Mood Disorders
Depression and Bipolar Disorders
BY: T. Franklin Murphy | September 27, 2022 (Modified January 10, 2023)
Depression and Bipolar Disorders
BY: T. Franklin Murphy | September 27, 2022 (Modified January 10, 2023)
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Mood Disorders is a group of psychiatric illnesses that health professionals use to describe types of depression and bipolar disorders. These disorders simultaneously affect emotions, drain energy, and curtail motivation.
Two of the most common mood disorders are major depressive disorder and bipolar disorder. Major depression disorder will afflict nearly 16% of the population sometime during their lifetime. Bipolar disorder has a lifetime prevalence of close to 5% (This include all the subcategories of bipolar disorder).
These disorders severely impact quality of life and are associated with increased mortality. Major depressive disorder is the second leading cause of disability in the world.
Two of the most common mood disorders are major depressive disorder and bipolar disorder. Major depression disorder will afflict nearly 16% of the population sometime during their lifetime. Bipolar disorder has a lifetime prevalence of close to 5% (This include all the subcategories of bipolar disorder).
These disorders severely impact quality of life and are associated with increased mortality. Major depressive disorder is the second leading cause of disability in the world.
Types of Mood Disorders
Mood disorders are subdivided into two major categories: depressive disorders and bipolar disorders. Both depressions and bipolar disorders impact the quality of life through dysregulation of emotion, interfering with relationships and motivation. The emotion lability interferes with predictable futures, significantly increasing stress.
Mood disorders often are self feeding systems where symptoms motivate behaviors that increase anxiety and depression, compounding the severity of symptoms rather than healing the wounds.
T. Franklin Murphy wrote, "anxiousness pushes for immobilization, escaping fears of failure, leaving victims cowering in helplessness to the vicissitudes of life." He continues, "depression saps energy, dulling motivation to act. Both diseases can debilitate leading to inactivity, entering life draining practices that are self-perpetuating" (2019). Because of the self-perpetuating nature of the mood disorders, it is essential they get diagnosed and treated early.
Mood disorders are diagnosed in one of the following categories:
Mood disorders often are self feeding systems where symptoms motivate behaviors that increase anxiety and depression, compounding the severity of symptoms rather than healing the wounds.
T. Franklin Murphy wrote, "anxiousness pushes for immobilization, escaping fears of failure, leaving victims cowering in helplessness to the vicissitudes of life." He continues, "depression saps energy, dulling motivation to act. Both diseases can debilitate leading to inactivity, entering life draining practices that are self-perpetuating" (2019). Because of the self-perpetuating nature of the mood disorders, it is essential they get diagnosed and treated early.
Mood disorders are diagnosed in one of the following categories:
Depressive Disorders
Major Depressive Disorder
Major depressive disorder is characterized by a persistent feeling of sadness and emptiness, lasting longer than two weeks. For diagnosis the depressive episode must also include four of the following symptoms:
For diagnoses, these symptoms cannot be caused by substance use, general medical conditions, or medication use.
Persistent Depressive Disorder
Persistent depressive disorder is a broad category containing four more specific diseases:
Dysthymic Disorder
Often dysthymic disorder and persistent depressive disorder are used interchangeably. Dysthymic disorder is a continuous long-term (chronic) form of depression.
Those suffering from dysthymic disorder may disengage from life, losing interest in normal activities, feeling hopeless, and lacking motivation to accomplish simple tasks. Typically, dysthymic disorder is accompanied by low self-esteem and an overall feeling of inadequacy.
In dysthymic disorder these symptoms last for years and may significantly interfere with relationships, school, and work.
Recurrent Major Depression without Recovery Between Episodes
Major depression disorder is debilitating, but when the episodes occur without recovery life can be unlivable. Recurrence of major depressive episodes, as described in the medical community, is the return of the symptoms after at least 2 consecutive months between episodes, during which criteria for a major depressive episode is not met, and there must be 5 out of 9 symptoms of depression (Lye, et al., 2020).
