Mood disorders

Definition

Mood disorders are mental disorders characterized by periods of depression, sometimes alternating with periods of elevated mood.

Description

While many people go through sad or elated moods from time to time, people with mood disorders suffer from severe or prolonged mood states that disrupt their daily functioning. Among the general mood disorders 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 depressed state) is experienced, this condition is called unipolar. Major depression refers to a single severe period of depression, marked by negative or hopeless thoughts 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). These patients go from depression to a frenzied, abnormal elevation in mood. Mania and hypomania are similar, but mania is usually more severe and debilitating to the patient. 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 as major depression, but the symptoms last for many years. It seems that a mild form 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 double depression.

Psychologists have identified the teenage years as one of the most difficult phases of human life. Although they are often seen as a time for enjoying friendship and engaging in activities that adults would not usually do, the teenage period can be difficult. Many changes in the human mind take place during puberty . Apart from the onset of sexual maturity, teenagers must also make key decisions about their future, develop their identities, change schools and meet a new sets of friends, find out about their family's past, and cope with a wide range of other issues. Many young people have difficulty coping with these stresses.

Four out of five teenagers who commit suicide are male, but the average female teenager is prone to attempt suicide four more times during her teen years than the average male. White teenage males are more likely to commit suicide than any other ethnic group, but teenage suicide among blacks was as of 2004 increasing. Teenagers who have unsuccessfully tried to commit suicide in the past are more likely to attempt suicide in the future. The odds increase after each failed attempt. There are two groups of teens that are at the highest risk for committing suicide: Native Americans and teens who are gay, lesbian, bisexual, and transgendered.

Gay and bisexual male teens, which represent about 10 percent of the male teen population, are six to seven times more at risk for attempting suicide than their heterosexual peers. Several surveys show gay and lesbian youth account for 30 percent of all suicides among teens, according to the U.S. Department of Health and Human Services. Yet most studies of teen suicide have not been concerned with identifying sexual orientation.

Demographics

As many as 14 percent of children will experience at least one episode of major depression by age 15. Girls are significantly more likely to experience depression than boys after the age of 16. Out of 100,000 adolescents, two to three thousand will have mood disorders out of which 8 to 10 will commit suicide. In the early 2000s, suicide, attempted suicide, and thoughts of committing suicide are growing problems among adolescents in the United States and much of the world. It is the third leading cause of death among 15 to 19 year olds in the United States and the sixth leading cause of death among 10 to 14 year olds. About 2 percent of adolescent girls and 1 percent of adolescent boys attempt suicide each year in the United States. Another 5 to 10 percent of children and teens each year come up with a plan to commit suicide.

Causes and symptoms

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. In adults, major life stressors (like divorce , serious financial problems, death of a family member, etc.) will often provoke the symptoms of depression in susceptible people. Children's versions of these stressors contribute to their vulnerability to depression.

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

• loss of appetite
• change in 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
• certain physical symptoms such as stomachaches or headaches

Bipolar disorder includes mania or hypomania. Mania is an abnormal elevation in mood. These individuals may be excessively cheerful, have grandiose ideas, and may sleep less. They may talk nonstop for hours, have unending enthusiasm, and demonstrate poor judgment. Sometimes the elevation in mood is marked by irritability and hostility rather than cheerfulness. While the person may at first seem normal with an increase in energy, others who know the person well see a marked difference in behavior. The patient may seem to be in a frenzy and will often make poor, bizarre, or dangerous choices in his or 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.

When to call the doctor

There are many methods for helping teenagers deal with mood disorders, both medical and psychological. Most teenagers who have mood disorders believe their problems are too hard or embarrassing to talk about, so it is important for a helper to show they can be trusted and talked to. Seeing a psychologist is widely recommended as well. Psychologists can improve a teenager's vision of life by listening to them and making them feel it will work out for the best.

If a child or teen is so depressed that he or she is talking about suicide, doctors recommend that parents or other helpers do not ask the adolescent what reason they have to think of such a thing to do; rather, one should listen and wait for the child to gain trust enough so that he or she finally can feel comfortable in talking about the problem. Helpers should, however, show understanding of the teenager's situation. Doctors also recommend that helpers do not mention any "reasons to live" to the teenager, as that might send the teenager back into depressing thoughts, e.g. "What reason do I have to live?" Many doctors recommend that teenagers be taken to a hospital immediately after they express the desire to commit suicide.

Diagnosis

Doctors diagnose mood disorders based on the patient's description of the symptoms as well as the patient's family history. The length of time the patient has had symptoms is also important. Generally patients are diagnosed with dysthymia if they feel depressed more days than not for at least two years. The depression is mild but long lasting. In major depressive disorder, the patient is depressed almost all day nearly every day of 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 to medication.

