By Dr. Cheryl Lane, PhD
Almost everyone experiences at least brief periods of sadness, feeling “down”, or being energetic and upbeat at various points in his/her lifetime. That’s just part of being human. However, there’s a significant portion of the population that has disturbances in their mood that are not considered normal. Individuals in this group have what is clinically referred to as a “mood disorder”.
What “mood” means in a medical context
While many people use the term “mood” to simply refer to their feelings at any given moment (e.g. “I’m in a happy mood”), mental health professionals use it a bit differently. In clinical settings, it is used to describe a persistent emotional state that affects how the person sees the world.
Mood disorders are characterized by a significant disturbance in a person’s persistent emotional state or mood. The two primary types of moods are depression and mania. Thus, most mood disorders fall under the broad categories of depressive disorders and bipolar disorders (formerly known as “manic depressive” disorders).
Most individuals with a bipolar mood disorder experience episodes of depression as well as manic (or hypomanic) episodes. The term “bipolar” refers to these fluctuations in mood from one “pole” to the other.
Characteristics of Depression
Individuals experiencing a depressed mood often feel sad, “blue”, pessimistic, lethargic, irritable, apathetic, worthless, and / or hopeless. Difficulties concentrating and making decisions are common. They often experience problematic changes in their sleep and appetite, such as eating and sleeping more than usual, struggling with insomnia, or not feeling like eating much at all. In severe cases, depressed individuals may contemplate and even attempt suicide – usually in an attempt to escape their emotional pain.
Characteristics of Mania
Individuals experiencing a manic mood typically exhibit unusually high energy levels. They may be extremely happy or “euphoric”, unusually sociable or enthusiastic, or even very irritable. They may be very grandiose, have little need for sleep, experience racing thoughts, be easily distracted, appear agitated, and / or be unusually talkative. They may suddenly take on a lot of projects or engage in highly pleasurable (and often risky) activities, such as going on a major shopping spree or having sex with several partners over a short period of time.
Other Characteristics of Mood Disorders
Mood disorders significantly disrupt people’s lives in one or more ways. They may impair their ability to function normally at work or in their social life, or negatively impact their relationships. Their symptoms may be severe enough to require hospitalization in order to ensure their safety (or the safety of others).
In some cases of severe depression and mania, psychotic features are present. Psychosis essentially means there is a “disconnect” with reality. Symptoms of psychosis often include hallucinations (e.g. hearing voices when no one is around) or delusions (e.g. believing that aliens have removed their internal organs).
Prevalence of Mood Disorders
According to the National Institute of Health, 20% of the U.S. adult population will suffer a mood disorder during their lifetime. During any given 12 month period, 9.5% of the adult population has a mood disorder, with approximately 5% of them classified as severe. Unfortunately, only 20% of those with mood disorders receive adequate treatment.
Mood disorders are among the top 10 causes of disability worldwide (Murray & Lopez, 1996), with unipolar major depression being the most widely experienced. Women are 50% more likely than men to experience a mood disorder.
Diagnosis of Mood Disorders
Mood disorders are diagnosed by a physician, nurse practitioner, or mental health professional. The diagnostic process usually involves an interview with the patient and / or those close to him/her (e.g. a spouse or parent).
With depressive disorders, it is not uncommon for patients to seek treatment from their primary doctor for related physical symptoms such as insomnia or low energy. Unless their doctor takes the time to explore the symptoms sufficiently, an accurate diagnosis may not be made. Due to the stigma and shame often associated with both depression and bipolar disorder, many patients are also reluctant to disclose more obvious symptoms. They may deny them even if their doctor asks. Men in particular are less likely to admit to a low libido or feelings of sadness, worthlessness, and hopelessness.
Treatment of Mood Disorders
Most mood disorders are treatable. Even with treatment, however, some mood disorders last for a lifetime or recur periodically. For example, some people have one acute, relatively brief episode of major depressive disorder that resolves with appropriate treatment. Others, however, may have experience depression that lasts for several months or even years, or have recurring episodes throughout their lifetime. Unlike unipolar depression, bipolar disorder is considered a lifelong disorder that requires ongoing treatment.
The two primary types of treatment for mood disorders are psychotherapy and medication. Psychotherapy, as a general rule, focuses on managing symptoms as well as addressing the underlying psychological issues that may be causing or exacerbating the mood disorder. Medication is used to treat and / or manage the disorder by targeting imbalances in the person’s brain chemistry.
There are a variety of effective psychotherapeutic approaches that may be used in the treatment of mood disorders. However, many studies have shown that one of the most effective types of psychotherapy – particularly for depressive disorders – is cognitive behavioral therapy. In cases of mild and even moderate depression, psychotherapy alone is often sufficient. Severe cases of depression often require medication, at least initially.
Many clinicians argue that medication alone is not the best treatment for depressive disorders. This is because medication doesn’t address the psychological issues, such as negative thought patterns or low self-esteem, that often play a significant role in depression. Many patients find that if they stop taking medication, their symptoms return. Psychotherapy can also help patients learn effective coping skills that will help thwart or minimize future episodes.
Unlike depressive disorders, the treatment of bipolar disorders almost always includes ongoing medication. Mood stabilizers are typically used to help prevent manic and hypomanic episodes. Other medications may also be used in conjunction with the mood stabilizers. Psychotherapy can help bipolar individuals learn to manage stress (which can trigger mood episodes), learn more effective coping skills, and manage their disorder in general.
Treatment effectiveness for mood disorders depends on a variety of factors. These include the degree of patient compliance with treatment, the skill and experience of treatment providers, the severity of the disorder, whether or not the patient has other co-occurring disorders, the level of support in the patient’s life, and the type of treatment itself.
With severe mood disorders, such as a patient who is extremely manic or severely depressed and suicidal, hospitalization is often necessary. Once his/her symptoms are stabilized, the patient can continue treatment on an outpatient basis.