Mood disorder

Mood disorder
Classification and external resources
ICD-10	F30-F39
ICD-9	296
MeSH	D019964

Mood disorder is the term designating a group of diagnoses in the Diagnostic and Statistical Manual of Mental Disorders (DSM IV TR) classification system where a disturbance in the person's mood is hypothesized to be the main underlying feature.^[1] The classification is known as mood (affective) disorders in ICD 10.

English psychiatrist Henry Maudsley proposed an overarching category of affective disorder.^[2] The term was then replaced by mood disorder, as the latter term refers to the underlying or longitudinal emotional state,^[3] whereas the former refers to the external expression observed by others.^[1]

Two groups of mood disorders are broadly recognized; the division is based on whether the person has ever had a manic or hypomanic episode. Thus, there are depressive disorders, of which the best known and most researched is major depressive disorder (MDD) commonly called clinical depression or major depression, and bipolar disorder (BD), formerly known as manic depression and characterized by intermittent episodes of mania or hypomania, usually interlaced with depressive episodes.

Classification

Depressive disorders

• Major depressive disorder (MDD), commonly called major depression, unipolar depression, or clinical depression, where a person has one or more major depressive episodes. After a single episode, Major Depressive Disorder (single episode) would be diagnosed. After more than one episode, the diagnosis becomes Major Depressive Disorder (Recurrent). Depression without periods of mania is sometimes referred to as unipolar depression because the mood remains at one emotional state or "pole".^[4]

Individuals with a major depressive episode or major depressive disorder are at increased risk for suicide. Seeking help and treatment from a health professional dramatically reduces the individual's risk for suicide. Studies have demonstrated that asking if a depressed friend or family member has thought of committing suicide is an effective way of identifying those at risk, and it does not "plant" the idea or increase an individual's risk for suicide in any way.^[5] Epidemiological studies carried out in Europe suggest that at this moment, roughly 8.5 percent of the worlds population are suffering from a depressive disorder. No age group seems to be exempt from depression and studies have found that depression appears in infants as young as 6 months old who have been separated from their mothers.^[6]

In nursing, a depressive disorder is frequent in primary care and general hospital practice but is often undetected. Unrecognised depressive disorder may slow recovery and worsen prognosis in physical illness, therefore, it is important that all doctors should be able to recognize the condition, treat the less severe cases and identify those requiring specialist care. ^[7]

Diagnosticians recognize several subtypes or course specifiers:

• Atypical depression (AD) is characterized by mood reactivity (paradoxical anhedonia) and positivity, significant weight gain or increased appetite ("comfort eating"), excessive sleep or somnolence (hypersomnia), a sensation of heaviness in limbs known as leaden paralysis, and significant social impairment as a consequence of hypersensitivity to perceived interpersonal rejection.^[8] Difficulties in measuring this subtype have led to questions of its validity and prevalence.^[9]

• Melancholic depression is characterized by a loss of pleasure (anhedonia) in most or all activities, a failure of reactivity to pleasurable stimuli, a quality of depressed mood more pronounced than that of grief or loss, a worsening of symptoms in the morning hours, early morning waking, psychomotor retardation, excessive weight loss (not to be confused with anorexia nervosa), or excessive guilt.^[10]

• Psychotic major depression (PMD), or simply psychotic depression, is the term for a major depressive episode, particularly of melancholic nature, where the patient experiences psychotic symptoms such as delusions or, less commonly, hallucinations. These are most commonly mood-congruent (content coincident with depressive themes).^[11]

• Catatonic depression is a rare and severe form of major depression involving disturbances of motor behavior and other symptoms. Here the person is mute and almost stuporose, and either immobile or exhibits purposeless or even bizarre movements. Catatonic symptoms can also occur in schizophrenia, a manic episode, or be due to neuroleptic malignant syndrome.^[12]

• Postpartum depression (PPD) is listed as a course specifier in DSM-IV-TR; it refers to the intense, sustained and sometimes disabling depression experienced by women after giving birth. Postpartum depression, which affects 10–15% of women, typically sets in within three months of labor, and lasts as long as three months.^[13] It is quite common for women to experience a short term feeling of tiredness and sadness in the first few weeks after giving birth; however, postpartum depression is different because it can cause significant hardship and impaired functioning at home, work, or school as well as possibly difficulty in relationships with family members, spouses, friends, or even problems bonding with the newborn.^[14] In the treatment of postpartum major depressive disorders and other unipolar depressions in women who are breastfeeding, nortriptyline, paroxetine (Paxil), and sertraline (Zoloft) are generally considered to be the preferred medications.^[15]

