What Are Mood Disorders?
We all experience mood changes and mood swings. Sometimes we’re happy – maybe even euphoric – and other times we’re sad and feeling low. These changes in your mood are completely normal. For others, however, their mood swings are so pronounced and lingering that they begin to affect people in major ways – loss of work, marital strife, divorce. Sometimes these mood swings even cause people to lose touch with reality, and may even be life-threatening. Situations like these represent mood disorders.
Mood disorders are considered to be disturbances in emotional experiences that are strong enough to intrude on living.
Marked by changes in mood, depression and bipolar disorder (also known as manic depression) are both highly treatable, medical illnesses. Unfortunately, many people don’t get the help they need because of the misunderstanding surrounding the illnesses or the fear associated with stigma. The following are brief descriptions of depression and bipolar disorder.
According to the 2005 National Comorbidity Survey-Replication study, about 20.9 million American adults, or 9.5 percent of the population ages 18 and older, have mood disorders. These include major depressive disorder; dysthymic disorder (a chronic, mild depression); and bipolar disorder (also called manic depression). Major depressive disorder is, by itself, the leading cause of disability among Americans age 15 – 44, according to the World Health Organization.
Changes in mood that interfere with everyday life may indicate a mood disorder such as depression or bipolar disorder. Mood disorders are treatable medical conditions. With appropriate diagnosis, treatment, and support, most people struggling with mood disorders will get better.
If you have concerns about mood or behavior changes in yourself or someone you know, it’s important that you gain an understanding of how to recognize mood disorders like depression and bipolar disorder, and how to get appropriate diagnosis and treatment for them.
Symptoms of Mood Disorders:
Depending on age and the type of mood disorder, a person may have different symptoms of depression. The following are the most common symptoms of a mood disorder:
- Ongoing sad, anxious, or “empty” mood
- Feeling hopeless or helpless
- Having low self-esteem
- Feeling inadequate or worthless
- Excessive guilt
- Repeating thoughts of death or suicide, wishing to die, or attempting suicide (Note: People with this symptom should get treatment right away!)
- Loss of interest in usual activities or activities that were once enjoyed, including sex
- Relationship problems
- Trouble sleeping or sleeping too much
- Changes in appetite and/or weight
- Decreased energy
- Trouble concentrating
- A decrease in the ability to make decisions
- Frequent physical complaints (for example, headache, stomachache, or tiredness) that don’t get better with treatment
- Running away or threats of running away from home
- Very sensitive to failure or rejection
- Irritability, hostility, or aggression
In mood disorders, these feelings are more intense than what a person may normally feel from time to time. It’s also of concern if these feelings continue over time, or interfere with one’s interest in family, friends, community, or work. Any person who expresses thoughts of suicide should get medical help right away.
The symptoms of mood disorders may look like other conditions or mental health problems. Always talk with a healthcare provider for a diagnosis.
Who Is At Risk For A Mood Disorder?
Anyone can feel sad or depressed at times. However, mood disorders are more intense and harder to manage than normal feelings of sadness. Children, teens, or adults who have a parent with a mood disorder have a greater chance of also having a mood disorder. However, life events and stress can expose or worsen feelings of sadness or depression. This makes the feelings harder to manage.
Sometimes, life’s problems can trigger depression. Being fired from a job, getting divorced, losing a loved one, death in the family, and financial trouble, to name a few, all can be difficult and coping with the pressure may be troublesome. These life events and stress can bring on feelings of sadness or depression or make a mood disorder harder to manage.
The risk of depression in women is nearly twice as high as it is for men. Once a person in the family has this diagnosis, their brothers, sisters, or children have a higher chance of the same diagnosis. In addition, relatives of people with depression are also at increased risk for bipolar disorder.
Medical Risk Factors For Mood Disorders Include:
Depression is a type of mood disorder that some believe is triggered when neurotransmitters in the brain are out of balance. Neurotransmitters are chemical messengers that help the brain communicate with other parts of the body. These chemicals help regulate many physiological functions.
Low levels of neurotransmitters may play a role in why some people are more susceptible to depression, including the neurotransmitters:
Having an immediate family member with depression or a mood disorder can increase your risk for depression. The American Psychiatric Association (APA) states that if one identical twin is diagnosed with depression, the other twin has a 70 percent chance of developing it.
However, depression can occur in people with no family history, which is why some scientists believe it can be a product of both genes and life experiences.
