Chapter 7 Mood Disorders
Feelings of depression (and joy) are universal, which makes it all the more difficult to understand disorders
AN OVERVIEW OF DEPRESSION AND MANIA
- Depressive disorders, affective disorders and depressive neuroses have been grouped under the heading
mood disorders because they are characterized by gross deviations in mood.
- The fundamental experience of depression and mania contribute, either singly or together, to all the mood
Major depressive episode the most commonly diagnosed and most severe depression.
Criteria an extremely depressed mood state that lasts at least 2 weeks and includes cognitive symptoms
(such as feelings of worthlessness and indecisiveness) and disturbed physical function (such as altered
sleeping patterns, significant changes in appetite and weight, or very notable loss of energy. The episode is
typically marked by a general loss of interest and of the inability to experience any pleasure (anhedonia)
from life, including interactions with family/friends. The physical changes (sometimes call somatic or
vegetative symptoms) are central to this disorder as they strongly indicate a full major depressive episode.
Avg 9 month
Mania individuals find extreme pleasure in every activity by abnormally exaggerating joy or euphoria. They
become extraordinarily active (hyperactive), requiring very little sleep, and may develop grandiose plans,
believing they can accomplish anything they desire. Speech is typically very rapid and may become
incoherent, because the individual is attempting to express so many exciting ideas at once (flight of ideas).
Criteria Manic episode requires a duration of only one week, less if the episode is severe enough to require
hospitalization (ex. self-destructive shopping sprees). Duration = 2-6 months untreated.
Hypomanic a less severe version of a manic episode that does not cause marked impairment in social or
occupational functioning. (Hypo means below; thus, the episode if below the level of a manic episode)
THE STRUCUTRE OF MOOD DISORDERS
- Individuals who experience either depression or mania are said to have unipolar mood disorder, because
their mood remains at one pole of the depression-mania continuum. Almost everyone with a unipolar mood
disorder has unipolar depression (mania alone is rare).
- Individuals who alternate between depression and mania is said to have a bipolar mood disorder,
traveling from one pole of the depression-elation continuum to the other and back again.
- However, an individual can experience manic symptoms but feel somewhat depressed or anxious at the
same time. This combination is called dysphoric manic or mixed episode. The patient may experience
symptoms of mania as being out of control or dangerous and becomes anxious or depressed about them.
- The rare individual who has only manic episodes also meets criteria for bipolar mood disorder because
experience shows that this individual can be expected to become depressed at a later time.
Major depressive disorder, single episode most easily recognized mood disorder and defined by the
absence of manic or hypomanic episodes before or during the episode. Chapter 7 Mood Disorders
Major depressive disorder, recurrent - If two or more major depressive episodes occurred and were
separated by at least two months during which the individual was not depressed. Recurrence is very
important in predicting the future course of the disorder as well as in choosing appropriate treatments.
Individuals with recurrent major depression usually have a family history of depression.
Dysthymic disorder shares many of the symptoms of major depressive disorder (milder), but remains
relatively unchanged over long periods of time, sometimes 20 or 30 years or more. Dysthymic disorder is
defined as a persistently depressed mood that continues for at least two years, and isnt free of symptoms for
more than 2 months at a time. It differs from a major depressive episode only in the severity, chronicity, and
number of its symptoms, which are milder and fewer, but last longer.
Double Depression Experience both Major Depression episodes and dysthymic disorder
- Although the typical age of onset of dysthymic disorder is around early 20s, adolescent onset of depression
is associated with (1) greater chronicity it last longer (2) relatively poor prognosis (response to treatment),
and (3) a stronger likelihood of the disorder running in the family of the affected individual.
- Patients with dysthymia were more likely to attempt suicide than a comparison group with episodes of
major depressive disorder during a 5-year period.
From Grief to Depression
- The frequency of sever depression following the death of a loved one is so high (approx. 62%) that mental
health professionals do not consider it a disorder unless very severe symptoms appear (psychotic features or
suicidal thoughts) or the less alarming symptoms last longer than two months.
- Many of the psychological and social factors related to mood disorders in general, including a history of past
depressive episodes, also predict the development of a normal grief response into a pathological grief
reaction or impacted grief reaction.
- The key-identifying feature of bipolar disorders is the tendency of manic episodes to alternate with major
depressive episodes in an unending roller coaster ride from the peaks of elation to the depths of despair. A
manic episode might occur only once or repeatedly.
Bipolar II Disorder Individuals with major depressive episodes alternating with hypomanic episodes
rather than full manic episodes. Criteria One episode is seen as a continuation of the last.
Bipolar I Disorder the same as Bipolar II disorder, except the individual experiences a full manic episode.
Criteria must have a symptom-free period of at least two months between them.
- The high during a manic state is so pleasurable, people may stop taking their medication during periods of
distress or discouragement in an attempt to bring on a manic state once again.
Cyclothymic Disorder (like dysthymic disorder) is a chronic alternation of mood elevation and depression
that does not reach the severity of manic or major depressive episodes. Individuals with cyclothymic
disorder tend to be in one mood sate or the other for many years with relatively few periods of neutral mood.
Criteria pattern must last for at least two years (1 year for children and adolescents)
- The average age of onset for bipolar I disorder is 18, and for bipolar II it is 22, although cases of both begin
in childhood (1/3 of most cases). Individuals who develop bipolar disorder after the age of 40, the course
appears chronic; that is, depression and mania alternate indefinitely.
- In typical cases, cyclothymia is chronic and lifelong. In 1/3 of patients, cyclothymic mood swings develop
into full-blown bipolar disorder. This disorder is often not recognized, and those experiencing it are thought
to be high-strung, explosive, moody, or hyperactive.Chapter 7 Mood Disorders
- Other symptoms, or specifiers, may or may not accompany a mood disorder. The postpartum onset
specifier can apply to both major depressive and manic episodes. It is characterized by severe manic or
depressive episodes that first occur during the postpartum period (four weeks immediately following
childbirth), typically 2-3 days after delivery.
- Having an infant with a difficult temperament is an important type of stressor that can contribute to
postpartum depression. Low socioeconomic status and high levels of life stress are also related to the
persistence of postpartum depression. Early recognition is very important because a mother in the midst of
an episode has killed her newborn child.
Specific Describing Course of Mood Disorders
Three specifiers may accompany recurrent mania or depression:
1) Longitudinal course specifiers: Most likely, the patient will require a long and intense course of
treatment to maintain a normal mood state for as long as possible after recovering from the current episode.
2) Rapid-cycling specifier: Only applies to bipolar I and bipolar II disorders. Some people move very quickly
in and out of depressive or manic episodes. An individual with bipolar disorder who experiences at least four
manic or depressive episodes within a year is considered to have rapid-cycling pattern. As many as 90% are
female and most people with rapid-cycling begin with a depressive episode rather than manic.
3) Seasonal pattern specifier: Applies to both bipolar disorders and to recurrent major depressive disorder.
It accompanies episodes that occur during certain seasons (ex. winter depression). IN bipolar disorder,