Mood disorders

Mood disorders are mental disorders characterized by periods of depression, sometimes alternating with periods of elevated mood. While many people go through sad or elated moods from time to time, people with mood disorders sufferfrom severe or prolonged mood states that disrupt their daily functioning. Among the general mood disorders classified in the fourth edition (1994) of theDiagnostic and Statistical Manual of Mental Disorders (DSM-IV)are major depressive disorder, bipolar disorder, and dysthymia.

In classifying and diagnosing mood disorders, doctors determine if the mood disorder is unipolar or bipolar. When only one extreme in mood (the depressedstate) is experienced, the depression is called unipolar. Major depression refers to a single severe period of depression, marked by negative or hopelessthoughts and physical symptoms like fatigue. In major depressive disorder, some patients have isolated episodes of depression. In between these episodes,the patient does not feel depressed or have other symptoms associated with depression. Other patients have more frequent episodes.

Bipolar depression or bipolar disorder (sometimes called manic depression) refers to a condition in which people experience two extremes in mood. They alternate between depression (the "low" mood) and mania or hypomania (the "high"mood), which are abnormal elevations in mood. Mania and hypomania are similar, but mania is usually more severe and debilitating to the patient. The person may be excessively cheerful, have grandiose ideas, and may sleep less. They may talk nonstop for hours, have unending enthusiasm, and demonstrate poorjudgement. Sometimes the elevation in mood is marked by irritability and hostility rather than cheerfulness. The patient may seem to be in a frenzy and will often make poor, bizarre, or dangerous choices in his/her personal and professional lives. Hypomania is not as severe as mania and does not cause the level of impairment in work and social activities that mania can.

Dysthymia is a recurrent or lengthy depression that may last a lifetime. It is similar to major depressive disorder, but dysthymia is chronic, long-lasting, persistent, and mild. Patients may have symptoms that are not as severe asmajor depression, but the symptoms last for many years. It seems that a mildform of the depression is always present. In some cases, people may also experience a major depressive episode on top of their dysthymia, a condition sometimes referred to as a "double depression."

Mood disorders tend to run in families. These disorders are associated with imbalances in certain chemicals that carry signals between brain cells (neurotransmitters). These chemicals include serotonin, norepinephrine, and dopamine. Women are more vulnerable to unipolar depression than are men. Major life stressors (like divorce, serious financial problems, death of a family member,etc.) will often provoke the symptoms of depression in susceptible people.

Major depression is more serious than just feeling "sad" or "blue." The symptoms of major depression may include:

  • Loss of appetite
  • A changein the sleep pattern, like not sleeping (insomnia) or sleeping too much
  • Feelings of worthlessness, hopelessness, or inappropriate guilt
  • Fatigue
  • Difficulty in concentrating or making decisions
  • Overwhelming and intense feelings of sadness or grief
  • Disturbed thinking. The person may also have physical symptoms like stomachaches or headaches.

Doctors diagnose mood disorders based on the patient's description of the symptoms and the patient's family history. The length of time the patient has had symptoms is also important. Generally patients are diagnosed with dysthymiaif they feel depressed more days than not for at least two years. In major depressive disorder, the patient is depressed almost all day nearly every dayof the week for at least two weeks. The depression is severe. Sometimes laboratory tests are performed to rule out other causes for the symptoms (like thyroid disease). The diagnosis may be confirmed when a patient responds well tomedication.

The most effective treatment for mood disorders is a combination of medication and psychotherapy. The four different classes of drugs used in mood disorders are heterocyclic antidepressants (HCAs), selective serotonin reuptake inhibitors (SSRI inhibitors), monoamine oxidase inhibitors (MAOI inhibitors), andmood stabilizers such as lithium.

A number of psychotherapy approaches are useful as well. Interpersonal psychotherapy helps the patient recognize the interaction between the mood disorderand interpersonal relationships. Cognitive-behavioral therapy explores how the patient's view of the world may be affecting his or her mood and outlook.

When depression fails to respond to treatment or when there is a high risk ofsuicide, electroconvulsive therapy (ECT) is sometimes used. ECT is believedto affect neurotransmitters like the medications do. Patients are anesthetized and given muscle relaxants to minimize discomfort. Then low-level electriccurrent is passed through the brain to cause a brief convulsion. The most common side effect of ECT is mild, short-term memory loss.

There are many alternative therapies that may help in the treatment of mood disorders, including acupuncture, botanical medicine, homeopathy, aromatherapy, constitutional hydrotherapy, and light therapy.Short-term clinical studies have shown that the herb St. John's wort (Hypericum perforatum) can effectively treat some types of depression. Thoughit appears very safe, the herb may have some side effects and its long-termeffectiveness has not been proven. It has not been tested in patients with bipolar disorder. St. John's wort and antidepressant drugs should not be takensimultaneously.

Most cases of mood disorders can be successfully managed if properly diagnosed and treated. People can also take steps to improve mild depression and keepit from becoming a condition that needs medical attention. For example, stress management (like relaxation training or breathing exercises), exercise, and avoidance of drugs or alcohol may be beneficial in improving a mild depression or mood disorder.

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