Mood Disorders

Mood disorders, also called affective disorders, are a group of illnesses that have as their distinguishing characteristic an experience of mood that is unusual for the circumstances. Common mood disorders include bipolar disorder, depression, postpartum depression, cyclothymia, schizoaffective disorder, and seasonal affective disorder. Most mood disorders are at least somewhat treatable with drugs and psychotherapy.

 Description of Mood Disorders

While many people go through sad or elated moods from time to time, people with mood disorders suffer from severe or prolonged mood states that disrupt their daily functioning. Mood disorders in which a single mood exists to an unhealthy degree are called unipolar disorders. Severe depression is an example of a unipolar mood disorder and is relatively common among both adolescents and adults. Depression may be characterized by a number of symptoms, including diminished pleasure or interest, irregular sleep patterns, fatigue, suicidal thoughts, lack of concentration or memory, and delusional guilt. Generally speaking, a person may be diagnosed with depression if four or more of these features have been present for a two-week period, in tandem with either loss of interest or a generally depressed mood.

In classifying and diagnosing mood disorders, doctors determine if the mood disorder is unipolar or bipolar. When only one extreme in mood (the depressed state) is experienced, this type of depression is called unipolar. Major depression refers to a single severe period of depression, marked by negative or hopeless thoughts and physical symptoms like fatigue. In major depressive disorder, some patients have isolated episodes of depression. In between these episodes, the patient does not feel depressed or have other symptoms associated with depression. Other patients have more frequent episodes.

Bipolar depression or bipolar disorder (sometimes called manic depression) refers to a condition in which people experience two extremes in mood. Mania is essentially the inverted state of depression, often characterized by an unrealistically high self-image, a lack of sleep accompanied by little or no fatigue, runaway trains of thought, engaging in potentially harmful pleasurable activities to an alarming degree, distractibility, and an increased agitation of movement. This change in the mood or "mood swing" can last for hours, days, weeks or even months. These highs and lows are frequently seasonal. Mania and hypomania are similar, but mania is usually more severe and debilitating to the patient. If these symptoms persist for more than a continuous week, are not the result of drug use, and are severe enough to impair social interaction, a diagnosis of mania may result.

Dysthymia is a recurrent or lengthy depression that may last a lifetime. It is similar to major depressive disorder, but dysthymia is chronic, long-lasting, persistent, and mild. Patients may have symptoms that are not as severe as major depression, but the symptoms last for many years. It seems that a mild form of the depression is always present. In some cases, people also may experience a major depressive episode on top of their dysthymia, a condition sometimes referred to as a "double depression."

 Causes and Symptoms

Mood disorders tend to run in families. These disorders are associated with imbalances in certain chemicals that carry signals between brain cells (neurotransmitters). These chemicals include serotonin, norepinephrine, and dopamine. Women are more vulnerable to unipolar depression than are men. Major life stressors (like divorce, serious financial problems, death of a family member, etc.) will often provoke the symptoms of depression in susceptible people.

Major depression is more serious than just feeling "sad" or "blue." The symptoms of major depression may include:

  • Loss of appetite
  • A change in sleep patterns, like not sleeping (insomnia) or sleeping too much
  • Feelings of worthlessness, hopelessness, or inappropriate guilt
  • Fatigue
  • Difficulty in concentrating or making decisions
  • Overwhelming and intense feelings of sadness or grief
  • Disturbed thinking. The person may also have physical symptoms
    like stomach aches or headaches.

Bipolar disorder includes mania or hypomania. Mania is an abnormal elevation in mood. The person may be excessively cheerful, have grandiose ideas, and may sleep less. He or she may talk nonstop for hours, have unending enthusiasm, and demonstrate poor judgement. Sometimes the elevation in mood is marked by irritability and hostility rather than cheerfulness. While the person may at first seem normal with an increase in energy, others who know the person well see a marked difference in behavior. The patient may seem to be in a frenzy and often will make poor, bizarre, or dangerous choices in his/her personal and professional lives. Hypomania is not as severe as mania and does not cause the level of impairment in work and social activities that mania can.

 Diagnosis

Doctors diagnose mood disorders based on the patient's description of the symptoms as well as the patient's family history. The length of time the patient has had symptoms also is important. Generally patients are diagnosed with dysthymia if they feel depressed more days than not for at least two years. The depression is mild but long lasting. In major depressive disorder, the patient is depressed almost all day nearly every day of the week for at least two weeks. The depression is severe. Sometimes laboratory tests are performed to rule out other causes for the symptoms (like thyroid disease). The diagnosis may be confirmed when a patient responds well to medication.

 Treatment

The most effective treatment for mood disorders is a combination of medication and psychotherapy. In fact, a 2003 report revealed that people on medication for bipolar disorder had better results if they also participated in family-focused therapy. The four different classes of drugs used in mood disorders are:

  • Heterocyclic antidepressants (HCAs)
  • Selective serotonin reuptake inhibitors (SSRI inhibitors)
  • Monoamine oxidase inhibitors (MAOI inhibitors)
  • Mood stabilizers, like lithium carbonate are often used by people with
    bipolar mood disorders.

A number of psychotherapy approaches are useful as well. Interpersonal psychotherapy helps the patient recognize the interaction between the mood disorder and interpersonal relationships. Cognitive-behavioral therapy explores how the patient's view of the world may be affecting his or her mood and outlook.

When depression fails to respond to treatment or when there is a high risk of suicide, electroconvulsive therapy (ECT) sometimes is used. ECT is believed to affect neurotransmitters like the medications do. Patients are anesthetized and given muscle relaxants to minimize discomfort. Then low-level electric current is passed through the brain to cause a brief convulsion. The most common side effect of ECT is mild, short-term memory loss.
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