Mood Disorders

Mood disorders, also called affective disorders, are a group of illnesses that have as their distinguishing characteristic an experience of mood that is unusual for the circumstances. Common mood disorders include bipolar disorder, depression, postpartum depression, cyclothymia, schizoaffective disorder, and seasonal affective disorder. Most mood disorders are at least somewhat treatable with drugs and psychotherapy.

Two groups of mood disorders are broadly recognized; the division is based on whether the person has ever had a manic or hypomanic episode. Thus, there are depressive disorders, of which the best known and most researched is major depressive disorder commonly called clinical depression or major depression, and bipolar disorder, formerly known as "manic depression" and described by intermittent periods of manic and depressed episodes.

The relationship between pure depressive syndromes and bipolar disorders is not well understood; depression is more frequent in families of bipolar individuals, but the reverse is not true.

Depressive disorders or hypomaniac episodes:
Major depressive disorder (MDD), commonly called major depression, unipolar depression, or clinical depression, where a person has one or more major depressive episodes. After a single episode, Major Depressive Disorder (single episode) would be diagnosed. After more than one episode, the diagnosis becomes Major Depressive Disorder (Recurrent). Depression without periods of mania is sometimes referred to as unipolar depression because the mood remains at one emotional state or "pole".
Individuals with a major depressive episode or major depressive disorder are at increased risk for suicide. Seeking help and treatment from a health professional dramatically reduces the individual's risk for suicides

There are several subtypes of depressive disorders:
Atypical depression –It  is characterized by mood reactivity and positivity, significant weight gain or increased appetite excessive sleep or somnolence, a sensation of heaviness in limbs known as leaden paralysis, and significant social impairment as a consequence of hypersensitivity to perceived interpersonal rejection.

Melancholic depression- It is characterized by a loss of pleasure in most or all activities, a failure of reactivity to pleasurable stimuli, a quality of depressed mood more pronounced than that of grief or loss, a worsening of symptoms in the morning hours, early morning waking, psychomotor retardation, excessive weight loss or excessive guilt.

Psychotic major depression - It is the term for a major depressive episode, particularly of melancholic nature, where the patient experiences psychotic symptoms such as delusions or, less commonly, and hallucinations. These are most commonly mood-congruent

Catatonic depression- It is a rare and severe form of major depression involving disturbances of motor behavior and other symptoms. Here the person is mute and almost stuporose, and either immobile or exhibits purposeless or even bizarre movements. Catatonic symptoms also occur in schizophrenia, a manic episode, or due to neuroleptic malignant syndrome.

Postpartum depression- It refers to the intense, sustained and sometimes disabling depression experienced by women after giving birth. Postpartum depression, which has incidence rate of 10–15%, typically sets in within three months of labor, and lasts as long as three months. It is quite common for women to experience a short term feeling of tiredness and sadness in the first few weeks after giving birth; however, postpartum depression is different because it can cause significant hardship and impaired functioning at home, work, as well as possibly difficulty in relationships with family members, spouses, friends, or even problems bonding with the newborn.

Seasonal affective disorder- It is also known as "winter depression" or "winter blues" is a specifier. Some people have a seasonal pattern, with depressive episodes coming on in the autumn or winter, and resolving in spring. The diagnosis is made if at least two episodes have occurred in colder months with none at other times over a two-year period or longer. It is commonly hypothesised that people who live at higher latitudes tend to have less sunlight exposure in the winter and therefore experience higher rates of SAD, but the epidemiological support for this proposition is not strong (and latitude is not the only determinant of the amount of sunlight reaching the eyes in winter). SAD is also more prevalent in people who are younger and typically affects more females than males.

Recurrent brief depression- It distinguished from major depressive disorder primarily by differences in duration. People with RBD have depressive episodes about once per month, with individual episodes lasting less than two weeks and typically less than 2–3 days. Diagnosis of RBD requires that the episodes occur over the span of at least one year and, in female patients, independently of the menstrual cycle. People with clinical depression can develop RBD, and vice versa, and both illnesses have similar risks.

Bipolar disorders:
Bipolar disorder is a mood disorder formerly known as "manic depression" and described by alternating periods of mania and depression (and in some cases rapid cycling, mixed states, and psychotic symptoms).
Bipolar Disorder has been broken down into two types:

Bipolar I: For a diagnosis of Bipolar I disorder, a person must have at least one manic episode. Mania is sometimes referred to as the other extreme to depression. Mania is an intense high where the person feels euphoric, almost indestructible in areas such as personal finances, business dealings, or relationships. They may have an elevated self-esteem, be more talkative than usual, have flight of ideas, a reduced need for sleep, and be easily distracted. The high, although it may sound appealing, will often lead to severe difficulties in these areas, such as spending much more money than intended, making extremely rash business and personal decisions, involvement in dangerous sexual behavior, and/or the use of drugs or alcohol. Depression is often experienced as the high quickly fades and as the consequences of their activities becomes apparent, the depressive episode can be exacerbated.