Treatment

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 as follows:

• heterocyclic antidepressants (HCAs), such as amitriptyline (Elavil)
• selective serotonin reuptake inhibitors (SSRI inhibitors), such as fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft)
• monoamine oxidase inhibitors (MAOI inhibitors), such as phenelzine sulfate (Nardil) and tranylcypromine sulfate (Parnate)
• mood stabilizers, such as lithium carbonate (Eskalith) and valproate, often used in people with bipolar mood disorders

A number of psychotherapy approaches are useful as well. Interpersonal psychotherapy helps the patient recognize the interaction between the mood disorder and 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 of suicide, electroconvulsive therapy (ECT) is sometimes used. ECT is believed to affect neurotransmitters like the medications do. Patients are anesthetized and given muscle relaxants to minimize discomfort. Then low-level electric current is passed through the brain to cause a brief convulsion. The most common side effect of ECT is mild, short-term memory loss.

Alternative treatment

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. The therapy used is an individual choice. Short-term clinical studies have shown that the herb St. John's wort (Hypericum perforatum ) can effectively treat some types of depression. Though it appears very safe, the herb may have some side effects and its long-term effectiveness has not been proven. It has not been tested in patients with bipolar disorder. St. John's wort and antidepressant drugs should not be taken simultaneously, so patients should tell their doctor if they are taking St. John's wort.

Prognosis

Most cases of mood disorders can be successfully managed if properly diagnosed and treated.

Prevention

People can take steps to improve mild depression and keep it from becoming worse. They can learn stress management (like relaxation training or breathing exercises), exercise regularly, and avoid drugs or alcohol.

Parental concerns

Parents who are concerned that their child may have a mood disorder should seek help, such as from a psychiatrist, psychologist, or counselor. Make an appointment with a therapist or counselor who can talk to the child about his or her problems and ways to cope. There are a number of ways parents can help children and teens deal with loneliness, depression, and suicidal feelings. First, parents should let the child do the talking, and they should listen very carefully. They should let the child know they take his or her feelings and thoughts seriously. They should try to find out what is the root of the problem. They may also ask direct questions of the child, such as "Are you thinking of committing suicide?" or "Are you thinking of ending your life?" Third, they should stay with the child. They should not leave the child alone if they say they want to commit suicide. By staying with the child, the parent may be saving the child's life.

KEY TERMS

Cognitive therapy —Psychological treatment aimed at changing a person's way of thinking in order to change his or her behavior and emotional state.

Electroconvulsive therapy (ECT) —A psychological treatment in which a series of controlled electrical impulses are delivered to the brain in order to induce a seizure within the brain. This type of therapy is used to treat major depression and severe mental illness that does not respond to medications.

Neurotransmitter —A chemical messenger that transmits an impulse from one nerve cell to the next.

Serotonin —A widely distributed neurotransmitter that is found in blood platelets, the lining of the digestive tract, and the brain, and that works in combination with norepinephrine. It causes very powerful contractions of smooth muscle and is associated with mood, attention, emotions, and sleep. Low levels of serotonin are associated with depression.

See also Depressive disorders.

Resources

BOOKS

Empfield, Maureen, and Nicholas Bakalar.Understanding Teenage Depression: A Guide to Diagnosis, Treatment, and Management. New York: Owl Books, 2001.

Frank, Kim. The Handbook for Helping Kids with Anxiety and Stress. Chapin, SC: Youthlight Inc., 2003.

Ghaemi, S. Nassir. Mood Disorders: A Practical Guide. New York: Lippincott Williams & Wilkins, 2003.

Nutt, David, et al. Mood and Anxiety Disorders in Children and Adolescents. Florence, KY: Martin Dunitz, Ltd., 2001.

PERIODICALS

Cassano, Giovanni B., et al. "The Mood Spectrum in Unipolar and Bipolar Disorder: Arguments for a Unitary Approach." American Journal of Psychiatry 161 (July 2004): 1264–69.

Coyle, Joseph T., et al. "Depression and Bipolar Support Alliance Consensus Statement on the Unmet Needs in Diagnosis and Treatment of Mood Disorders in Children and Adolescents." Journal of the American Academy of Child and Adolescent Psychiatry 42 (December 2003): 1494–1503.

Koplewicz, Harold S. "More than Moody: Recognizing and Treating Adolescent Depression." The Brown University Child and Adolescent Behavior Letter 18 (December 2002): 1–3.

Youngstrom, Eric A., et al. "Comparing the Diagnostic Accuracy of Six Potential Screening Instruments for Bipolar Disorder in Youths Aged 5 to 17 Years." Journal of the American Academy of Child and Adolescent Psychiatry 43 (July 2004): 847–58.

ORGANIZATIONS

Child & Adolescent Bipolar Foundation. 1000 Skokie Blvd., Suite 425, Wilmette, IL 60091. Web site: <www.bpkids.org>.

National Academy of Child & Adolescent Psychiatry. 3615 Wisconsin Ave. NW, Washington, DC 20016. Web site: <www.aacap.org>.

WEB SITES

"Child and Adolescent Mental Health: Overview of Mood Disorders." Medical University of South Carolina, 2004. Available online at <www.musckids.com/health_library/mentalhealth/overview.htm> (accessed November 11, 2004).

"Mood Disorders." National Youth Network, 2004. Available online at <www.nationalyouth.com/mooddisorders.html> (accessed November 11, 2004).

Robert Scott Dinsmoor Ken R. Wells

Mood Disorders

Definition

Mood disorders are mental disorders characterized by periods of depression, sometimes alternating with periods of elevated mood.

