MOOD DISORDERS

Types of Mood Disorders

 This chapter explores the two major forms of mood

disorders: depressive disorders and bipolar disorders
(mood swing disorders).
 Depressive disorders are also called Unipolar disorders
because the mood disturbance goes in only one
emotional direction or pole: down. By contrast, Mood
swing disorders are called Bipolar disorders because they
involve states of both depression and elation, which often
appear in an alternating pattern.
 Major Depressive Disorder

 The diagnosis of major depressive disorder (also called major

depression) is based on the occurrence of at least one major
depressive episode (MDE) in the absence of a history of mania or
hypomania. A major depressive episode involves a clinically
significant change in functioning involving a range of depressive
symptoms, including depressed mood (feeling sad, hopeless, or
“down in the dumps”) and/or loss of interest or pleasure in all or
virtually all activities for a period of at least two weeks (APA, 2013).
 Major depression is not simply a state of sadness or the blues.
People with major depressive disorder (MDD) may have poor
appetite, lose or gain substantial amounts of weight, have trouble
sleeping or sleep too much, and become physically agitated or—at
the other extreme—show a marked slowing down in their motor
(movement) activity.
 Major Depressive Disorder

 Major depression impairs people’s ability to meet the ordinary responsibility of

everyday life. People with major depression may lose interest in most of their
usual activities and pursuits, have difficulty concentrating and making decisions,
have pressing thoughts of death, and attempt suicide.
 Many people don’t seem to understand that people who are clinically depressed
can’t simply “shake it off” or “snap out of it.” Many people still view depression as
a sign of weakness, not a diagnosable disorder.
 Another factor explaining the lack of care is that many depressed patients seek
help from their family physicians, who often fail to either detect depression or
make referrals to mental health professionals (Simon et al., 2004).
 Major depression is a major public health problem, not only affecting
psychological functioning but also impairing a person’s ability to meet school,
work, family, and social responsibilities
 Major depression, particularly in more severe episodes, may be accompanied by
psychotic features, such as delusions that one’s body is rotting from illness. People
with major depression may also exhibit psychotic behaviors, such as
hallucinations, as in “hearing” voices condemning the person for perceived
misdeeds.
 Major Depressive Disorder

 Major depressive episodes may resolve in a matter of

months or last for a year or more. Some people
experience a single episode of major depression and then
return to their earlier state of normal psychological
functioning (Eaton et al., 2008).
 Evidence shows that risk of repeat episodes is related to
genetic influences and the presence of other significant
medical or psychiatric illnesses (Burcusa & Iacono, 2007;
Richards, 2011).
 Major Depressive Disorder

SEASONAL AFFECTIVE DISORDER

 Although our moods may vary with the weather, the changing of the seasons from summer
to fall and winter can lead to a type of depression called seasonal affective (mood) disorder
(SAD) (Madsen, Dam, & Hageman, 2011). Whatever the underlying cause, the therapeutic
use of bright artificial light, called phototherapy, often helps relieve depression in SAD and
also Antidepressant drugs, such as Prozac, may also help relieve depression in patients with
seasonal affective disorder.
POSTPARTUM DEPRESSION
 Many new mothers, perhaps as many as 80%, experience mood changes following
childbirth
 Given these turbulent hormonal shifts, it might be considered “abnormal” for most women
not to experience some changes in feeling states shortly following childbirth. However,
some new mothers, about one in seven according to recent estimates (Friedman, 2009),
experience more severe mood changes that can be classified as a mood disorder called
postpartum depression (PPD)
 The word postpartum derives from the Latin roots post, meaning “after,” and papere,
meaning “to bring forth.”
 Postpartum depression needs to be distinguished from a much less common but more
severe reaction, called postpartum psychosis, in which the new mother loses touch with
reality and experiences symptoms such as hallucinations, delusions, and irrational thinking.
 Persistent Depressive Disorder (Dysthymia)

 The diagnosis of persistent depressive disorder is used to classify cases of

chronic lasting for at least two years.
 Dysthymia typically begins in childhood or adolescence and tends to
follow a chronic course through adulthood. The word dysthymia derives
from Greek roots dys-, meaning “bad” or “hard,” and thymos, meaning
“spirit.”
 People with dysthymia feel “bad spirited” or “down in the dumps” most
of the time, but they are not as severely depressed as those with major
depressive disorder.
 Although dysthymia is less severe than major depressive disorder,
persistent depressed mood and low self-esteem can affect the person’s
occupational and social functioning, as in the following case.
 Some people are affected by both dysthymia and major depression at the
same time. The term double depression applies to those who have a
major depressive episode superimposed on a longer-standing dysthymia
 Premenstrual Dysphoric Disorder

