Mood disorders are mental disorders characterized by periods of depression, sometimes alternating with periods of elevated mood. 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. Among the general mood disorders are major depressive disorder, bipolar disorder, and dysthymia. 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 condition 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 nor 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.
They alternate between depression (the low mood) and mania or hypomania (the high mood). These patients go from depression to a frenzied, abnormal elevation in mood. Mania and hypomania are similar, but mania is usually more severe and debilitating to the patient. 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 may also experience a major depressive episode on top of their dysthymia, a condition sometimes referred to as double depression. 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. In adults, major life stressors (like divorce, serious financial problems, death of a family member, etc. ) will often provoke the symptoms of depression in susceptible people.
Children’s versions of these stressors contribute to their vulnerability to depression. Major depression is more serious than just feeling sad or “blue. ” The symptoms of major depression may include the following: loss of appetite, change in the sleep pattern, 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, and certain physical symptoms such as stomachaches or headaches.
Bipolar disorder includes mania or hypomania. Mania is an abnormal elevation in mood. These individuals may be excessively cheerful, have grandiose ideas, and may sleep less. They may talk nonstop for hours, have unending enthusiasm, and demonstrate poor judgment. 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 will often make poor, bizarre, or dangerous choices in his or 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. The most effective treatment for mood disorders is a combination of medication and psychotherapy.
The four different classes of drugs used in mood disorders are as follows: heterocyclic antidepressants (HCAs), such as amitriptyline (Elavil), selective serotonin reuptake inhibitors (SSRI inhibitors), such as fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft), monoamine oxidase inhibitors (MAOI inhibitors), such as phenelzine sulfate (Nardil) and tranylcypromine sulfate (Parnate), and mood stabilizers, such as lithium carbonate (Eskalith) and valproate, often used in 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) is sometimes 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.