• Seasonal affective disorder (SAD), also known as "winter depression" or "winter blues", is a specifier. Some people have a seasonal pattern, with depressive episodes coming on in the autumn or winter, and resolving in spring. The diagnosis is made if at least two episodes have occurred in colder months with none at other times over a two-year period or longer.^[16] It is commonly hypothesised that people who live at higher latitudes tend to have less sunlight exposure in the winter and therefore experience higher rates of SAD, but the epidemiological support for this proposition is not strong (and latitude is not the only determinant of the amount of sunlight reaching the eyes in winter). SAD is also more prevalent in people who are younger and typically affects more females than males.^[17]

• Dysthymia, which is a chronic, different mood disturbance where a person reports a low mood almost daily over a span of at least two years. The symptoms are not as severe as those for major depression, although people with dysthymia are vulnerable to secondary episodes of major depression (sometimes referred to as double depression).^[18] The treatment of dysthymia is largely the same as for major depression, including antidepressant medications and psychotherapy.^[19]

• Depressive Disorder Not Otherwise Specified (DD-NOS) is designated by the code 311 for depressive disorders that are impairing but do not fit any of the officially specified diagnoses. According to the DSM-IV, DD-NOS encompasses "any depressive disorder that does not meet the criteria for a specific disorder." It includes the research diagnoses of recurrent brief depression, and minor depressive disorder listed below.

• Recurrent brief depression (RBD), distinguished from major depressive disorder primarily by differences in duration. People with RBD have depressive episodes about once per month, with individual episodes lasting less than two weeks and typically less than 2–3 days. Diagnosis of RBD requires that the episodes occur over the span of at least one year and, in female patients, independently of the menstrual cycle.^[20] People with clinical depression can develop RBD, and vice versa, and both illnesses have similar risks.^[21]

• Minor depressive disorder, or simply minor depression, which refers to a depression that does not meet full criteria for major depression but in which at least two symptoms are present for two weeks.^[22]

Specific treatments for depressive disorder

Many forms of treatment are available. Treatments may include cognitive-behavioral therapy, music therapy, art therapy, group therapy, psychotherapy, animal-assisted therapy (also known as pet therapy), physical exercise, medicines such as antidepressants, and keeping a gratitude journal.

Bipolar disorders

• Bipolar disorder (BD), a mood disorder formerly known as "manic depression" and described by alternating periods of mania and depression (and in some cases rapid cycling, mixed states, and psychotic symptoms). Subtypes include:

• Bipolar I is distinguished by the presence or history of one or more manic episodes or mixed episodes with or without major depressive episodes. A depressive episode is not required for the diagnosis of Bipolar I disorder, but depressive episodes are often part of the course of the illness.
• Bipolar II consisting of recurrent intermittent hypomanic and depressive episodes.
• Cyclothymia is a form of bipolar disorder, consisting of recurrent hypomanic and dysthymic episodes, but no full manic episodes or full major depressive episodes.
• Bipolar Disorder Not Otherwise Specified (BD-NOS), sometimes called "sub-threshold" bipolar, indicates that the patient suffers from some symptoms in the bipolar spectrum (e.g. manic and depressive symptoms) but does not fully qualify for any of the three formal bipolar DSM-IV diagnoses mentioned above.

It is estimated^{[by whom?]} that roughly 1% of the adult population suffers from bipolar I, a further 1% suffers from bipolar II or cyclothymia, and somewhere between 2% and 5% percent suffer from "sub-threshold" forms of bipolar disorder.

Substance induced mood disorders

A mood disorder can be classified as substance-induced if its etiology can be traced to the direct physiologic effects of a psychoactive drug or other chemical substance, or if the development of the mood disorder occurred contemporaneously with substance intoxication or withdrawal. Alternatively, an individual may have a mood disorder coexisting with a substance abuse disorder. Substance-induced mood disorders can have features of a manic, hypomanic, mixed, or depressive episode. Most substances can induce a variety of mood disorders. For example, stimulants such as amphetamine, methamphetamine, and cocaine can cause manic, hypomanic, mixed, and depressive episodes.

