Involve only depressive symptoms (depressive disorders) and those involve manic symptoms (bipolar disorders).

Mood disorders introduction

• DSM-IV-TR recognizes two broad types of mood disorders: those that involve only depressive symptoms (depressive disorders) and those involve manic symptoms (bipolar disorders).

Mood Disorders Are Commonly Divided By

Polarity (Type of Mood Disturbance):

• Unipolar Disorders: Involve only depressive episodes.
• Bipolar Disorders: Involve both manic (or hypomanic) and depressive episodes.

Severity and Duration:

• Acute vs. Chronic (e.g., Persistent Depressive Disorder = chronic).
• Mild, Moderate, or Severe based on symptom impact.

Etiology/Cause:

• Primary mood disorders: Mood disturbance is the main issue.
• Secondary mood disorders: Caused by medical conditions, medications, or substance use.

Episode Type:

• Major depressive episodes
• Manic episodes
• Hypomanic episodes
• Mixed episodes

DSM-5 Classification:

• Depressive Disorders:
• Bipolar and Related Disorders:

Unipolar vs. Bipolar Disorders

Mood disorders are first divided based on polarity, or the direction of mood changes. In unipolar disorders, a person only experiences low mood, such as sadness, fatigue, and loss of interest in life. A common example is Major Depressive Disorder, where someone feels deeply sad and hopeless for weeks or months. On the other hand, bipolar disorders involve both “lows” (depression) and “highs” (mania or hypomania). In Bipolar I Disorder, a person may have extreme energy, talk too fast, and act recklessly during a manic episode, followed by a period of deep depression. These disorders usually begin in young adulthood. Depression is more common in women, while bipolar disorder affects men and women equally.

Severity and Duration

Mood disorders can also be described by how severe and how long the symptoms last. Some people have mild symptoms that still allow them to function, while others have severe symptoms that interfere with daily life or even lead to hospitalization. Disorders can also be short-term (acute) or long-lasting (chronic). For example, Persistent Depressive Disorder (also called dysthymia) is a form of depression that lasts for at least two years. Someone with dysthymia may not feel deeply depressed but struggles with low energy and sadness most of the time.

Primary vs. Secondary Causes

Mood disorders can be primary, meaning they happen on their own, or secondary, meaning they are caused by something else. A primary mood disorder is like Bipolar Disorder or Major Depression, where the mood problem is the main issue. But sometimes, mood symptoms come from other medical problems or medications. For example, a person taking steroids for asthma or arthritis might feel unusually energetic or irritable—that would be a secondary mood disorder caused by medication. Similarly, people with thyroid problems or chronic illnesses may develop depression as a side effect of their condition.

Types of Mood Episodes

Mood disorders are also classified by the type of episode a person experiences. A depressive episode includes deep sadness, low energy, poor sleep, and negative thoughts. A manic episode is the opposite someone might feel too happy or irritable, sleep very little, and make risky decisions. A hypomanic episode is a milder version of mania. Some people even experience mixed episodes, where they feel both energetic and deeply sad at the same time. These can be very confusing and are common in bipolar disorder.

DSM-5 Classification (Diagnostic Manual)

Doctors and therapists use a guide called the DSM-5 to diagnose mood disorders. It groups them into two main types: Depressive Disorders and Bipolar and Related Disorders. Under depressive disorders, we have conditions like Major Depressive Disorder, Persistent Depressive Disorder, and Disruptive Mood Dysregulation Disorder, which is a childhood condition involving frequent anger outbursts. Under bipolar disorders, we include Bipolar I, Bipolar II, and Cyclothymic Disorder. Each condition has specific criteria that must be met for diagnosis, and understanding these helps professionals give the right treatment.

Depressive disorders

• The symptoms of depression include profound sadness and/or an inability to experience pleasure. 
• When people develop a depressive disorder, their heads may reverberate with self-recriminations. They may become focused on their flaws and deficits. 
• Paying attention can be so exhausting that they have difficulty absorbing what they read and hear. They often view things in a very negative light, and they tend to lose hope. 
• Physical symptoms of depression are also common, including fatigue and low energy as well as physical aches and pains.
• Although people with depression typically feel exhausted – they may find it hard to fall asleep and may wake up frequently. Other people sleep throughout the day. 
• They may find that food tastes bland or that their appetite is gone, or they may experience an increase in appetite. 
• Sexual interest disappears. 
• Thought and movement may slow for some (psychomotor retardation), but others can’t sit still – they pace, fidget, and wring their hands (psychomotor agitation). 
• When people become utterly dejected and hopeless, thoughts about suicide are common.
• Depressive disorders and Under depressive disorders, there are another two types of disorders as mentioned in DSM-IV-TR. They are: 
  • Major depressive disorder (MDD)
  • Dysthymic disorder (also called dysthymia). 

 Major depressive disorder

• The DSM-IV-TR diagnosis of major depressive disorder (MDD) requires depressive symptoms to be present for at least 2 weeks. 
• As shown in the DSM-IV-TR criteria, at least 4 additional symptoms must be present. They are: 
  • Changes in sleep
  • Changes in appetite; 
  • Changes in concentration and decision-making
  • Feeling of worthlessness;
  • Suicidal
  • Psychomotor agitation or retardation.

• MDD is called an episodic disorder – because symptoms tend to be present for period of time and then clear. Even though episodes tend to dissipate over time, an untreated episode may stretch on for 5 months or even longer. 
• Major depressive episodes tend to recur – once given episode clear, a person is likely to experience another episode.

