As many as 19 million Americans million are affected by mood disorders ( The two main types of mood disorders are bipolar disorder and major depressive disorder which are described as disturbances in mood, behavior and emotion.“ Bipolar disorder is a complex disorder in which the core feature is pathological disturbance in mood ranging from extreme elation, or mania, to severe depression usually accompanied by disturbances in thinking and behavior, which may include psychotic symptoms, such as delusions and hallucinations” (Craddock, Jones 1999). Major depressive disorder or unipolar depression is characterized by a consistent low mood and lack of interest in things typically enjoyed .A second classification of major depressive disorder, is dysthymic disorder which is a chronic but less severe form of major depression (John W. Santrock 2007). Also major depression has many subgroups including seasonal affect disorder and postpartum depression.
While there are many treatment options for the symptoms of mood disorders and promising scientific research, much is still unknown about a disorder that affects so many lives. According to Dinsmoor, R. S. &ump; Odle, T. G. (2009), bipolar depression refers to a condition in which people experience two extremes in mood. The bipolar spectrum includes; bipolar I, bipolar 2, bipolar NOS (not otherwise specified) and cyclothymia and all are related to disturbances in mood but differ in severity of symptoms. They are differentiated by the “impact the symptoms have on the person’s social or occupational function” (Duckworth &ump; Sachs 2011). Typically bipolar I is more severe than bipolar II and bipolar II is more severe than Cyclothymia, which is a more chronic unstable mood state in which the “highs” are not as high and the “lows” are not as low.(Duckworth &ump; Sachs 2011) Mood swings associated with bipolar disorder are identified as depression, mania and hypomania (a less severe form of mania). In bipolar depression patients alternate between mania (and hypo-mania) as well as depression.
These patients switch from a low mood to a frenzied abnormal elevation in mood .A manic episode is, “a period of excessive euphoria, inflated self-esteem, wild optimism and hyperactivity, often accompanied by delusions of grandeur and hostility if activity is blocked” (Dinsmoor, R. S. &ump; Odle, T. G. 2009). According Samuel E. Wood (2011), while manic, “they may waste large sums of money on get-rich-quick schemes and if family members or friends try to stop them they are likely to become hostile, enraged, or even dangerous; they might even harm themselves, so quite often they must be hospitalized during manic episodes to protect them and others from the disastrous consequences of their poor judgment”. Depressed bipolar patients show low self-esteem and prolonged feelings of sadness. They may withdraw from friends and family, as well as activities they use to enjoy. Loss of energy and excessive anxiety are also common.
They may experience changes in eating or sleeping habits as well as a more serious symptom, thoughts of suicide. (Duckworth,K &ump; Sachs,G 2011). Every individual with bipolar experience is different, and they may have all of the symptoms or just select symptoms. Whichever symptoms bipolar people are experiencing they can often interfere with personality, work, school and social functioning. The causes of and triggers for a person with bipolar disorder are not completely known. Individual experiences vary and there are significant differences in severity, many hypothesized causes, and very few concrete answers. On set of bipolar disorder typically appears in late adolescence or early adulthood ( S.E.Wood et al 2011). According to Craddock and Jones (1999), the mean age of onset for both men and women is at 21 years of age. Research indicates that the disorder is caused by a combination of factors including; genetics, brain activity and environment (Healthplace 2009).
Traumatic life events have also been shown to be related to the development of Bipolar disorder. According to the National Alliance of Mental Illness (2010), “A stressful environment or negative life events may interact with an underlying genetic or biological vulnerability to produce the disorder”, although not everyone with a predisposition for bipolar actually experiences it. Bipolar disorder is also thought to be related to the disruption of the serotonin, nor-epinephrine and dopamine neurotransmitters in the brain. PET scans have revealed abnormal patterns of brain activity in people with mood disorders (Myers 2007). Researchers are trying to determine if there are, “chromosomal impairments linked to the disease, although results have varied widely” (Craddock, Jones 1999). In 2007 The American Journal of Psychiatry (2010) published the results of a study that suggested there is a link between the 16th chromosome and the disorder, although “gene studies have failed to identify genes that increase risk in a consistent manner”.
According to experts if parents have bipolar disorder there is a 10-15% chance that their offspring may develop the disorder and monozygotic twin studies have revealed that the risk is even greater if you are a twin (Bressert 2007). While genes may play a role it is not the only factor for the development of bipolar. Long term use of SSRI’s and recreational drugs has also been linked to the onset of the disorder (Duckworth &ump; Sachs 2011). Major Depressive Disorder, or unipolar depression, can have a profound effect on the lives of those impacted. Much like the depressive phase of bipolar, people with unipolar depression experience long periods (at least two weeks) of; irregular sleep schedules, irregular eating patterns, lethargy and withdrawal from positive aspects of their lives (Bressert 2007). Two subgroup of major depressive disorder are postpartum depression and seasonal affect disorder (Duckworth &ump; Sachs 2010). Postpartum depression is considered one of the most significant major depressions for new mothers. PPD can occur during pregnancy as well as after birth.