 Premenstrual dysphoric disorder (PMDD) was introduced as a diagnostic

category in DSM-5 (Epperson, 2013). It had been classified in the previous
edition of the DSM as a proposed diagnosis requiring further study
 PMDD is a more severe form of premenstrual syndrome (PMS), which is a
cluster of physical and mood-related symptoms occurring during the
woman’s premenstrual period.
 The diagnosis of PMDD is intended to apply to women who experience a
rang of significant psychological symptoms in the week before menses
(and improvement beginning within a few days following the onset of
menses).
 A range of symptoms need to be present to diagnose PMDD, including
symptoms such as mood swings, sudden tearfulness or feelings of
sadness, depressed mood or feelings of hopelessness, irritability or anger,
feelings of anxiety, tension, being on edge, greater sensitivity to cues of
rejection, and negative thoughts about oneself.
 We have noted that major depressive disorder and
dysthymia are depressive disorders in the sense that the
disturbance of mood is only in one direction—down. Yet,
people with mood disorders may have fluctuations in
mood in both directions that exceed the usual ups and
downs of everyday life. These types of disorders are
called bipolar disorders. Here, we focus on the major
types of mood swing disorders: (1) bipolar disorder and
(2) cyclothymic disorder.
 Bipolar Disorder

 Bipolar disorder is characterized by extreme swings of

mood and changes in energy and activity levels.
 The first episode may be either manic or depressive.
Manic episodes typically last a few weeks or perhaps a
month or two and are generally much shorter and end
more abruptly than major depressive episodes. Some
people with bipolar disorder attempt suicide “on the way
down” from the manic phase.
 Bipolar Disorder

The DSM -5 distinguishes between two types of bipolar disorder, bipolar I

disorder and bipolar II disorder. The distinction can be confusing, so
let’s try to clarify.
 The distinction is based on whether the person has ever experienced a
full-blown manic episode (Youngstrom, 2009). The diagnosis of bipolar
I disorder applies to people who have had at least one full manic
episode at some point in their lives. Typically, bipolar I disorder
involves extreme mood swings between manic episodes and major
depression with intervening periods of normal mood.
 Bipolar II disorder applies to people who have had hypomanic
episodes (from the Greek prefix hypo-, meaning “under” or “less
than”) as well as a history of at least one major depressive episode,
but have never had a full-blown manic episode. Hypomanic episodes
are less severe than manic episodes and are not accompanied by the
extreme social or occupational problems associated with full-blown
mania (Tomb et al., 2012).
 Bipolar Disorder

MANIC EPISODE
 A manic episode typically begins abruptly, gathering force within days. A hallmark
feature of a manic episode, as well as a hypomanic episode, is increased activity
or energy
 . The basic difference between a full manic episode and a hypomanic episode is
one of degree or severity. During a manic episode, the person experiences a
sudden elevation or expansion of mood and feels unusually cheerful, euphoric, or
optimistic.
 People in a manic episode tend to show poor judgment and to be argumentative,
sometimes going so far as to destroy property. Roommates may find them
abrasive and keep a distance from them. They may become extremely generous
and make large chari table contributions they can ill afford or give away costly
possessions.
 People in a manic episode tend to speak very rapidly (with pressured speech).
Their thoughts and speech may jump from topic to topic in a rapid flight of ideas.
Others find it difficult to get a word in edgewise. They typically experience an
inflated sense of self esteem that may range from extreme self-confidence to
wholesale delusions of grandeur.
 Cyclothymic Disorder

 Cyclothymia is derived from the Greek kyklos, which means

“circle,” and thymos, meaning “spirit.” The notion of a circular-
moving spirit is an apt description, because this disorder represents
a chronic cyclical pattern of mood disturbance characterized by
mild mood swings lasting at least two years (one year for children
and adolescents).
 Cyclothymic disorder (also called cyclothymia) usually begins in late
adolescence or early adulthood and persists for years. Few, if any,
periods of normal mood last for more than a month or two.
However, the periods of elevated or depressed mood are not
severe enough to warrant a diagnosis of bipolar disorder
 The boundaries between bipolar disorder and cyclothymic disorder
are not clearly established. Some forms of cyclothymic disorder
may represent a mild, early type of bipolar disorder
GOMAWOSUMNIDA