Description

While many people go through sad or elated moods from time to time, people with mood disorders suffer from severe or prolonged mood states that disrupt their daily functioning. Among the general mood disorders classified in the fourth edition (1994) of the Diagnostic 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 depressed state) is experienced, this type of depression is called unipolar. Major depression refers to a single severe period of depression, marked by negative or hopeless thoughts 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). These patients go from depression to a frenzied, abnormal elevation in mood. Mania and hypomania are similar, but mania is usually more severe and debilitating to the patient.

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 as major depression, but the symptoms last for many years. It seems that a mild form of the depression is always present. In some cases, people also may experience a major depressive episode on top of their dysthymia, a condition sometimes referred to as a "double depression."

Causes and symptoms

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 change in sleep patterns, 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.

Bipolar disorder includes mania or hypomania. Mania is an abnormal elevation in mood. The person may be excessively cheerful, have grandiose ideas, and may sleep less. He or she may talk nonstop for hours, have unending enthusiasm, and demonstrate poor judgement. Sometimes the elevation in mood is marked by irritability and hostility rather than cheerfulness. While the person may at first seem normal with an increase in energy, others who know the person well see a marked difference in behavior. The patient may seem to be in a frenzy and often will 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.

Diagnosis

Doctors diagnose mood disorders based on the patient's description of the symptoms as well as the patient's family history. The length of time the patient has had symptoms also is important. Generally patients are diagnosed with dysthymia if they feel depressed more days than not for at least two years. The depression is mild but long lasting. In major depressive disorder, the patient is depressed almost all day nearly every day of 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 to medication.

Treatment

The most effective treatment for mood disorders is a combination of medication and psychotherapy. In fact, a 2003 report revealed that people on medication for bipolar disorder had better results if they also participated in family-focused therapy. The four different classes of drugs used in mood disorders are:

• Heterocyclic antidepressants (HCAs), like amitriptyline (Elavil)
• Selective serotonin reuptake inhibitors (SSRI inhibitors), like fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft)
• Monoamine oxidase inhibitors (MAOI inhibitors), like phenelzine sulfate (Nardil) and tranylcypromine sulfate (Parnate)
• Mood stabilizers, like lithium carbonate (Eskalith) and valproate, often used in people with bipolar mood disorders.

A number of psychotherapy approaches are useful as well. Interpersonal psychotherapy helps the patient recognize the interaction between the mood disorder and 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 of suicide, electroconvulsive therapy (ECT) sometimes is used. ECT is believed to affect neurotransmitters like the medications do. Patients are anesthetized and given muscle relaxants to minimize discomfort. Then low-level electric current is passed through the brain to cause a brief convulsion. The most common side effect of ECT is mild, short-term memory loss.

Alternative treatment

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. The therapy used is an individual choice. Short-term clinical studies have shown that the herb St. John's wort (Hypericum perforatum ) can effectively treat some types of depression. Though it appears very safe, the herb may have some side effects and its long-term effectiveness has not been proven. It has not been tested in patients with bipolar disorder. Despite uncertainty concerning its effectiveness, a 2003 report said acceptance of the treatment continues to increase. A poll showed that about 41% of 15,000 science professionals in 62 countries said they would use St. John's wort for mild to moderate depression. Although St. John's wort appears to be a safe alternative to conventional antidepressants, care should be taken, as the herb can interfere with the actions of some pharmaceuticals. The usual dose is 300 mg three times daily. St. John's wort and antidepressant drugs should not be taken simultaneously, so patients should tell their doctor if they are taking St. John's wort.

Prognosis

Most cases of mood disorders can be successfully managed if properly diagnosed and treated.

Prevention

People can take steps to improve mild depression and keep it from becoming worse. They can learn stress management (like relaxation training or breathing exercises), exercise regularly, and avoid drugs or alcohol.

Resources

PERIODICALS

"Family-focused Therapy May Reduce Relapse Rate." Health & Medicine Week September 29, 2003: 70.

"St. John's Wort Healing Reputation Upheld." Nutraceuticals International. September 2003.

ORGANIZATIONS

American Psychiatric Association. 1400 K Street NW, Washington DC 20005. (888) 357-7924. 〈http://www.psych.org〉.

National Depressive and Manic Depressive Association (NDMDA). 730 N. Franklin St., Ste. 501, Chicago, IL 60610. (800) 826-3632. 〈http://www.ndmda.org〉.

National Institute of Mental Health. Mental Health Public Inquiries, 5600 Fishers Lane, Room 15C-05, Rockville, MD 20857. (888) 826-9438. 〈http://www.nimh.nih.gov〉.

KEY TERMS

Cognitive therapy— Psychotherapy technique designed to help people change their attitudes, perceptions, and patterns of thinking.

Electroconvulsive therapy (ECT)— Therapy for mood disorders that involves passing electrical current through the brain in order to create a brief convulsion.

Neurotransmitter— A chemical that aids or alters the transmission of impulses between the points that connect nerves.

Serotonin— A chemical messenger in the brain thought to play a role in mood regulation.