating or thinking clearly
5.) Suicidal ideation

Mood disorders are distinguished by the extent and severity of a person’s symptoms, and  diagnoses are defined by the patterns of an individual’s mood disturbances observed through time . These periods of disturbed mood are referred to as mood episodes, and they are the product of individuals’ physical and cognitive symptoms interacting or  interfering with their daily lives. Episodes can last anywhere from a couple weeks to  several months. People that have mood disorders will have likely experienced multiple  mood episodes in the past.

There are different types of episodes, and clinicians match the type of mood episodes  with their frequency to identify an individual’s disorder. There are manic or hypomanic  episodes, depressive episodes, and mixed episodes. In a manic or hypomanic episode,  individuals may experience: an increase in self-esteem, a decreased need for sleep, be  more talkative than usual, increase their goal oriented activity, and impulsively engage  in risky behaviors they deem pleasurable. In a depressive episode, individuals may have:  a prolonged depressed mood, decreased interest and pleasure in most activities,  substantial weight losses/gains, insomnia/hypersomnia, psychomotor complications,  persistent fatigue, feelings of excessive guilt or worthlessness, indecisiveness, difficulty  concentrating, and suicidal ideation. If you are experiencing suicidal thoughts we  urge you to contact emergency services immediately. Finally, in a mixed episode  individuals experience symptoms of manic and depressive episode simultaneously, or in  rapid succession of one another.

Depressive disorders are the most prominent type of mood disorders, and patients can  achieve a full remission from their symptoms with proper therapy. Major Depressive  Disorder is characterized by one or more major depressive episodes. A major depressive  episode (MDE) occurs when an individual experiences a depressed mood or lost interest accompanied by at least four other symptoms of depression for at least two weeks.  Dysthymic disorder occurs when individuals experience two or more years of depressed  mood for the majority of days during that period, in addition to other symptoms that do  not meet the criteria of a major depressive episode.

Bipolar disorders are marginally less common than depressive disorders. While bipolar  disorders are technically incurable, treatment will help those with bipolar disorder to  control their symptoms. Bipolar I Disorder occurs when individuals endure one or more  manic or mixed episodes, that are usually accompanied by major depressive episodes.  Bipolar II Disorder is typified by one or more major depressive episodes followed by at  least one hypomanic or manic episode. Cyclothymic disorder occurs when people exhibit  symptoms of hypomania and depression for two or more years.

Medically and substance induced mood disorders are also fairly common. Medically  induced mood disorders present a prominent and persistent disturbance in mood as the  direct result of a medical condition. The severity and length of the condition are relative  to the medical condition of an individual. Substance induced mood disorders induce a  prominent and persistent mood disturbance as a direct consequence of drug abuse, a  medication, toxin exposure, or any other somatic treatment for depression. Substance  induced mood disorders are typically impermanent, but are relative to how long an  individual is exposed to the substance responsible for creating the disorder.

The Burden of Mood Disorders

More than 20.9 million Americans, approximately 10% of the total population, have a mood disorder. While the population affected by mood disorders has lingered around 10%, the individual, societal, and economic burden of these disorders has increased in  recent decades.  

The increased burden of mood disorders stems from the difficulty in their identification  and treatment. Most individuals with a condition are not recognized by a physician in a  timely manner, not treated appropriately according to minimal guideline standards, and  some may never actually see a specialist. If their condition is misdiagnosed, it will  consequently be mistreated, causing the condition to worsen and thus increase the  individual’s psychological and physiological burden.  

The inability to address the indirect costs of mood disorders increases their societal and  economic burden. Most injuries and ailments primarily have direct costs - diagnoses and  treatment. Mood disorders on the other hand, are dominated by indirect costs such as  sick days, unemployment, long-term disability, and suicide attempts. All of these costs  are presented as negative externalities to families, employers, and the governmental  sectors responsible for paying out disability.  

Longer life spans are also responsible for enhancing the burden of mood disorders.  Living longer makes individuals more likely to develop a malignant case of depression.  This is because the vulnerability of other chronic conditions such as cancer, increase  individuals’ risk factors and susceptibility to these conditions.  

Depressive Disorders

14.8 million people are affected by depression each year in the United States. This  accounts for 6.7% of the total population, and makes depression the most common form  of mood disorder. There are a number of notable risk factors in the development of a  depressive disorder. Individuals with preexisting or chronic medical conditions,  individuals that struggle with substance abuse problems, individuals tasked with a  difficult life transition or experience, and individuals that have been prescribed multiple  medications are significantly more likely to develop a malignant case of depression.  