Major Depressive Episode Superimposing On Dysthymic Disorder ("Double Depression")
Double depression occurs when a person suffering from dysthymic disorder experiences worsening symptoms, leading to a full episode of major depression (Saling, 2021).
Chronic Major Depression
Chronic depression is diagnosed when the current major depressive episode has lasted more than two years.
Disruptive Mood Dysregulation Disorder
This diagnostic category is reserved for children between the ages of 6-18 years of age. The main presenting symptom are:
These symptoms must go beyond the scope of what is considered normal and age appropriate (Datta, et al., 2021).
Premenstrual Dysphoric Disorder
Premenstrual dysphoric disorder is recognized as a distinct disorder in DSM-5.
Psychological Symptoms:
Physical components:
Symptoms must improve within a few days of the onset of menstrual cycles and resolve after menses to be diagnosed with this specific disorder.
At least five physical, affective, and/or behavioral symptoms must be present, and one or more of the following:
In addition one or more of the following bringing the overall total symptoms to at least five:
Other Depression Disorders
Depression may also be caused by drugs, medication, or a general medical condition. These episodes of depression may be diagnosed and treated differently.
Major depressive disorder is characterized by a persistent feeling of sadness and emptiness, lasting longer than two weeks. For diagnosis the depressive episode must also include four of the following symptoms:
- insomnia or hypersomnia
- increase or decrease of appetite
- psychomotor agitation or retardation
- decreased energy
- decreased concentration
- suicidal ideation
- thoughts of worthlessness or guilt
For diagnoses, these symptoms cannot be caused by substance use, general medical conditions, or medication use.
Persistent Depressive Disorder
Persistent depressive disorder is a broad category containing four more specific diseases:
Dysthymic Disorder
Often dysthymic disorder and persistent depressive disorder are used interchangeably. Dysthymic disorder is a continuous long-term (chronic) form of depression.
Those suffering from dysthymic disorder may disengage from life, losing interest in normal activities, feeling hopeless, and lacking motivation to accomplish simple tasks. Typically, dysthymic disorder is accompanied by low self-esteem and an overall feeling of inadequacy.
In dysthymic disorder these symptoms last for years and may significantly interfere with relationships, school, and work.
Recurrent Major Depression without Recovery Between Episodes
Major depression disorder is debilitating, but when the episodes occur without recovery life can be unlivable. Recurrence of major depressive episodes, as described in the medical community, is the return of the symptoms after at least 2 consecutive months between episodes, during which criteria for a major depressive episode is not met, and there must be 5 out of 9 symptoms of depression (Lye, et al., 2020).
Major Depressive Episode Superimposing On Dysthymic Disorder ("Double Depression")
Double depression occurs when a person suffering from dysthymic disorder experiences worsening symptoms, leading to a full episode of major depression (Saling, 2021).
Chronic Major Depression
Chronic depression is diagnosed when the current major depressive episode has lasted more than two years.
Disruptive Mood Dysregulation Disorder
This diagnostic category is reserved for children between the ages of 6-18 years of age. The main presenting symptom are:
- anger, and tantrums
- persistent irritability, or negative mood,
- and anger that is disproportionate to the situation
- duration for 12 or more months
These symptoms must go beyond the scope of what is considered normal and age appropriate (Datta, et al., 2021).
Premenstrual Dysphoric Disorder
Premenstrual dysphoric disorder is recognized as a distinct disorder in DSM-5.
Psychological Symptoms:
- irritability
- nervousness
- anger
- agitation
- insomnia
- and depression
Physical components:
- gastrointestinal symptoms (nausea, bloating, constipation, abdominal cramps)
- skin issues (acne)
- neurologic symptoms (headache, dizziness, fainting)
- ocular symptoms (vision changes and eye infection)
Symptoms must improve within a few days of the onset of menstrual cycles and resolve after menses to be diagnosed with this specific disorder.