Chronic sleep problems are associated with depression. Although experts don’t know if a lack of sleep causes depression, bouts of low mood do seem to follow periods of poor sleep.
The pain and stress that come with certain conditions can take a toll on a person’s mental state. Many chronic conditions are linked to higher rates of depression, including:
- chronic pain
- heart disease
- thyroid disease
- multiple sclerosis
- Alzheimer’s disease
- Parkinson’s disease
- Huntington’s disease
Social Risk Factors for Depression:
Sometimes, our past and present experiences can trigger mood disorders, including depression.
People who were neglected or abused as children have a high risk for major depression. Such negative experiences can cause other mental disorders as well.
Women are twice as likely to have depression as men, but this may be due to the fact that more women seek treatment for their symptoms than men. Some believe depression can be caused by hormonal changes throughout life. Women are particularly vulnerable to depression during pregnancy and after childbirth, which is called postpartum depression, as well as during menopause.
Lack of social support:
Prolonged social isolation and having few friends or supportive relationships is a common source of depression. Feelings of exclusion or loneliness can bring on an episode in people who are prone to mood disorders.
Major life events:
Even happy events, such as having a baby or landing a new job, can increase a person’s risk for depression. Other life events linked to depression include:
- losing a job
- buying a house
- getting a divorce
The death of a loved one is certainly a major life event. Great sadness is a major part of the grieving process. Some people will feel better in a matter of months, but others experience more serious, long-term periods of depression. If your grieving symptoms last more than two months, you should see your doctor to be evaluated for depression.
Substance Risk Factors for Mood Disorders:
In many cases, substance abuse and depression go hand-in-hand. Drugs and alcohol may lead to chemical changes in the brain that raise the risk for depression. Self-medication with drugs and alcohol can also lead to depression.
Certain medications have been linked to depression, including:
- blood pressure medication
- sleeping pills
- prescription painkillers
If you are taking any such medications, speak to your doctor about your concerns. Never stop taking a medication without first consulting your physician.
What Are The Types of Mood Disorders?
Mood disorders describe a broad category of disorders in which a person’s mood is the primary underlying symptom.
If you have a mood disorder, your general emotional state or mood is distorted or inconsistent with your circumstances and interferes with your ability to function. You may be extremely sad, empty or irritable (depressed), or you may have periods of depression alternating with being excessively happy (mania).
Anxiety disorders can also affect your mood and often occur along with depression. Mood disorders may increase your risk of suicide.
Major Depressive Disorder requires two or more major depressive episodes. According to the National Institute of Mental Health (NIMH), major depression is one of the most common mental disorders in the United States.
If you think you may hurt yourself or attempt suicide, call 911 or your local emergency number immediately.
Also consider these options if you’re having suicidal thoughts:
- Call your doctor or mental health professional.
- Call a suicide hotline number — in the U.S., call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255). Use that same number and press “1” to reach the Veterans Crisis Line.
- Reach out to a close friend or loved one.
- Contact a minister, spiritual leader or someone else in your faith community.
Depressed mood and/or loss of interest or pleasure in life activities for at least 2 weeks and at least five of the following symptoms that cause clinically significant impairment in social, work, or other important areas of functioning nearly every day:
- Depressed mood most of the day, almost every day.
- Lack of interest or pleasure in all or most activities
- Significant unintentional weight loss or gain
- Insomnia or sleeping too much.
- Agitation or psychomotor retardation noticed by others
- Fatigue or loss of energy.
- Feelings of worthlessness or excessive guilt.
- Diminished ability to think or concentrate, or indecisivenesss
- Frequent thoughts of death, dying, or suicide
Major Depressive Disorder is generally treated with a combination of antidepressants, including SSRI’s, SNRI’s, and talk therapy. Also, those with depression should eat well, exercise often, and stick to a stress-free life.
Dysthymia and Persistent Depressive Disorder
This is a chronic, low-grade, depressed, or irritable mood that lasts for at least 2 years.
Persistent depressive disorder, also called dysthymia is a continuous long-term (chronic) form of depression. You may lose interest in normal daily activities, feel hopeless, lack productivity, and have low self-esteem and an overall feeling of inadequacy. These feelings last for years and may significantly interfere with your relationships, school, work and daily activities.
If you have persistent depressive disorder, you may find it hard to be upbeat even on happy occasions — you may be described as having a gloomy personality, constantly complaining or incapable of having fun. Though persistent depressive disorder is not as severe as major depression, your current depressed mood may be mild, moderate or severe.
