Mood Disorders

Mood disorders are among the most common mental disorders in the Western world. Formerly called affective disorders, these disorders involve a predominant disturbance in mood. In each case, the mood disturbance leads to other problems, which frequently include physical symptoms (such as fatigue), behavioral symptoms (such as social withdrawal), and cognitive symptoms (such as self-critical thoughts). The various mood disorders differ based on the type and duration of symptoms. Severe mood disorders develop from a combination of biological, stressful experiences and personality types or interpersonal factors. Treatment options usually include a combination of medication and psychotherapy.

The various mood disorders can be distinguished based on the nature of the mood disturbance, the severity of symptoms, and their duration. The depressive disorders (sometimes known as unipolar disorders) are primarily characterized by a sad mood or a profound loss of enjoyment in most activities. In younger persons, the mood may be irritable rather than despondent. The depressed mood is often experienced as sadness, tearfulness, discouragement, and feeling “down in the dumps.” In some cases, the person may complain of feeling emotionless. The loss of enjoyment or loss of pleasure, called anhedonia, is virtually always present to some extent in the depressive disorders; it is often experienced as a loss of interest in one's hobbies and usual activities. A reduction in sex drive is another common experience.

Other common symptoms of depressive disorders include sleep problems, low energy, and changes in appetite. Common sleep problems include insomnia in the form of nighttime waking and difficulty returning to sleep or early morning waking. Because of low energy and fatigue, the smallest tasks may seem overwhelming. Changes in appetite may be so profound as to cause extreme unintended changes in weight, usually weight loss, over a short period of time. During periods of depressed mood, cognitions frequently involve a sense of worthlessness and excessive guilt. Trivial events may be misinterpreted as proof of one's inadequacy, consistent with the negative mood. Decision making and concentration are compromised. Thoughts about death and suicide are common.

The disturbance in bipolar disorders involves periods of depressed mood and separate periods in which the mood is abnormally elevated. The signs of a manic mood include feelings of euphoria, a “high,” or an abnormally cheerful mood. The mood may rapidly turn to irritability if others are perceived as interfering with the individual's plans. Inflated self-esteem occurs invariably; it may range from boastful selfconfidence to grandiose delusions, such as having the firm belief that one has supernatural powers.

Many symptoms of the manic phases of bipolar disorders are opposite to those experienced in the depressive disorders. In a manic phase, the individual may demonstrate an uninhibited enthusiasm for pleasurable activities, which could include irresponsible spending sprees and indiscriminate sexual pursuits. The need for sleep is markedly reduced and surplus energy abounds. In a manic phase of bipolar disorder, a person may speak in an incessant, rapid, and loud manner. Thoughts may flow at such a rapid pace that the person may seem unable to keep up with them, a phenomenon known as flight of ideas. Excess energy, combined with unbridled enthusiasm and a euphoric mood, often lead unknowing observers to conclude [Page 513]that the individual is under the influence of a stimulant drug, such as cocaine. Indeed, many of the symptoms of bipolar disorder seem excessive and uncontained.

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