INTRODUCTION

A mood disorder is a mental health class that health professionals use to broadly describe all types of depression and bipolar disorders. Mood disorders are characterized by a serious change in mood that cause disruption to life activities. Though many different subtypes are recognized, three major states of mood disorders exist: depressive, manic, and bipolar. Major depressive disorder is characterized by overall depressed mood. Elevated moods are characterized by mania or hypomania. The cycling between both depressed and manic moods is characteristic of bipolar mood disorders. In addition to type and subtype of mood, these disorders also vary in intensity and severity. For example, dysthymic disorder is a lesser form of major depression and cyclothymic disorder is recognized as a similar, but less severe form of bipolar disorder.

TYPES OF MOOD DISORDERS

Two of the most common mood disorders are depression and bipolar disorder. Some of their many subtypes are:

Depression (major or clinical depression). Depression is a common mental disorder. Grief or sadness is a typical response to a traumatic life event or crisis, such as the death of a spouse or family member, loss of a job, or a major illness. However, when the depression continues to be present even when stressful events are over or there is no apparent cause, physicians would then classify the depression as clinical or major depression. For a person to be diagnosed with clinical depression, symptoms must last for at least two weeks.

There are several different types of depression. Symptoms may vary depending on the form of the disorder.

• Postpartum depression (peripartum depression) - This type of depression occurs during pregnancy or after delivery
• Persistent depressive disorder (dysthymia) - This is a chronic form of depression that can last for at least two years. Symptoms may occasionally lessen in severity during this time.
• Seasonal affective disorder (SAD) - This is another type of depression that occurs during certain seasons of the year. It typically starts in the late autumn or early winter and lasts until spring or summer. Less commonly, SAD episodes may also begin during the late spring or summer. Symptoms of winter seasonal affective disorder may resemble those of a major depression. They tend to disappear or lessen during spring and summer.
• Psychotic depression - This is a type of severe depression combined with psychotic episodes, such as hallucinations (seeing or hearing things that others do not) or delusions (having fixed but false beliefs). The episodes may be upsetting or disturbing and often have a theme.
• Depression related to a medical condition, medication, or substance abuse

Bipolar disorder (manic-depressive disorder). Bipolar disorder is defined by swings in mood from periods of depression to mania. When someone experiences a low mood, symptoms may resemble those of a clinical depression. Depressive episodes alternate with manic episodes or mania. During a manic episode, a person may feel elated or can also feel irritable or have increased levels of activity.

There are four basic types of bipolar disorder.

• Bipolar I - This is the most severe form. Manic episodes last at least seven days or may be severe enough to require hospitalization. Depressive episodes will also occur, often lasting for at least two weeks. Sometimes symptoms of both mania and depression are present at the same time.
• Bipolar II disorder - This disorder causes cycles of depression similar to those of bipolar I. A person with this illness also experiences hypomania, which is a less severe form of mania. Hypomanic periods are not as intense or disruptive as manic episodes. Someone with bipolar II disorder is usually able to handle daily responsibilities and does not require hospitalization.
• Cyclothymia disorder (cyclothymia) - This type of bipolar disorder has sometimes been defined as a milder form of bipolar disorder. People with cyclothymia experience continuous irregular mood swings – from mild to moderate emotional “highs” to mild to moderate “lows” – for extended periods of time. In addition, changes in mood can occur quickly and at any time. There are only short periods of normal mood. For an adult to be diagnosed with cyclothymic, symptoms have to be experienced for at least 2 years. For children and adolescents, the, symptoms must persist for at least one year.
• “Other” or “unspecified” bipolar disorder - Symptoms of this type of bipolar disorder do not meet the criteria for one of the other types but people still have significant, abnormal changes in mood.

Other mood disorders

• Premenstrual dysphoric disorder - This type of mood disorder occurs seven to 10 days before menstruation and goes away within a few days of the start of the menstrual period. Researchers believe this disorder is brought about by the hormonal changes related to the menstrual cycle. Symptoms may include anger, irritability, tension, decreased interest in usual activities, and sleep problems.
• Intermittent explosive disorder - This is a lesser-known mood disorder marked by episodes of unwarranted anger. It is commonly referred to as “flying into a rage for no reason.” In an individual with intermittent explosive disorder, the behavioral outbursts are out of proportion to the situation.