Bipolar II: Similar to Bipolar I Disorder, there are periods of highs as described above and often followed by periods of depression. Bipolar II Disorder, however is different in that the highs are hypo manic, rather than manic. In other words, they have similar symptoms but they are not severe enough to cause marked impairment in social or occupational functioning and typically do not require hospitalization in order to assure the safety of the person.

Cyclothymia – It is a different form of bipolar disorder, consisting of recurrent hypomanic and dysthymic episodes, but no full manic episodes or full major depressive episodes.

There are some other types of mood disorders which are as follows:
Substance induced mood disorders: A mood disorder can be classified as substance-induced if its etiology can be traced to the direct physiologic effects of a psychoactive drug or other chemical substance, or if the development of the mood disorder occurred contemporaneously with substance intoxication or withdrawal. Alternately, an individual may have a mood disorder coexisting with a substance abuse disorder. Substance-induced mood disorders can have features of a manic, hypomanic, mixed, or depressive episode.

Alcohol induced mood disorders: High rates of major depressive disorder occur in heavy drinkers and those with alcoholism. In some cases, alcohol misuse directly causes the development of depression in a significant number of heavy drinkers. High rates of suicide also occur in those who have alcohol-related problems. It is usually possible to differentiate between alcohol-related depression and depression which is not related to alcohol intake by taking a careful history of the patient. Depression and other mental health problems associated with alcohol misuse may be due to distortion of brain chemistry, as they tend to improve on their own after a period of abstinence.

Benzodiazepine induced mood disorders: The long-term use of benzodiazepines, such as Valium and Librium, may have a similar effect on the brain as alcohol, and are also implicated in depression. Major depressive disorder can also develop as a result of chronic use of benzodiazepines or as part of a protracted withdrawal syndrome. Benzodiazepines are a class of medication which are commonly used to treat insomnia, anxiety and muscular spasms. As with alcohol, the effects of benzodiazepine on neurochemistry, such as decreased levels of serotonin and nor epinephrine, are believed to be responsible for the increased depression. Major depressive disorder may also occur as part of the benzodiazepine withdrawal syndrome Depression resulting from withdrawal from benzodiazepines usually subsides after a few months but in some cases may persist for 6–12 months.

Interferon-alpha induced mood disorders: Combination therapy with interferon and ribavirin for chronic hepatitis C virus (HCV) infection may induce major depression.

Causes and symptoms:
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. Major life stressors (like divorce, serious financial problems, death of a family member, etc.) will often provoke the symptoms of depression in susceptible people.
Major depression is more serious than just feeling "sad" or "blue." The symptoms of major depression may include:
• loss of appetite
• a 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. The person may also have physical symptoms like stomachaches or headaches

Bipolar disorder includes mania or hypomania. Mania is an abnormal elevation in mood. The person may be excessively cheerful, have grandiose ideas, and may sleep less. They may talk nonstop for hours, have unending enthusiasm, and demonstrate poor judgement. 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/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.

Diagnosis:
Doctors diagnose mood disorders based on the patient's description of the symptoms as well as the patient's family history. The length of time the patient has had symptoms is also important. Generally patients are diagnosed with dysthymia if they feel depressed more days than not for at least two years. The depression is mild but long lasting. In major depressive disorder, the patient is depressed almost all day nearly every day of the week for at least two weeks. The depression is severe. Sometimes laboratory tests are performed to rule out other causes for the symptoms (like thyroid disease). The diagnosis may be confirmed when a patient responds well to medication.

Treatment:
A number of psychotherapy approaches are useful. 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.

Alternative treatment:
There are many alternative therapies that may help in the treatment of mood disorders, including acupuncture, botanical medicine, homeopathy, aromatherapy, constitutional hydrotherapy, and light therapy. The therapy used is an individual choice.

Prognosis:
For more severe cases, prognosis is poor in terms of ’curing’ the illness, as most people need to remain on medication for their entire lives. The manic episodes may slow down as a result of the natural aging process. With medication, the illness can be kept at a minimum level, with some people not experiencing any overt symptoms for months and even years.

Compiled by Ashish Arora
Article 6/13.
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