At least five physical, affective, and/or behavioral symptoms must be present, and one or more of the following:
- marked affective lability (mood swings, sadness, tearfulness, increased sensitivity to rejection)
- marked anger or irritability
- marked depressive mood
- or marked anxiety/tension
In addition one or more of the following bringing the overall total symptoms to at least five:
- decreased interest
- decreased concentration
- change in appetite
- change in sleep,
- feelings of being overwhelmed
- decreased energy
- Physical symptoms (breast swelling or tenderness, joint or muscle pain, bloating, weight gain) (Datta, et al., 2021).
Other Depression Disorders
Depression may also be caused by drugs, medication, or a general medical condition. These episodes of depression may be diagnosed and treated differently.
Bipolar Disorders
Bipolar disorder is characterized by biphasic mood episodes that alter between depression and mania but can also be diagnosed by a depression interrupted by a single episode of mania.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, further breaks down bipolar disorder into four more descriptive subcategories:
Bipolar I Disorder
Bipolar I is defined as at least one manic episode with elevated moods such as:
For diagnosis symptoms should last at least one week and impair social and occupational functions. Depressive or mixed episodes may also be present (Datta, et al., 2021).
Bipolar II Disorder
Bipolar II is when major depressive episodes also have at least one hypomanic episode. Hypomania is an elevated mood and increased energy levels lasting for at least four days. Hypomanic episodes are less severe than manic episodes and do not include psychosis.
The duration of hypomanic episodes varies between patients. In between episodes patients may experience residual symptoms, such as:
Cyclothymia
Cyclothymia patients don't meet the threshold for diagnosis of major depression, mania, or hypomania. However, they suffer a low-grade version of mild hypomania and major depression that lasts for at least two years.
Substance-Induced Bipolar Disorder
When criteria of any bipolar diagnoses is induced by substance use than the disorder may be diagnosed as substance induced and require a different form of treatment that also includes specific treatment methods to combat the substance use or abuse.
What Causes Mood Disorders?
Like so many other disorders, typically the cause of mood disorders is a complex mix of genetics and environments that activate susceptibilities. Datta, Suryadevara, & Cheong eloquently wrote, "highly intricate genetic differences and psychosocial stressors together are typically the determinants for stress responses and the resiliency or susceptibility for depression" (2021, p. 1713).
The different mood disorders varying levels of hereditary associations, with all of them having increased risk when a mood disorder is present in the family.
Major depressive order has a significant genetic component. "Genetic studies have revealed a heritability of 37% and a 2.8 times increased risk of developing this illness among first-degree relatives of probands with major depressive disorder" (Rakofsky & Rapaport, 2018).
Long exposure to high stress environments may weaken our resilience, creating greater susceptibility to mood disorders. Gabor Maté wrote that "excessive stress occurs when the demands made on an organism exceed that organism’s reasonable capacities to fulfill them" (Maté, 2011, Kindle location 575). This disease model is referred to in psychology as general adaptation syndrome.
The diathesis stress model provides an accurate description of the possible cause of mood disorders. Murphy wrote that the "diathesis–stress model explores how biological or genetic traits (diatheses) interact with environmental influences (stressors) to produce disorders such as depression, anxiety, or schizophrenia" (2021).
Mood disorders may also be induced by or cooccur with other diseases such as:
How Are Mood Disorders Treated?
Mild mood disorder symptoms may be treated with therapy or personal practices of meditation and mindfulness. More serious symptoms require that attention of trained medical professionals and medication that can be supplemented with therapy and personal practices.
Since mood disorders cover a wide spectrum of symptoms there is no single medication that works universally. Doctors may have to carefully monitor and adjust type and dosage. This can only be done when a patiently honestly and routinely reports progress and worsening of symptoms.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, further breaks down bipolar disorder into four more descriptive subcategories:
Bipolar I Disorder
Bipolar I is defined as at least one manic episode with elevated moods such as:
- distractibility
- insomnia
- grandiosity
- flights of ideas
- goal-directed activities
- pressured speech
- and thoughtless risk-taking behavior
For diagnosis symptoms should last at least one week and impair social and occupational functions. Depressive or mixed episodes may also be present (Datta, et al., 2021).
