Mood disorders and their types

A mood disorder is a pattern of illness due to an abnormal mood. It’s a pervasive distortion of one’s emotional state. Nearly every patient who has a mood disorder experiences the “lows” of depression at some time, but some may also have the “highs” of mania. Many, but not all, mood disorders are diagnosed on the basis of a mood episode.

Broadly speaking, emotions can be described as two main types:

1. Affect, which is a short-lived emotional response to an idea or an event, and

2. Mood, which is a sustained and pervasive emotional response which colors the whole psychic life.

Mood disorders are diverse in nature, as is illustrated by the many types of depression recognized in the DSM-5 that we will discuss. Nevertheless, in all mood disorders (formerly called affective disorders), extremes of emotion or affect—soaring elation or deep depression—dominate the clinical picture. Other symptoms are also present, but the abnormal mood is the defining feature.

The two key moods involved in mood disorders are mania, often characterized by intense and unrealistic feelings of excitement and euphoria, and depression, which usually involves feelings of extraordinary sadness and dejection. Some people with mood disorders experience only time periods or episodes characterized by depressed moods. However, other people experience manic episodes at certain time points and depressive episodes at other time points. Normal mood states can occur between both types of episodes.

Types of mood disorders

Major Depressive Disorder :

The diagnostic criteria for major depressive disorder (also known as major depression) require that the person exhibit more symptoms than are required for dysthymia and that the symptoms be more persistent (not interwoven with periods of normal mood). To receive a diagnosis of major depressive disorder, a person must be in a major depressive episode and never have had a manic, hypomanic, or mixed episode.

An affected person must experience either markedly depressed moods or marked loss of interest in pleasurable activities most of every day, nearly every day, for at least two consecutive weeks. In addition to showing one or both of these symptoms, the person must experience additional symptoms during the same period.

Bipolar I disorder :

Bipolar I disorder is distinguished from major depressive disorder by the presence of mania (see Table 7.2 for a summary). A mixed episode is characterized by symptoms of both full-blown manic and major depressive episodes for at least 1 week, whether the symptoms are intermixed or alternate rapidly every few days. Such cases were once thought to be relatively rare but have increasingly been recognized as relatively common (e.g., Cassidy et al., 1998; Goodwin & Jamison, 2007).

Indeed Goodwin & Jamison’s (2007) review of 18 studies reported that an average of 28 percent of bipolar patients at least occasionally experiences mixed states. Moreover, many patients in a manic episode have some symptoms of depressed mood, anxiety, guilt, and suicidal thoughts, even if these are not severe enough to qualify as a mixed episode.

Bipolar II disorder : 

In this, the person does not experience full-blown manic (or mixed) episodes but has experienced clear-cut hypomanic episodes as well as major depressive episodes (Akiskal & Benazzi, 2005). Bipolar II disorder is equally or somewhat more common than bipolar I disorder, and, when combined, estimates are that about 2 to 3 percent of the U.S. population will suffer from one or the other disorder (e.g., Kessler et al., 2007; Kupfer, 2005). Bipolar II disorder evolves into bipolar I disorder in only about 5 to 15 percent of cases, suggesting that they are distinct forms of the disorder (Coryell, 1995; Goodwin & Jamison, 2007).

Recently, a subthreshold form of bipolar II disorder has also been recognized as careful study has revealed that as many as 40 percent of individuals diagnosed with unipolar MDD have a similar number of hypomanic symptoms, although not with a sufficient number or duration to qualify for a full-blown hypomanic episode (Zimmerman, 2009). Along with related findings, such results are leading researchers and clinicians to recognize that unipolar MDD is a far more heterogeneous category than previously recognized.

Mania :

Premenstrual Dysphoric Disorder :

Postpartum Depression (Peripartum Depression) :

Postpartum “Blues” Even though the birth of a child would usually seem to be a happy event, postpartum depression sometimes occurs in new mothers (and occasionally fathers) and it is known to have adverse effects on child outcomes (e.g., Ramchandani et al., 2005). In the past, it was believed that postpartum major depression in mothers was relatively common, but more recent evidence suggests that only “postpartum blues” are very common.

The symptoms of postpartum blues typically include changeable mood, crying easily, sadness, and irritability, often liberally intermixed with happy feelings (Miller, 2002; O’Hara et al., 1990, 1991; Reck et al., 2009). Such symptoms occur in as many as 50 to 70 percent of women within 10 days of the birth of their child and usually subside on their own (Miller, 2002; Nolen-Hoeksema & Hilt, 2009).

New findings show that hypomanic symptoms are also frequently observed, intermixed with the more depression-like symptoms (Sharma et al., 2009).

Persistent Mood Disorder :

These disorders are characterized by persistent mood symptoms which last for more than 2 years (1 year in children and adolescents) but are not severe enough to be labeled as even hypomanic or mild depressive episodes.

If the symptoms consist of persistent mild depression, the disorder is called dysthymia; and if symptoms consist of persistent instability of mood between mild depression and mild elation, the disorder is called cyclothymia.