Depressed mood most of the day for more days than not, for at least 2 years, and the presence of two or more of the following symptoms that cause clinically significant impairment in social, work, or other important areas of functioning:
- Poor appetite or overeating.
- Insomnia or sleeping too much
- Low energy or fatigue
- Low self-esteem
- Poor concentration or difficulty making decisions.
- Feelings of hopelessness\
Treatment includes antidepressants, talk therapy, as well as good self-care habits.
Bipolar disorder is characterized by more than one bipolar episode.
There are three types of bipolar disorder:
Bipolar 1 Disorder, in which the primary symptom presentation is manic, or rapid (daily) cycling episodes of mania and depression. A manic episode is a period of abnormally elevated mood and high energy, accompanied by abnormal behavior that disrupts life. Most people with bipolar I disorder also suffer from episodes of depression. Often, there is a pattern of cycling between mania and depression. This is where the term “manic depression” comes from. In between episodes of mania and depression, many people with bipolar I disorder can live normal lives.
Bipolar 2 Disorder, in which the primary symptom presentation is recurrent depression accompanied by hypomanic episodes (a milder state of mania in which the symptoms are not severe enough to cause marked impairment in social or occupational functioning or need for hospitalization, but are sufficient to be observable by others). Bipolar II is similar to bipolar I disorder, with moods cycling between high and low over time.However, in bipolar II disorder, the “up” moods never reach full-blown mania. The less-intense elevated moods in bipolar II disorder are called hypomanic episodes, or hypomania.
A person affected by bipolar II disorder has had at least one hypomanic episode in his or her life. Most people with bipolar II disorder suffer more often from episodes of depression. This is where the term “manic depression” comes from. In between episodes of hypomania and depression, many people with bipolar II disorder typically live normal lives
Cyclothymic Disorder, a chronic state of cycling between hypomanic and depressive episodes that do not reach the diagnostic standard for bipolar disorder. Cyclothymia — or cyclothymic disorder — is a relatively mild mood disorder. In cyclothymic disorder, moods swing between short periods of mild depression and hypomania, an elevated mood. The low and high mood swings never reach the severity or duration of major depressive or full mania episodes. People with cyclothymic disorder have milder symptoms than occur in full-blown bipolar disorder.
Manic episodes are characterized by:
A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary)
During the period of mood disturbance, three (or more) of the following symptoms have persisted (4 if the mood is only irritable) and have been present to a significant degree:
- increased self-esteem or grandiosity
- decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
- more talkative than usual or pressure to keep talking
- flight of ideas or subjective experience that thoughts are racing
- distractability (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
- increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
- excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)
Bipolar disorder is treated with three main classes of medication: mood stabilizers, antipsychotics, and, while their safety and effectiveness for the condition are sometimes controversial, antidepressants..
Typically, treatment entails a combination of at least one mood-stabilizing drug and/or atypical antipsychotic, plus psychotherapy. The most widely used drugs for the treatment of bipolar disorder include lithium carbonate and valproic acid (also known as Depakote or generically as divalproex). Lithium carbonate can be remarkably effective in reducing mania, although doctors still do not know precisely how it works. Lithium may also prevent recurrence of depression, but its value seems greater against mania than depression; therefore, it is often given in conjunction with other medicines known to have greater value for depression symptoms, sometimes including antidepressants.
Seasonal Affective Disorder (SAD)
is a form of depression most often associated with fewer hours of daylight in the far northern and southern latitudes from late fall to early spring
Seasonal affective disorder (SAD) is a type of depression that’s related to changes in seasons — SAD begins and ends at about the same times every year. If you’re like most people with SAD, your symptoms start in the fall and continue into the winter months, sapping your energy and making you feel moody. Less often, SAD causes depression in the spring or early summer.
Treatment for SAD may include light therapy (phototherapy), medications and psychotherapy.
Don’t brush off that yearly feeling as simply a case of the “winter blues” or a seasonal funk that you have to tough out on your own. Take steps to keep your mood and motivation steady throughout the year.