Anxiety related to lack of income, child care cost, and lack of support at home or at work can trigger postpartum depression, and can cause problems in the bonding process between mother and child. The symptoms of postpartum depression include: agitation, anxiety or irritability, frequent crying, sadness, loss of energy or fatigue, and thoughts of death or suicide (Postpartum.com 2011). PPD can have grave consequences including harm to the child, if not treated. Mothers can pursue many avenues for relief from symptoms. First and foremost is the support of her friends and family. They can also seek therapy, including cognitive behavioral therapy, talk thereby and medication which is proven effective in managing the symptoms of depression. One highly visible case of postpartum depression was the experiences of Brook Shields who bravely chronicled her journey in the book, “Down Came the Rain”. According to researchers major depressive disorder is a combination of brain chemistry, family history and psychosocial environment and most often is associated with chemical imbalances of several neurotransmitters such as serotonin and dopamine.
Scientists also believe that there is evidence to suggest that there is a genetic predisposition to major depression. There is an increased risk for developing depression when there is a family history of the illness “Life events, such as the death of a loved one, a major loss or change, chronic stress, and alcohol and drug abuse, may trigger episodes of depression. Some illnesses such as heart disease and cancer and some medications may also trigger depressive episodes. It is also important to note that many depressive episodes occur spontaneously and are not triggered by a life crisis, physical illness or other risks”. (NAMI.ORG 2011). There are several treatment options for major depressive disorder and bipolar disorder, including medical treatments, talk therapy, and other types of therapy. Medication is the most commonly used method of treating mood disorders since it is most successful, especially when combined with psychotherapy.
As the treatment begins to be effective, negative thinking will begin to fade and one will begin to see day to day improvements. Serotonin Re-Uptake Inhibitors (SSRI’s) and Serotonin norepinephrine reuptake inhibitors (SNRI’s) are the most commonly used form of antidepressants to treat mood disorders. This includes medications such as Prozac, Zoloft, and Cymbalta. They have also found that bipolar patients respond favorably to anti-seizure medications. While some individuals may feel the effects of the medications after a couple of weeks, it is typical to take 4-9 months to get a full response and prevent symptoms from coming back. For those who are resistant to these medications, they may be augmented with medications such as lithium or triidothyronine. Another treatment for mood disorders is talk therapy. Individuals with depression will usually benefit from some type of talk therapy or counseling, especially when used in combination with medications.
One type of talk therapy is Cognitive Behavioral Therapy or CBT. This type of therapy attempts to teach the individual ways of fighting negative thoughts. The individual learns to become aware of their symptoms, what makes depression worse, and how to solve problems. Another type of therapy is psychotherapy, which can help the individual understand the issues behind their behaviors, thoughts, and feelings. Group therapy is also successful for some, as it allows individuals to come together that are having similar experiences. Other therapies such as electroconvulsive therapy (ECT) and Transcranial magnetic stimulation (TMS) may help those with major depressive disorder who have not seen any results with traditional treatments. TMS uses high frequency magnetic pulses to target specific areas of the brain that are believed to be affected and is often considered as a second-line treatment if ETC is not successful.
Light therapy may also be used to treat depression that occurs over the winter months and to restore a normal sleep cycle, but is not considered an effective treatment for mood disorders when used alone. Mood disorders are complex and there are not any simple solutions. They affect people from every race, social and cultural background and economic status. Mood disorders can have profound effects on families as well as those afflicted, but there is hope. According to Craddock and Jones (1999) “It is however, almost certain over the next few years bipolar susceptibility genes will be identified.
This will have a major impact of disease pathophysiology and will provide important opportunities to investigate the interactions between genetics and environmental factors”. Mood disorders can be traced to our earliest times (indeed, to the Book of Genesis by some writers: Ostow, 1980) and across cultures (Al- Issa, 1982; Carson, et al., 1988). Many famous people apparently suffered from these disorders. Eg: Lincoln and Freud suffered from depression. They are among the most prevalent of psychological disorders (Reus I. Introduction , 1988).
The Mood Disorders are characterized by prolonged and persistent positive and/or negative emotions, which are of such intensity that they can color and interfere with all aspects of one’s life. The key ingredient here is mood. Although thoughts may also be disturbed, thought disorder (ie: impairment of intellectual functioning – reflected by incoherence, unconnected, chaotic thoughts, bizarre speech and the like) is not a defining feature (Thought disorder is central to Schizophrenia, which we will be discussing in later lectures). The emotions experienced in these disorders are typically thought to exist along a continuum with normal emotions (Beck, 1967; Reus, 1988). For example, we’ve all experienced sadness at some point in our lives. But such experiences do not warrant a diagnosis. As we shall see, clinical depression is very different from sadness.
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