The type and severity of an individual’s depressive disorder varies on their situation. For  example, a person with a pre-existing medical condition that is also tasked with a  difficult life transition is significantly more likely to develop a case of Major Depressive  Disorder. On the other hand, an individual that has no prior medical history, and is  enduring a difficult situation is more likely to develop a case of reactive depression.  

There are three primary types of depressive mood disorders. The type of mood disorder  is categorized by individuals’ symptoms, and the frequency and severity of their mood  episodes. As previously stated, mood episodes are unusually intense emotional states  that occur in distinct periods. Each episode represents a drastic change from a person’s  usual mood or behavior, and is the result of the interaction between their specific  hereditary endowment and the matrix of psychological and social forces impinging on  the individual.

The first and most common type of depressive disorder is Major Depressive Disorder.  Major Depressive Disorder occurs when an individual one or more major depressive  episodes in which they experience two or more weeks of depressed mood or loss of  interest in addition to four other depressive symptoms. Major Depressive Disorder will  interfere with individuals’ daily lives by inhibiting their ability to work, sleep, eat,  concentrate, and enjoy their daily lives. Major Depressive Disorder can be caused by  internal biological factors, external social factors, or a combination of internal and  external factors. Identifying the factor(s) causal in the development of the disorder will  be important in formulating an effective treatment method, because treatment is  conducted on a symptomatic basis.  

Dysthymia, also referred to as persistent depressive disorder, is the second type of mood  disorder. Individuals with dysthymia will exhibit symptoms of depression that do not  quite meet the criteria for a major depressive episode, but they endure them for a  significantly longer period of time. Dysthymia is characterized by individuals’  experience of depressive symptoms for two or more years, and are affected by their  symptoms more days than not over the course of that. While the symptoms may be less  severe, the duration of the symptoms allow them to become deeply embedded into  individuals daily lives. If individuals allow their symptoms to become part of their daily  life, they will be substantially harder to recover from. In order to effectively treat  symptoms such as these, individuals will be forced to physically and cognitively  restructure their daily habits. This will be the only way in which they will be able to fully  rid themselves of their symptoms, and achieve remission from their condition.  

The third type of depressive disorder is Reactive Depression. It is also referred to as  Adjustment Disorder with depressed mood. This subtype of clinical depression is directly  caused by the stress of some external event. The reason it is referred to as reactive  depression is because their condition fluctuates directly according to ascertainable  psychological factors, such as depressed mood or lost interest. Individuals going through  a divorce, financial struggles, or have recently lost a loved one have the highest risk of  developing reactive depression. They will typically blame their environment as the cause  of their condition, and recognize the abnormality in their mood.

Internal Vs. External Depression

Major Depressive Disorder and Dysthymia are classified as endogenic, or internal  depression. Internal depressions are caused by some biological or hereditary derangement within an individual, and have two defining characteristics. They’re  generally equated with psychosis, and are regarded as arising primarily from internal  biological factors. It should be noted that mood variation for individuals with endogenic  depression has been likened to the swinging of a pendulum, meaning that their mood  changes are completely independent from their environment. The symptoms for internal  depression include: a diffused outlook, phasic morning-evening, continuity, detachment  from reality, and emotional numbness. It has also been observed that, “symptoms  seemed alien to the individual and not congruent with his or her premorbid personality  (Beck & Alford, 2009, p. 72).” So in other words, individuals’ personalities were changed  so drastically that they could no longer identify with their pre-depressed selves, and they  were unable to identify exactly when their symptoms began.  

On the other hand, reactive depression is referred to as exogenous, or external  depression. External depressions are neurotic in nature, and are produced by external  events like bereavement, financial problems, divorce, and unemployment. Unlike  endogenic depressions, symptoms of exogenic depressions directly fluctuate according to  ascertainable psychological factors. This suggests that their mood variations would be  directly related to their environment, which further differentiates endogenic and exogenic depressions. Furthermore, individuals with reactive depressions are often able  to provide insight on the abnormality of their particular situation. This signifies that they  are still able to identify with the personality traits they had before the development of  their condition. This recognition is vitally important because it provides these  individuals with a frame of reference on the status of their condition. 