Common symptoms of SAD include fatigue, even with too much sleep, and weight gain associated with overeating and carbohydrate cravings. SAD symptoms can vary from mild to severe and can include many symptoms similar to major depression, such as:
- Feeling of sadness or depressed mood
- Marked loss of interest or pleasure in activities once enjoyed
- Changes in appetite; usually eating more, craving carbohydrates
- Change in sleep; usually sleeping too much
- Loss of energy or increased fatigue despite increased sleep hours
- Increase in restless activity (e.g., hand-wringing or pacing) or slowed movements and speech
- Feeling worthless or guilty
- Trouble concentrating or making decisions
- Thoughts of death or suicide or attempts at suicide
SAD may begin at any age, but it typically starts when a person is between ages 18 and 30.
Treatment for seasonal affective disorder may include light therapy, medications and psychotherapy. If you have bipolar disorder, tell your doctor — this is critical to know when prescribing light therapy or an antidepressant. Both treatments can potentially trigger a manic episode.
Premenstrual Dysphoric Disorder (PMDD)
Premenstrual dysphoric disorder (PMDD) is a much more severe form of premenstrual syndrome (PMS). It may affect women of childbearing age. It’s a severe and chronic medical condition that needs attention and treatment. Lifestyle changes and sometimes medicines can help manage symptoms.
In general, to diagnose PMDD the following symptoms must be present:
Over the course of a year, during most menstrual cycles, 5 or more of the following symptoms must be present:
- Depressed mood
- Anger or irritability
- Trouble concentrating
- Lack of interest in activities once enjoyed
- Increased appetite
- Insomnia or the need for more sleep
- Feeling overwhelmed or out of control
- Other physical symptoms, the most common being belly bloating, breast tenderness, and headache
- Symptoms that disturb your ability to function in social, work, or other situations
- Symptoms that are not related to, or exaggerated by, another medical condition
Two types of medication may help with PMDD: those that affect ovulation and those that impact the central nervous system (CMS).
Examples include the use of:
- SSRI antidepressants such as fluoxetine (Prozac, Sarafem), sertraline (Zoloft), paroxetine (Paxil), and citalopram (Celexa)
- oral contraceptives that contain drospirenone and ethinyl estradiol
- gonadotropin-releasing hormone analogs such as leuprolide (Lupron), nafarelin (Synarel) and goserelin (Zoladex)
- danazol (Danocrine)
Cognitive therapy (CT) has been shown to help those with PMS. Combined with medication, CT may also help those with PMDD.
Disruptive Mood Dysregulation Disorder (Formerly Childhood Bipolar Disorder)
This is a disorder of chronic, severe and persistent irritability in children that often includes frequent temper outbursts that are inconsistent with the child’s developmental age.
The defining characteristic of disruptive mood dysregulation disorder (DMDD) in children is a chronic, severe, and persistent irritability. This irritability is often displayed by the child as a temper tantrum, or temper outburst, that occur frequently (3 or more times per week). When the child isn’t having a temper outburst, they appear to be in a persistently irritable or angry mood, present most of the day, nearly every day. As the DSM-5 Fact Sheet says, “Far beyond temper tantrums, DMDD is characterized by severe and recurrent temper outbursts that are grossly out of proportion in intensity or duration to the situation.”
This disorder, which was new to the DSM-5 in 2013, was created in an effort to replace the diagnosis of childhood bipolar disorder. The prevalence of this disorder is not yet known, but is expected to be within the 2 to 5 percent range for children.
The onset of symptoms must be before age 10, and a diagnosis should not be made for the first time before age 6 or after age 18.
Diagnostic Criteria for Disruptive Mood Dysregulation Disorder:
- Severe recurrent temper outbursts manifested verbally (e.g., verbal rages) and/or behaviorally (e.g., physical aggression toward people or property) that are grossly out of proportion in intensity or duration to the situation or provocation
- The temper outbursts are inconsistent with developmental level (e.g., the child is older than you would expect to be having a temper tantrum).
- The temper outbursts occur, on average, three or more times per week
- The mood between temper outbursts is persistently irritable or angry most of the day, nearly every day, and is observable by others (e.g., parents, teachers, friends).
- The above criteria have been present for 1 year or more, without a relief period of longer than 3 months. The above criteria must also be present in two or more settings (e.g., at home and school), and are severe in at least one of these settings
- The diagnosis should not be made for the first time before age 6 years or after age 18. Age of onset of these symptoms must be before 10 years old.
- There has never been a distinct period lasting more than 1 day during which the full symptom criteria, except duration, for a manic or hypomanic episode have been met.
- The behaviors do not occur exclusively during an episode of major depressive disorder and are not better explained by another mental disorder.