CAUSES

There may be several underlying factors, depending on the type of the disorder. Various genetic, biological, environmental, and other factors have been associated with mood disorders.

Risk factors include:

• Family history
• Previous diagnosis of a mood disorder
• Trauma, stress or major life changes in the case of depression
• Physical illness or use of certain medications. Depression has been linked to major diseases such as cancer, diabetes, Parkinson’s disease and heart disease.
• Brain structure and function in the case of bipolar disorder

SYMPTOMS

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

· 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.

TREATMENT

Treatment will depend on the specific illness and symptoms that are present. Usually, therapy involves a combination of medication and psychotherapy (also called “talk therapy”). Therapy sessions may be conducted by a psychologist, psychiatrist, or other health professional.

Medications to treat depression and/or bipolar disorders

• Antidepressants - Many different medications are available to treat depression and depressive episodes of bipolar disorder. Some of the most widely used drugs are selective serotonin reuptake inhibitors (SSRIs). These include citalopram (Celexa®), escitalopram (Lexapro®), sertraline (Zoloft®), fluoxetine (Prozac®), and paroxetine (Paxil®). Serotonin and norepinephrine reuptake inhibitors (SNRIs) such as duloxetine (Cymbalta®) and venlafaxine (Effexor®) also are commonly prescribed and are similar to SSRIs in their action. Bupropion (Wellbutrin®) is used to treat depression and seasonal affective disorder. It works differently than SSRIs or SNRIs. Older types of antidepressants include tricylic antidepressants, monoamine oxidase inhibitors, and tetracyclic antidepressants. Although different types are found to work equally well, some antidepressants may be more effective depending on the individual. It is important to take the antidepressants as prescribed and continue taking them even if you feel better. Usually an antidepressant must be taken as prescribed for 4 to 6 weeks before it begins to work.
• Mood stabilizers - These medications help to regulate the mood swings that occur with bipolar disorder or other disorders. They reduce abnormal brain activity. Mood stabilizers may also be prescribed along with antidepressants in some cases. Some of the most widely used mood stabilizers include lithium and anticonvulsant drugs, such as valproic acid (Valproic®), lamotrigine (Lamictal®), carbamazepine (Tegretol®), and oxecarbazepine (Trileptal®).
• Antipsychotics - Patients with bipolar disorder who experience mania or mixed episodes may be treated with an atypical antipsychotic drug, such as aripiprazole (Abilify®). Atypical antipsychotics may also sometimes be used to treat depression, if symptoms are not controlled with an antidepressant alone.

Psychotherapy (talk therapy)

Patients with depression and other mood disorders may benefit from various types of psychotherapy or counseling sessions. Types of therapy include:

• Cognitive-behavioral therapy
• Interpersonal therapy
• Problem-solving therapy

Brain stimulation therapies

Brain stimulation therapies are thought to work by causing changes in the chemicals in the brain that are known to be associated with symptoms of depression and bipolar disorders. There are several types of brain stimulation therapies including:

• Electroconvulsive therapy (ECT) - ECT has long been used to treat severe depression or bipolar disorder in cases when medication or psychotherapy have been unsuccessful. Before having ECT, a patient is placed under general anesthesia and is given a muscle relaxant. Electrodes are placed in certain locations on the scalp or forehead. An electric current is passed through the brain to induce a seizure. The patient awakens after five to 10 minutes. The ECT sessions can be performed on an outpatient basis. Usually, two or three sessions per week are required, over a period of two weeks or more. Generally, six to 12 sessions are required.
• Repetitive Transcranial Magnetic Stimulation (rTMS) - This noninvasive procedure uses a magnetic coil to apply short electromagnetic pulses to specific nerve cells in the brain. The magnet is positioned against the forehead, while pulses are sent through the skull. The procedure is used to treat major depression for patients who do not respond to at least one antidepressant drug.

Treatments for seasonal depression

Antidepressant medications, such as SSRIs and bupropion, and psychotherapy are used to treat seasonal affective disorder. In addition, patients may benefit from light therapy and vitamin D supplements.

• Light therapy - This technique has long been used to treat SAD. It is based on the idea of supplementing natural sunlight with bright artificial light during the fall and winter. Patients may use a light box that provides cool-white fluorescent light. Each morning, the person is exposed to the artificial light for about 20 to 60 minutes. The light is about 20 times more intense than regular indoor lighting.