M05.09.11 M05.09.03 Mood disorders
Mood disorders are a class of mental illnesses characterized by persistent disturbances in a person’s emotional state, which can significantly affect their thoughts, behavior, and overall well-being. This section provides an overview of some common mood disorders encountered in clinical practice. Understanding these conditions is crucial for medical students.
Major Depressive Disorder (MDD)
- Epidemiology: Women are more likely to experience MDD than men.
- Diagnostic Criteria (DSM-5):
- Presence of depressed mood or anhedonia (loss of pleasure) for at least two weeks, along with other symptoms such as:
- Low energy or fatigue
- Difficulty concentrating or making decisions
- Sleep disturbances (insomnia or hypersomnia)
- Changes in appetite or weight (weight loss or gain)
- Psychomotor agitation or retardation
- Feelings of worthlessness or guilt
- Recurrent thoughts of death or suicidal ideation
- Symptoms must cause significant impairment in social, occupational, or other important areas of functioning.
- Presence of depressed mood or anhedonia (loss of pleasure) for at least two weeks, along with other symptoms such as:
- Biological Considerations: MDD is associated with decreased levels of neurotransmitters like norepinephrine, dopamine, and serotonin in the brain.
- Suicide Risk: Individuals with MDD have a 15% lifetime risk of suicide.
Treatment:
* Antidepressant medications are the mainstay of treatment for MDD. * Psychotherapy, particularly cognitive behavioral therapy (CBT), can also be beneficial.
Seasonal Affective Disorder (SAD):
- Description: A subtype of MDD characterized by recurrent depressive episodes occurring primarily during winter months in the Northern Hemisphere.
- Symptoms: Similar to MDD, but may also include social withdrawal, craving for carbohydrates, and hypersomnia.
- Cause:
- Disruption in melatonin production due to decreased sunlight exposure.
- Treatment: Bright light therapy (phototherapy) is a highly effective treatment for SAD.
Persistent Depressive Disorder (PDD):
- Comparison to MDD: A less severe and chronic form of depression compared to MDD.
- Diagnostic Criteria (DSM-5):
- Depressive symptoms present for at least two years on most days.
- Symptoms do not meet the criteria for a major depressive episode.
- Functional impairment is less severe compared to MDD.
- Treatment: Psychotherapy is the primary treatment approach for PDD.
Bipolar Disorder
- Genetics: Highly heritable; considered the most genetic of all psychiatric disorders. Men and women are equally affected.
- Bipolar I Disorder: Characterized by a manic episode (lasting at least one week) or a mixed episode (symptoms of mania and depression occurring simultaneously) that causes significant impairment in functioning.
- Manic episode symptoms include:
- Increased energy and activity level
- Decreased need for sleep
- Elation or euphoria
- Inflated sense of self-esteem or grandiosity
- Racing thoughts and flight of ideas
- Increased talkativeness and distractibility
- Increased risk-taking behavior
- Poor judgment
- Depressive episodes are also common in bipolar I disorder but are not necessary for diagnosis.
- Manic episode symptoms include:
- Bipolar II Disorder: Characterized by hypomanic episodes (less severe than manic episodes) alternating with major depressive episodes.
Table 9-6. Bipolar Disorder Classification
| Feature | Mania | Hypomania |
|---|---|---|
| Symptoms | Severe | Less severe |
| Level of Functioning | Not functional | Functional |
| Hospitalization | Typically required | Usually not required |
Cyclothymic Disorder:
- Description: Characterized by numerous mood swings over at least two years, with periods of hypomania alternating with periods of mild depression (neither meeting the full criteria for a manic or major depressive episode).
Table 9-7. Mood Disorders Summary
| Diagnosis | Duration | Mood Chart |
|---|---|---|
| Major depressive disorder | 2 weeks | Persistent depressed mood or anhedonia for at least 2 weeks |
| Persistent depressive disorder | 2 years | Depressive symptoms for most days over a 2-year period |
| Bipolar I disorder (mania) | 1 week | Depressive symptoms for most days over 2 years |
| Bipolar II disorder | Months | Hypomanic episodes alternating with major depressive episodes |
| Cyclothymic disorder | 2 years | Mood swings with hypomanic and mild depressive periods over 2 years |
Important Points to Remember
- Mood disorders are common and can significantly impact a person’s life.
- Early diagnosis and treatment are crucial for improving outcomes.
- Treatment options include medications and psychotherapy.