Bipolar II Disorder
Bipolar II is when major depressive episodes also have at least one hypomanic episode. Hypomania is an elevated mood and increased energy levels lasting for at least four days. Hypomanic episodes are less severe than manic episodes and do not include psychosis.
The duration of hypomanic episodes varies between patients. In between episodes patients may experience residual symptoms, such as:
- emotional dysregulation
- cognitive impairment
- and increased medical and psychiatric comorbidities (2021).
Cyclothymia
Cyclothymia patients don't meet the threshold for diagnosis of major depression, mania, or hypomania. However, they suffer a low-grade version of mild hypomania and major depression that lasts for at least two years.
Substance-Induced Bipolar Disorder
When criteria of any bipolar diagnoses is induced by substance use than the disorder may be diagnosed as substance induced and require a different form of treatment that also includes specific treatment methods to combat the substance use or abuse.
What Causes Mood Disorders?
Like so many other disorders, typically the cause of mood disorders is a complex mix of genetics and environments that activate susceptibilities. Datta, Suryadevara, & Cheong eloquently wrote, "highly intricate genetic differences and psychosocial stressors together are typically the determinants for stress responses and the resiliency or susceptibility for depression" (2021, p. 1713).
The different mood disorders varying levels of hereditary associations, with all of them having increased risk when a mood disorder is present in the family.
Major depressive order has a significant genetic component. "Genetic studies have revealed a heritability of 37% and a 2.8 times increased risk of developing this illness among first-degree relatives of probands with major depressive disorder" (Rakofsky & Rapaport, 2018).
Long exposure to high stress environments may weaken our resilience, creating greater susceptibility to mood disorders. Gabor Maté wrote that "excessive stress occurs when the demands made on an organism exceed that organism’s reasonable capacities to fulfill them" (Maté, 2011, Kindle location 575). This disease model is referred to in psychology as general adaptation syndrome.
The diathesis stress model provides an accurate description of the possible cause of mood disorders. Murphy wrote that the "diathesis–stress model explores how biological or genetic traits (diatheses) interact with environmental influences (stressors) to produce disorders such as depression, anxiety, or schizophrenia" (2021).
Mood disorders may also be induced by or cooccur with other diseases such as:
- Multiple Sclerosis
- Dementia
- Migraine Headaches
- Traumatic Brain Injury
- Parkinson Disease
- Epilepsy
- Stroke
How Are Mood Disorders Treated?
Mild mood disorder symptoms may be treated with therapy or personal practices of meditation and mindfulness. More serious symptoms require that attention of trained medical professionals and medication that can be supplemented with therapy and personal practices.
Since mood disorders cover a wide spectrum of symptoms there is no single medication that works universally. Doctors may have to carefully monitor and adjust type and dosage. This can only be done when a patiently honestly and routinely reports progress and worsening of symptoms.
References:
Datta, S., Suryadevara, U., & Cheong, J. (2021). Mood Disorders. Continuum, 27(6), 1712-1737.
Lye, M., Tey, Y., Tor, Y., Shahabudin, A., Ibrahim, N., Ling, K., Stanslas, J., Loh, S., Rosli, R., Lokman, K., Badamasi, I., Faris-Aldoghachi, A., & Razak, N. (2020). Predictors of recurrence of major depressive disorder. PLoS ONE, 15(3).
Gabor Maté (2011). When the Body Says No: Understanding the Stress-Disease Connection. Wiley; 1st edition
Murphy, T. Franklin (2019) Anxiety, Depression, and Inaction. Flourishing Life Society. Published 1-3-2019. Accessed 9-26-2022.
Murphy, T. Franklin (2021) Diathesis Stress Model. Flourishing Life Society. Published 9-7-2021. Accessed 9-27-2022.
Rakofsky, J., & Rapaport, M. (2018). Mood Disorders. Continuum, 24 (BEHAVIORAL NEUROLOGY AND PSYCHIATRY), 804-827.
Saling, Joseph (2020) Double Depression. WebMD. Published 8-19-2021. Accessed 9-27-2022
Other Flourishing Life Society articles of interest on this topic:
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