Dysthymic disorder

• Dysthymic disorder shares many of the symptoms of major depressive disorder but differ in its course. The symptoms are somewhat milder but remain relatively unchanged over long period of time, sometimes 20 or 30 years or more. 
• Dysthymic disorder is defined as a persistently depressed mood that continues at least 2 years, during the patient cannot be symptom free for more than 2 months at a time. 
• Dysthymic disorder differs from a major depressive episode only in the severity, chronicity, and number of its symptoms, which are milder and fewer but last longer. 
• Typically, dysthymic disorder develops first, perhaps at an early age, and then one or more major depressive episodes occur later. 

Bipolar disorders

• DSM-IV-TR recognizes 3 forms of bipolar disorders: 
  • Bipolar I disorder
  • Bipolar II disorder
  • Cyclothymic disorder. 

• Manic symptoms are the defining feature of each of these disorders. 
• These disorders are labelled “bipolar” because most people who experience mania will also experience depression during their lifetime.
• What is mania? 

• People may experience with abnormally exaggerated elation, joy, or euphoria. 
• In mania, individuals find extremely pleasure in every activity: they become extraordinary active (hyperactive), require little sleep, and may develop grandiose plan, believing they can accomplish anything they desire. 
• Speech is typically rapid and may become incoherent (attempting to express so many exciting ideas at once: flight of ideas) 
• Hospitalization may require, if individual was engaging self-destructive activities. 

Bipolar I disorder

• In DSM-IV-TR, the criteria for diagnosis of bipolar I disorder (formerly known as manic-depressive disorder) include a single episode of mania or a single mixed episode during the course of a person’s life.

Bipolar II disorder

• DSM-IV-TR also includes a milder form of bipolar disorder, called bipolar II disorder.

Cyclothymic disorder

• A milder but chronic version of bipolar disorder called cyclothymic disorder is similar in many ways to dysthymic disorder. 
• Cyclothymic disorder is a chronic alternation of mood elevation and major depression that does not reach the severity of manic or major depressive episodes. 
• Individual who have this tend to be in one mood state or the other years with relatively few periods of neutral mood. 

Causes of mood disorders 

• Neurotransmitters, the most in terms of their possible roles in mood disorders.
  • Norepinephrine.
  • Dopamine.
  • Serotonin.

• Original models suggested that depression would be tied to low levels of norepinephrine and dopamine. 
• Mania would be tied to high levels of norepinephrine and dopamine
• Mania and depression were also both posited to be tied to low levels of serotonin. 
• Researchers initially believed that mood disorders would be explained by absolute levels of neurotransmitters in the synaptic cleft that were either too high or too low. 

Brain imaging studies: 

• Brain imaging studies suggest that episodes of MDD are associated with changes in many of the brain systems that are activated when a person without symptoms of depression experiences strong emotions. 
• As one might expect, many different brain structures become involved when a person experiences emotion: the person needs to attend to and interpret the stimuli that are causing the emotion and then must make plans to deal with those stimuli. 

 Psychological: 

• Various aspects of personality and its development appear to be integral to the occurrence and persistence of depression. 
• Although depressive episodes are strongly correlated with adverse events, a person’s characteristic style of coping may be correlated with his or her resilience. 
• In addition, low self-esteem and self-defeating or distorted thinking are related to depression.

Social: 

• Poverty and social isolation are associated with increased risk of mental health problems in general. 
• Child abuse (physical, emotional, sexual, or neglect) is also associated with increased risk of developing depressive disorders later in life. 
• Abuse of the child by the caregiver is bound to distort the developing personality and create a much greater risk for depression and many other debilitating mental and emotional states. 
• Disturbances in family functioning, such as parental (particularly maternal) depression, severe marital conflict or divorce, death of a parent, or other disturbances in parenting are additional risk factors. 

Medications: 

• The effectiveness of antidepressants is none to minimal in those with mild or moderate depression but significant in those with very severe disease. 
• The effects of antidepressants are somewhat superior to those of psychotherapy, especially in cases of chronic major depression. 
• Antidepressant medication treatment is usually continued for 16 to 20 weeks after remission, to minimize the chance of recurrence, and even up to one year of continuation is recommended.

Treatment of Mood Disorders 

• Electroconvulsive Therapy and Transcranial Magnetic Stimulation (ECT): 

1. Electroconvulsive therapy (ECT) is a procedure whereby pulses of electricity are sent through the brain via two electrodes, hospital psychiatrists may recommend ECT for cases of severe major depression that have not responded to antidepressant medication or, less often, psychotherapy or supportive interventions.  
2. ECT can have a quicker effect than antidepressant therapy and thus may be the treatment of choice in emergencies such as catatonic depression where the person has stopped eating and drinking, or where a person is severely suicidal. 

Psychological treatments for depression: 

Cognitive-Behavioral Therapy:

• Clients are taught to examine carefully their thought processes while they are depressed and to recognize “depressive” errors in thinking.
• Clients are thought that errors in thinking can directly cause depression. Treatment involves correcting cognitive errors and substituting less depressing and more realistic thoughts and appraisals.

Interpersonal Psychotherapy:

After identifying life stressors that seem to precipitate the depression, the therapist and patient work collaboratively on the patient’s current interpersonal problems’:

1. Dealing with interpersonal role disputes – marital conflicts; 
2. Adjusting to the loss of a relationship; 
3. Acquiring new relationships; 
4. Identifying and correcting deficits in social skills. 

• After helping identifying the dispute… the next steps? 
  • Negotiation stage – both partners are aware it is a dispute, and they are
    trying to renegotiate it.
  • Impasse stage – the dispute smolders beneath the surface and results in low�level resentment, but no attempts are made to resolve it. 
  • Resolution stage – the partners are taking some action, such as divorce,
    separation or recommitting to the marriage.