Bipolar Disorders

Bipolar disorders are marginally less common than depressive disorders, and they affect  5 million Americans - approximately 2.6% of the total population. The diagnoses of  bipolar disorders has remained relatively stagnant in adults, but have been steadily  rising in children and adolescents. The effects of bipolar disorders are often more severe  than those of depressive disorders, and they can have a devastating impact on  individuals and their families if they go untreated.  

There is no singular cause for the development of a bipolar disorder, and factors usually  act in conjunction to develop the disorder. The risk factors for bipolar disorders include  genetics, brain structure, and brain functioning. Bipolar disorder runs in families. So  children and individuals with siblings or parents with the condition have a higher  likelihood of developing some form of bipolar disorder. In regards to brain structure and functioning, an MRI study found that adults with bipolar disorder have a smaller  prefrontal cortex that functions less than individuals without a condition. The prefrontal  cortex is involved in primary brain functioning such as problem solving and decision  making, so variances in the size and functioning of the prefrontal cortex may signify a  bipolar disorder. Additionally, the prefrontal cortex develops during adolescence which  may explain why bipolar diagnoses are rising in children and teens.  

There are three types of bipolar disorders, and they are characterized by the differences  and frequency of mood episodes. Individuals with bipolar disorders will experience  manic or hypomanic episodes, depressive episodes, and/or mixed episodes. In a manic  episode, an individual will experience a prolonged increase in happiness, become more  outgoing, sleep less, and engage in risky and impulsive behavior. In a depressed episode,  individuals will have a prolonged period of depressed mood, decreased pleasure and  interest in most activities, and difficulty concentrating amongst other things. Mixed  episodes occur when individuals endure symptoms of manic and depressive episodes  either simultaneously, or in rapid succession.  

Bipolar I disorder is the most commonly diagnosed type of bipolar disorder. It is  characterized by one or more manic or mixed mood episodes, usually accompanied by a  major depressive episode. People with bipolar I disorder may have substance abuse,  relationship, and academic problems that they will not recognize within themselves.  They will also be significantly more likely to seek out treatment when they are in the  midst of a depressed state because of their daunting effects.  

Bipolar II disorder is effectively the opposite of bipolar I disorder. It occurs when an  individual experiences a major depressive episode accompanied by either a manic or  hypomanic episode. Individuals with Bipolar II disorder typically have a more difficult  time with treatment. This is due to the fact that they believe they’ve improved their  condition while experiencing a manic or hypomanic episode. The difficulty in their  treatment increases the likelihood that they will relapse and endure another cycle of  mood episodes. Individuals with Bipolar II disorder are also more likely to develop Rapid  Cycling Bipolar Disorder, which occurs when an individual has four or more episodes of  mania, major depression, hypomania, and mixed episodes all in the span of one year.  

The third type of bipolar disorder is Cyclothymia. Similar to dysthymia, cyclothymia  plagues patients for an extended period of time. Individuals with this condition will  experience numerous periods of hypomanic and depressive symptoms over the course of  two or more years. Because of the chronicity of cyclothymia, the symptoms people  exhibit will become embedded in their personality. This makes it more difficult for them to recognize their condition because it will become their new norm. Consequently,  individuals with cyclothymia often have a more difficult time coping with and learning  to control their symptoms.  

Other Mood Disorders

The two remaining forms of mood disorders are medically induced mood disorders, and  substance induced mood disorders. The symptoms and severity of both of these forms of  mood disorder are relative to the length of an individual’s exposure to the underlying  cause of their disorder. These types of mood disorders are most commonly treated with  psychotherapy.

Medically induced mood disorders are prominent and persistent disturbances in mood  that are judged to be a direct consequence of a general medical condition. These are  particularly common in cancer patients, and individuals with long-lasting, life-altering  conditions. The symptoms of medically induced mood disorders are closely related to  those of major depressive disorder because patients are often saddened by the status of  their medical condition. This type of mood disorder typically persists as long as an  individual has the medical condition responsible for generating the mood disorder.  Fortunately, psychotherapy will aid these individuals by providing with the support and  positive coping methods necessary to control the negative effects of their disorder.

Substance induced mood disorders present a prominent and persistent disturbance in  mood that is judged to be the direct consequence of a drug of abuse, a medication, or any  other somatic treatment for depression. Similar to medically induced mood disorders,  substance induced mood disorders will persist as long as that individual is exposed to the  underlying cause of their mood disorder. Symptomatology of substance induced mood  disorders are similar to Bipolar I disorder, because individuals will feel a “high” when  they have access to their somatic treatment, quickly followed by a depressive episode  upon reflection of their actions. Individuals with substance induced mood disorders can  achieve a full remission from their condition through consistent and closely monitored  treatment.