As with all child mental disorders, the symptoms also can not be attributable to the physiological effects of a substance or to another medical or neurological condition.
If you think your child has DMDD, it is important to seek treatment. DMDD can impair a child’s quality of life and school performance and disrupt relationships with his or her family and peers. Children with DMDD may find it hard to participate in activities or make friends. Having DMDD also increases the risk of developing depression or anxiety disorders in adulthood.
While researchers are still determining which treatments work best, two major types of treatment are currently used to treat DMDD symptoms:
- Psychological treatments
- Parent training
- Computer based training
Psychological treatments should be considered first, with medication added later if necessary, or psychological treatments can be provided along with medication from the beginning.
It is important for parents or caregivers to work closely with the doctor to make a treatment decision that is best for their child.
Depression Related To Medical Illness
Is a persistent depressed mood and a significant loss of pleasure in most or all activities that’s directly related to the physical effects of another medical condition.
Depression associated with a chronic medical illness often aggravates the condition, especially if the illness causes pain and fatigue, or limits a person’s ability to interact with others. Depression can intensify pain, as well as fatigue and sluggishness. The combination of chronic illness and depression also can cause people to isolate themselves, which is likely to exacerbate the depression.
Research on chronic illnesses and depression indicates that depression rates are high among patients with chronic conditions:
- Heart attack: 40% to 65% experience depression
- Coronary artery disease (without heart attack): 18% to 20% experience depression
- Parkinson’s disease: 40% experience depression
- Multiple sclerosis: 40% experience depression
- Stroke: 10% to 27% experience depression
- Cancer: 25% experience depression
- Diabetes: 25% experience depression
- Chronic pain syndrome: 30% to 54% experience depression
- Huntington’s Chorea – depression is a hallmark of the beginning of the disease and the end of the disease
Depression Related To Substance Use And/Or Abuse:
It’s no secret that there is a strong connection between substance use and mental illness. In fact, substance abuse is nearly always linked to depression, this is called duel diagnosis, meaning that there are two closely related problems that need to be treated at the same time.
The National Bureau of Economic Research reports that people who have been diagnosed with a mental illness at some point in life consume 69 percent of the nation’s alcohol and 84 percent of the national’s cocaine. When a person struggles with substance abuse and a mental illness, this is known as a dual diagnosis or co-occurring disorder.
Depression is a mental illness frequently co-occurring with substance use. The relationship between the two disorders is bi-directional, meaning that people who abuse substances are more likely to suffer from depression, and vice versa. People who are depressed may drink or abuse drugs to lift their mood or escape from feelings of guilt or despair. But substances like alcohol, which is a depressant, can increase feelings of sadness or fatigue. Conversely, people can experience depression after the effects of drugs wear off or as they struggle to cope with how the addiction has impacted their life.
Depression is all too often a gateway into drug and alcohol use. It’s easy to see why. Those who experience feelings of depressions take alcohol and drugs in order to escape their negative emotions. But those who are clinically depressed are going to stay depressed if they do not seek treatment. And if these individuals are using drugs and alcohol on a regular basis, chances are their usage will soon turn into full-blown addiction as they continue in a vain attempt to self-medicate.
For some individuals who have depression and a substance use disorder, giving up drugs or alcohol can actually make depression worse. If you’ve been using alcohol for years to bury your depressive symptoms, you may find that your depression rises to the surface in sobriety. That’s why it’s so important to receive integrated treatment for both depression and substance abuse at the same time.
Without treating the depression that drives your addiction, or vice versa, you’re likely to go back to your addictive behaviors or to experience a return of your depressive symptoms as soon as you finish rehabilitation. In many cases, people who have depression and substance abuse drop out of conventional rehab programs because sobriety is too much to handle without the right level of therapeutic support.
How Are Mood Disorders Treated?
Mood disorders can often be treated with success. Treatment may include:
- Antidepressant and mood stabilizing medicines—especially when combined with psychotherapy have shown to work very well in the treatment of depression
- Psychotherapy—most often cognitive-behavioral and/or interpersonal therapy. This therapy is focused on changing the person’s distorted views of himself or herself and the environment around him or her. It also helps to improve interpersonal relationship skills, and identifying stressors in the environment and how to avoid them
- Family therapy
- Other therapies, such as electroconvulsive therapy and transcranial stimulation
Families play a vital supportive role in any treatment process. When correctly diagnosed and treated, people with mood disorders can live, stable, productive, healthy lives.