Alcohol induced mood disorders

High rates of major depressive disorder occur in heavy drinkers and those with alcoholism. Controversy has previously surrounded whether those who abused alcohol and developed depression were self-medicating their pre-existing depression, but recent research has concluded that, while this may be true in some cases, alcohol misuse directly causes the development of depression in a significant number of heavy drinkers. Participants studied were also assessed during stressful events in their lives and measured on a Feeling Bad Scale. Likewise, they were also assessed on their affiliation with deviant peers, unemployment, and their partner’s substance use and criminal offending. ^[23][24][25] High rates of suicide also occur in those who have alcohol-related problems.^[26] It is usually possible to differentiate between alcohol-related depression and depression which is not related to alcohol intake by taking a careful history of the patient.^[25][27][28] Depression and other mental health problems associated with alcohol misuse may be due to distortion of brain chemistry, as they tend to improve on their own after a period of abstinence.^[29]

Benzodiazepine induced mood disorders

The long-term use of benzodiazepines, such as Valium and Librium, may have a similar effect on the brain as alcohol, and are also implicated in depression.^[30] Major depressive disorder can also develop as a result of chronic use of benzodiazepines or as part of a protracted withdrawal syndrome. Benzodiazepines are a class of medication which are commonly used to treat insomnia, anxiety and muscular spasms. As with alcohol, the effects of benzodiazepine on neurochemistry, such as decreased levels of serotonin and norepinephrine, are believed to be responsible for the increased depression.^{[31][32][33][34]} Major depressive disorder may also occur as part of the benzodiazepine withdrawal syndrome.^[35][36][37] In a long-term follow-up study of patients dependent on benzodiazepines, it was found that 10 people (20%) had taken drug overdoses while on chronic benzodiazepine medication despite only two people ever having had any pre-existing depressive disorder. A year after a gradual withdrawal program, no patients had taken any further overdoses.^[38] Depression resulting from withdrawal from benzodiazepines usually subsides after a few months but in some cases may persist for 6–12 months.^[39][40]

Interferon-alpha induced mood disorders

Combination therapy with interferon-α and ribavirin for chronic hepatitis C virus (HCV) infection may induce major depression.^[41] In the study by Leutscher et al., evaluating 325 chronically HCV infected patients undergoing antiviral therapy, it was observed that (1) depressive symptoms among patients undergoing HCV therapy are commonly overlooked by routine clinical interviews, (2) the emergence of depression compromises the outcome of HCV therapy, and (3) the Major Depression Inventory (MDI) scale may be useful in identifying patients at risk for treatment-induced depression.

Origin

A number of authors have suggested that mood disorders are an evolutionary adaptation. A low or depressed mood can increase an individual's ability to cope with situations in which the effort to pursue a major goal could result in danger, loss, or wasted effort.^[42] In such situations, low motivation may give an advantage by inhibiting certain actions. This theory helps to explain why mood disorders are so prevalent, and why they so often strike people during their peak reproductive years. These characteristics would be difficult to understand if depression were a dysfunction.^[42]

A depressed mood is a predictable response to certain types of life occurrences, such as loss of status, divorce, or death of a child or spouse. These are events that signal a loss of reproductive ability or potential, or that did so in humans' ancestral environment. A depressed mood can be seen as an adaptive response, in the sense that it causes an individual to turn away from the earlier (and reproductively unsuccessful) modes of behavior.

A depressed mood is common during illnesses, such as influenza. It has been argued that this is an evolved mechanism that assists the individual in recovering by limiting his/her physical activity.^[43] The occurrence of low-level depression during the winter months, or seasonal affective disorder, may have been adaptive in the past, by limiting physical activity at times when food was scarce.^[43] It is argued that humans have retained the instinct to experience low mood during the winter months, even if the availability of food is no longer determined by the weather.^[43]

Sociocultural aspects

Kay Redfield Jamison and others have explored the possible links between mood disorders—especially bipolar disorder—and creativity. It has been proposed that a "ruminating personality type may contribute to both [mood disorders] and art."^[44] Jamison goes on to write in An Unquiet Mind^[45], “Intense creative episodes are, in many instances, indistinguishable from hypomania” She goes on to write, “There is a particular kind of pain, elation, loneliness, and terror involved in this kind of madness. When you're high it's tremendous. The ideas and feelings are fast and frequent like shooting stars...But, somewhere, this changes. The fast ideas are far too fast, and there are far too many; overwhelming confusion replaces clarity. Everything previously moving with the grain is now against-you are irritable, angry, frightened, uncontrollable...It will never end, for madness carves its own reality." Jane Collingwood notes an Oregon State University study that “looked at the occupational status of a large group of typical patients and found that ‘those with bipolar illness appear to be disproportionately concentrated in the most creative occupational category.’ They also found that the likelihood of ‘engaging in creative activities on the job’ is significantly higher for bipolar than nonbipolar workers.”^[46] In Liz Paterek’s article Bipolar Disorder and the Creative Mind she wrote “Memory and creativity are related to mania. Clinical studies have shown that those in a manic state will rhyme, find synonyms and use alliteration more than controls. This mental fluidity could contribute to an increase in creativity. Moreover mania creates increases in productivity and energy. Those in a manic state are more emotionally sensitive and show less inhibition about attitudes, which could create greater expression. Studies performed at Harvard looked into the amount of original thinking in solving creative tasks. Bipolar individuals, whose disorder was not severe, tended to show greater degrees of creativity.^[47]”The relationship between depression and creativity appears to be especially strong among poets.^[48][49]