Treating Mood Disorders

It is vitally important that anyone with a mood disorder receives proper and prolonged  treatment if they are to improve on their condition. In order for treatment to be  effective, it must address the type of mood disorder an individual has, its severity, the comorbid complications involved, and the patient’s preferred treatment method. If all of  these variables are accounted for, individuals will be significantly better equipped to  control their symptoms.

The longer a mood disorder goes unaccounted for, the worse the condition will become  because the frequency and severity of their mood episodes will likely increase. More  than two-thirds of mood disorders start in late adolescence or early adulthood as  secondary conditions to preexisting and untreated mental disorders such as anxiety,  ADD/ADHD, and addiction. So, it is vitally important for clinicians to recognize the risk  factors in order to provide an early intervention. Early interventions based on  personalized approaches for high-risk individuals can decrease the incidence of mood  disorders, their degree of disability, and their burden of depression.

The goal of treatment is to help patients reduce the frequency and severity of their mood  episodes in order to help them lead healthy and productive lives. While psychotherapy  and medication may be used exclusively, an effective maintenance treatment plan  usually includes a combination of medication and psychotherapy.

Psychotherapy sessions with patients are typically conducted on a weekly basis, and  meetings are typically 30-50 minutes long. Individuals will receive routine weekly  therapy as long as their symptoms remain prevalent, and decrease their number of  therapy sessions once they’ve been able to gain more control over their daily lives. The  goal of psychotherapy is to provide support, education, and guidance for individuals  with a condition and their families. Some of the most popular therapy options include:

  1. Cognitive Behavioral Therapy (CBT) : Focuses on helping individuals learn to change harmful or negative thought patterns and behaviors.
  2. Family Therapy : Involves the entire family unit to enhance collective coping
    strategies, recognize the onset of a mood episode, and improve interfamilial  communication and problem solving skills.
  3. Interpersonal & Social Rhythm Therapy : Helps individuals regiment daily routines and sleep schedules in order to improve their relationships with other  people and manage their daily lives.
  4. Psychoeducation : This teaches individuals about their condition, and the possible treatment options. This type of therapy is typically conducted in a group setting,  and allows individuals to recognize the impending signs of a mood disorder.

Medication is prescribed as a supplement to psychotherapy to help combat the  physiological symptoms of mood disorders. It is important that individuals on prescription drugs take them as prescribed, and conduct medication reviews with their  respective clinician. If any prescription drug is taken abusively, it can worsen an  individuals condition, and hamper their ability to recover from their condition. The most  commonly prescribed medications for mood disorders include:

  1. Antidepressants
  2. Mood Stabilizers
  3. Atypical Antipsychotics

How to Help A Loved One With A Mood Disorder

The best thing that you can do for a loved one with a mood disorder is to encourage them  to remain in treatment. Treatment is their only option at sustaining long-term control of  their symptoms, because the likelihood of relapsing symptoms is extremely high. The  following options provide a sturdy framework in which you can base your support off of:

  1. Offer continued emotional support, understanding, patience, and encouragement
  2. Educate yourself about their disorder. This will give you a better understanding of
    their daily struggles.
  3. Talk to them and listen very carefully to what they say about their feelings and/or
    condition
  4. Listen to the feelings they express, and try and be understanding about the
    situations that trigger their symptoms
  5. Help them engage in positive distractions.
  6. Gently remind them that, with time and treatment, their condition will improve.

References

1.) Wittchen, H.-U. “The Burden of Mood Disorders.” Science , vol. 338, no. 6103, 2012, pp. 15–15., doi:10.1126/science.1230817.
2.) https://www.mentalhelp.net/articles/understanding-mood-episodes-in-depression/
3.) “Hotline Information.” Depression Statistics - Depression and Bipolar Support Alliance.
4.) Beck, Aaron T., and Brad A. Alford . “Chapter 4. Classifying Mood Disorders.” Depression ,
doi:10.9783/9780812290882.64.
5.) https://infocenter.nimh.nih.gov/pubstatic/NIH%2012-3679/NIH%2012-3679.pdf
6.) http://www.psyweb.com/articles/depression/definition-of-reactive-depression

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