Dysthymia :

A chronic depression of mood which does not currently fulfill the criteria for recurrent depressive disorder, mild or moderate severity (F33.0 of F33.1), in terms of either severity or duration of individual episodes, although the criteria for mild depressive episode may have been fulfilled in the past, particularly at the onset of the disorder.

The balance between individual phases of mild depression and intervening periods of comparative normality is very variable. Sufferers usually have periods of days or weeks when they describe themselves as well, but most of the time (often for months at a time) they feel tired and depressed; everything is an effort and nothing is enjoyed.

They brood and complain, sleep badly, and feel inadequate, but are usually able to cope with the basic demands of everyday life. Dysthymia, therefore, has much in common with the concepts of depressive neurosis and neurotic depression. If required, the age of onset may be specified as early (in late teenage or the twenties) or late.

Cyclothymic Disorders :

Persistent instability of mood, involving numerous periods of mild depression and mild elation. This instability usually develops early in adult life and pursues a chronic course, although at times the mood may be normal and stable for months at a time.

The mood swings are usually perceived by the individual as being unrelated to life events. The diagnosis is difficult to establish without a prolonged period of observation or an unusually good account of the individual’s past behavior.

Because the mood swings are relatively mild and the periods of mood elevation may be enjoyable, cyclothymia frequently fails to come to medical attention. In some cases, this may be because the mood change, although present, is less prominent than cyclical changes in activity, self-confidence, sociability, or appetitive behavior. If required, the age of onset may be specified as early (in late teenage or the twenties) or late.

Seasonal Affective Disorder :

This is either a bipolar mood disorder or recurrent depressive episode which tends to occur in the same season on each occasion. It is usually more commonly seen in women.

For example, in a bipolar seasonal mood disorder, depression would tend to occur in the same months every time (usually winter months), while mania would occur in the months of some other season every episode (usually summer months).

This is thought to be due to changes in the length of the day (and light) and its effect on the hypothalamus. The characteristic symptoms of winter depression are dysphoria, decreased activity, and atypical depressive symptoms (increased fatigue, increased sleep, increased appetite and weight, and carbohydrate craving).

Involutional Melancholia :

As described by Kraepelin, this is a form of severe depression which occurs in the involutional period of life (i.e. 40-65 years of age).

It is typically characterized by marked agitation, presence of psychotic features (such as delusions of persecution, tactile and auditory hallucinations), and multiple somatic symptoms (or hypochondriacal delusions). Presently, it is no longer thought of as an independent entity but the term is used to describe the severity of a depressive episode.

Mixed Anxiety Depressive Disorder :

This disorder is characterized by the presence of depressive and anxiety symptoms which result in significant distress or disability in the person. The symptoms should not meet the criteria of either an anxiety disorder or a mood disorder.

This disorder is apparently seen more frequently in the medical outpatient departments and primary care centers. Several cases probably exist untreated in the general population, but rarely come to medical attention.

In clinical practice, it is important to consider a diagnosis of either a mood disorder or an anxiety disorder, before attempting a diagnosis of the mixed anxiety-depressive disorder.

Masked Depression :

In masked depression, the depressive mood is not easily apparent and is usually hidden behind the somatic symptoms. This is especially common in the elderly, where the somatic symptoms range from chronic pain, insomnia, atypical facial pain, and paraesthesias. The depressive symptoms can also be masked by drug and/or alcohol misuse. However, a more detailed examination will bring out the tell-tale symptomatology of depression.

The treatment is similar to a depressive episode.

Depressive Equivalents :

These are certain conditions that, though not a part of the depressive syndrome, are still thought to be comparable to depression (affective spectrum disorders). Some of these show clinical responses to anti-depressant treatment whilst others appear related to depression due to multiple complex reasons.

These disorders include agoraphobia, chronic pain, paraesthesias, panic attacks, alcoholism, drug abuse, hysteria, obsessive-compulsive disorder, and eating disorders ( anorexia nervosa and bulimia nervosa).

This term presently has an uncertain nosological status.

Agitated Depression :

This is a type of severe depression with marked motor restlessness or agitation. It is either seen alone or along with involutional melancholia. It is more common after the age of 40 years.

The treatment of agitated depression usually requires addition of antipsychotics or benzodiazepines to antidepressant therapy.

Double Depression :

People with double depression are moderately depressed on a chronic basis (meeting symptom criteria for dysthymia) but undergo increased problems from time to time, during which they also meet the criteria for a major depressive episode. Among clinical samples of people with dysthymia, the experience of double depression appears to be very common, although it may be much less common in people with the dysthymic disorder who never seek treatment (Akiskal, 1997).

Although nearly all individuals with double depression appear to recover from their major depressive episodes (although usually just to their previous level of dysthymia) recurrence is common (Boland & Keller, 2002; Klein, 2008, 2010; Klein et al., 2006).

In DSM-5, double depression will be classified as a form of persistent depressive disorder along with dysthymia and chronic major depressive disorder. The term “persistent” was adopted because it was felt to be less pejorative than the word chronic.

DISCLAIMER: After going through this,  if you think you have these symptoms/somebody around you does have ,  DON’T IMMEDIATE LABEL SELF/OTHERS,  rather consult an expert psychologist !!!

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