Epidemiology

According to a substantial amount of epidemiology studies conducted, women are twice as likely to develop certain mood disorders, such as major depression. There is an equal number of men and women who are diagnosed with bipolar disorder. g

See also

• Antidepressant
• Depression (differential diagnoses)
• Mood swing
• Self-medication

References

Notes

1. ^ ^{a b} Sadock 2002, p. 534
2. ^ Lewis, AJ (1934). "Melancholia: A Historical Review.". Journal of Mental Science 80 (328): 1–42. doi:10.1192/bjp.80.328.1. http://bjp.rcpsych.org/cgi/content/citation/80/328/1. 
3. ^ Berrios G E (1985). "The Psychopathology of Affectivity: Conceptual and Historical Aspects". Psychological Medicine 15 (4): 745–758. doi:10.1017/S0033291700004980. PMID 3909185. 
4. ^ Parker 1996, p. 173
5. ^ The ICD-10 Classification of Mental and Behavioural Disorders. World Health Organisation. 1993.
6. ^ Ayuso-Mateos, J.L. et al. , 2001.Depressive Disorders in Europe: Prevalence figures from the ODIN study. British Journal of Psychiatry, 179, pp308-316
7. ^ Gelder, Mayou, Geddes (2005). Psychiatry: Page 170. New York, NY; Oxford University Press Inc.
8. ^ American Psychiatric Association 2000, pp. 421–22
9. ^ Sadock 2002, p. 548
10. ^ American Psychiatric Association 2000, pp. 419–20
11. ^ American Psychiatric Association 2000, p. 412
12. ^ American Psychiatric Association 2000, pp. 417–18
13. ^ Ruta M Nonacs. eMedicine - Postpartum Depression
14. ^ O'Hara, Michael W. "Postpartum Depression: Causes and consequences." 1995.
15. ^ Weissman, A.M., et al. "Pooled Analysis of Antidepressant Levels in Lactating Mothers, Breast Milk, and Nursing Infants." American Journal of Psychiatry, 161:1066-1078, June 2004.
16. ^ American Psychiatric Association 2000, p. 425
17. ^ Lam Raymond W., Levitan Robert D. (2000). "Pathophysiology of seasonal affective disorder: a review". Journal of Psychiatry and Neuroscience 25 (5): 469–480. PMC 1408021. PMID 11109298. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1408021. 
18. ^ Sadock 2002, p. 552
19. ^ The ICD-10 Classification of Mental and Behavioural Disorders World Health Organisation 1993
20. ^ American Psychiatric Association 2000, p. 778
21. ^ Carta, Mauro Giovanni; Altamura, Alberto Carlo; Hardoy, Maria Carolina et al. (2003). "Is recurrent brief depression an expression of mood spectrum disorders in young people?". European Archives of Psychiatry and Clinical Neuroscience 253 (3): 149–53. doi:10.1007/s00406-003-0418-5. PMID 12904979. 
22. ^ Rapaport MH, Judd LL, Schettler PJ, Yonkers KA, Thase ME, Kupfer DJ, Frank E, Plewes JM, Tollefson GD, Rush AJ (2002). "A descriptive analysis of minor depression". American Journal of Psychiatry 159 (4): 637–43. doi:10.1176/appi.ajp.159.4.637. PMID 11925303. 
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25. ^ ^{a b} Schuckit MA, Smith TL, Danko GP, et al (November 2007). "A comparison of factors associated with substance-induced versus independent depressions". J Stud Alcohol Drugs 68 (6): 805–12. PMID 17960298. 
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27. ^ Schuckit MA, Tipp JE, Bergman M, Reich W, Hesselbrock VM, Smith TL (July 1997). "Comparison of induced and independent major depressive disorders in 2,945 alcoholics". Am J Psychiatry 154 (7): 948–57. PMID 9210745. http://ajp.psychiatryonline.org/cgi/pmidlookup?view=long&pmid=9210745. 
28. ^ Schuckit MA, Tipp JE, Bucholz KK, et al (October 1997). "The life-time rates of three major mood disorders and four major anxiety disorders in alcoholics and controls". Addiction 92 (10): 1289–304. doi:10.1111/j.1360-0443.1997.tb02848.x. PMID 9489046. http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0965-2140&date=1997&volume=92&issue=10&spage=1289. 
