Mood Disorders

Overview

What is a mood disorder?

A mood disorder is a mental health problem that primarily affects a person’s emotional state. It is a disorder in which a person experiences long periods of extreme happiness, extreme sadness, or both.

It is normal for someone’s mood to change, depending on the situation. However, to be diagnosed with a mood disorder, symptoms must be present for several weeks or longer. Mood disorders can cause changes in your behavior and can affect your ability to deal with routine activities, such as work or school.

Two of the most common mood disorders are depression and bipolar disorder. This article will review these disorders and some of their many subtypes.

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.

Symptoms and Causes

What causes mood disorders?

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

What are the symptoms of common mood disorders?

Symptoms depend on the type of mood disorder that is present.

Symptoms of major depression may include:

  • Feeling sad most of the time or nearly every day
  • Lack of energy or feeling sluggish
  • Feeling worthless or hopeless
  • Loss of appetite or overeating
  • Gaining weight or losing weight
  • Loss of interest in activities that formerly brought enjoyment
  • Sleeping too much or not enough
  • Frequent thoughts about death or suicide
  • Difficulty concentrating or focusing

Symptoms of bipolar disorder may include both depression and mania. Symptoms of hypomanic or manic episodes include:

  • Feeling extremely energized or elated
  • Rapid speech or movement
  • Agitation, restlessness, or irritability
  • Risk-taking behavior, such as spending too much money or driving recklessly
  • Unusual increase in activity or trying to do too many things at once
  • Racing thoughts
  • Insomnia or trouble sleeping
  • Feeling jumpy or on edge for no apparent reason

Diagnosis and Tests

How are mood disorders diagnosed?

Your doctor may perform a physical examination to rule out physiological causes for symptoms, such as a thyroid problem, other illnesses, or a vitamin deficiency. The doctor will ask about your medical history, any medications you are taking, and whether you or any family members have been diagnosed with a mood disorder. A mental health professional, such as a psychologist or psychiatrist, will conduct an interview or survey, asking questions about your symptoms, sleeping and eating habits, and other behavior.

Management and Treatment

How are mood disorders treated?

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.

Outlook / Prognosis

What’s the outlook for people with mood disorders?

Mood disorders such as depression and bipolar disorder may recur or be ongoing and therefore may require long-term or lifetime treatment. It is important to take your medications as prescribed. After starting your medications, it may take two to six weeks before you begin to notice a change in your symptoms. Do not stop taking your medication, even if you begin to feel better.

Discuss any concerns you have about changing or stopping medications with your doctor or another health professional. Ask your doctor whether you might need to try a different medication or have the dosage adjusted, if the one you are taking is ineffective or causes unpleasant side effects such as headaches, nausea, vomiting, or diarrhea.

Psychotherapy has been shown to be helpful treatment approach and is often used together with medication or brain stimulation therapy. Minor forms of depression can be treated with psychotherapy alone. Brain stimulation therapies are usually tried when other treatment options have not been successful, in people with severe symptoms, and in those who cannot tolerate the side effects of drug therapy. Every therapy has its potential role, as each patient with a mood disorder is unique.

Seek help immediately if you feel suicidal or have thoughts of harming yourself or others.

Last reviewed by a Cleveland Clinic medical professional on 07/16/2018.

References

  • National Institute of Mental Health. Accessed 7/17/2018.Any Mood Disorder. (https://www.nimh.nih.gov/health/statistics/any-mood-disorder.shtml)
  • National Institute of Mental Health. Accessed 7/17/2018. Depression. (https://www.nimh.nih.gov/health/topics/depression/index.shtml)
  • National Institute of Mental Health. Accessed 7/17/2018. Bipolar Disorder. (https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml)
  • National Institute of Mental Health. Accessed 7/17/2018. Brain Stimulation Therapies. (https://www.nimh.nih.gov/health/topics/brain-stimulation-therapies/brain-stimulation-therapies.shtml)
  • National Institute of Mental Health. Accessed 7/17/2018. Seasonal Affective Disorder. (https://www.nimh.nih.gov/health/topics/seasonal-affective-disorder/index.shtml)
  • National Institute of Mental Health. Accessed 7/17/2018. Mental Health Medications. (https://www.nimh.nih.gov/health/topics/mental-health-medications/index.shtml)
  • National Alliance on Mental Illness. Accessed 7/17/2018. Bipolar Disorder. (https://www.nami.org/Learn-More/Mental-Health-Conditions/Bipolar-Disorder)
  • National Alliance on Mental Illness. Accessed 7/17/2018. Depression. (https://www.nami.org/Learn-More/Mental-Health-Conditions/Depression)
  • American Psychiatric Association. Accessed 7/17/2018. Bipolar Disorders. (https://www.psychiatry.org/patients-families/bipolar-disorders/what-are-bipolar-disorders)
  • American Psychiatric Association. Accessed 7/17/2018.Help with Depression. (https://www.psychiatry.org/patients-families/depression)

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