29. ^ Wetterling T; Junghanns K (December 2000). "Psychopathology of alcoholics during withdrawal and early abstinence". Eur Psychiatry 15 (8): 483–8. doi:10.1016/S0924-9338(00)00519-8. PMID 11175926. 
30. ^ Semple, David; Roger Smyth, Jonathan Burns, Rajan Darjee, Andrew McIntosh (2007) [2005]. "13". Oxford Handbook of Psychiatry. United Kingdom: Oxford University Press. p. 540. ISBN 0198527837. 
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35. ^ Fyer AJ; Liebowitz MR, Gorman JM, Campeas R, Levin A, Davies SO, Goetz D, Klein DF (March 1987). "Discontinuation of Alprazolam Treatment in Panic Patients". Am J Psychiatry (benzo.org.uk) 144 (3): 303–8. PMID 3826428. http://www.benzo.org.uk/alprazolam.htm. Retrieved 10 December 2008. 
36. ^ Modell JG (Mar-April 1997). "Protracted benzodiazepine withdrawal syndrome mimicking psychotic depression" (PDF). Psychosomatics (Psychiatry Online) 38 (2): 160–1. PMID 9063050. http://psy.psychiatryonline.org/cgi/reprint/38/2/160.pdf. 
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39. ^ Ashton CH (March 1995). "Protracted Withdrawal From Benzodiazepines: The Post-Withdrawal Syndrome". Psychiatric Annals (benzo.org.uk) 25 (3): 174–179. http://www.benzo.org.uk/pha-1.htm. 
40. ^ Professor Heather Ashton (2004). "Protracted Withdrawal Symptoms From Benzodiazepines". Comprehensive Handbook of Drug & Alcohol Addiction. http://www.benzo.org.uk/pws04.htm. 
41. ^ Leutscher et al. Evaluation of depression as a risk factor for treatment failure in chronic hepatitis C. Hepatology. 2010 Aug;52(2):430-435. PMID20683942
42. ^ ^{a b} Nesse R (2000). "Is Depression an Adaptation?". Arch. Gen. Psychiatry 57 (1): 14–20. doi:10.1001/archpsyc.57.1.14. PMID 10632228. http://www-personal.umich.edu/%7Enesse/Articles/IsDepAdapt-ArchGenPsychiat-2000.pdf. 
43. ^ ^{a b c} Why We Get Sick: The New Science of Darwinian Medicine, Randolphe M. Nesse and George C. Williams | Vintage Books | 1994 | ISBN 0-8129-2224-7
44. ^ "Experts ponder link between creativity, mood disorders - CNN.com". CNN. 2 April 2009. http://www.cnn.com/2008/HEALTH/conditions/10/07/creativity.depression/index.html. Retrieved 13 May 2010. 
45. ^ Jamison, Kay R. An Unquiet Mind. New York: A.A. Knopf, 1995. Print
46. ^ Collingwood, Jane. "The Link Between Bipolar Disorder and Creativity | Psych Central." Psych Central - Trusted Mental Health, Depression, Bipolar, ADHD and Psychology Information . Web. 19 Nov. 2011. <http://psychcentral.com/lib/2010/the-link-between-bipolar-disorder-and-creativity/>.
47. ^ Paterek, Liz. "Bipolar Disorder and the Creative Mind." Serendip. 2006. Web. <http://serendip.brynmawr.edu>.
48. ^ Kaufman, JC (2001). "The Sylvia Plath effect: Mental illness in eminent creative writers". Journal of Creative Behavior 35 (1): 37–50. ISSN 0022-0175. http://creativeeducation.metapress.com/content/p1t4563378366t55/fulltext.pdf. 
49. ^ Bailey, DS (2003). "Considering Creativity: The 'Sylvia Plath' effect". Monitor on Psychology (APA) 34 (10): 42. http://www.apa.org/monitor/nov03/plath.html. 

Cited texts

• American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders, Fourth Edition, Text Revision: DSM-IV-TR. Washington, DC: American Psychiatric Publishing, Inc.. pp. 943. ISBN 0890420254 
• Parker, Gordon; Dusan Hadzi-Pavlovic, Kerrie Eyers (1996). Melancholia: A disorder of movement and mood: a phenomenological and neurobiological review. Cambridge: Cambridge University Press. ISBN 052147275X 
• Sadock, Benjamin J.; Sadock, Virginia A. (2002). Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry (9th ed.). Lippincott Williams & Wilkins. ISBN 0781731836