Mood disorders

Mood disorders are characterized by disordered mood. Mood typically is thought of as lying on a continuum of emotional experience, ranging from despair to elation. At one end of the spectrum is depression and at the other end is mania.

The normal human experience may include the entire spectrum without disorder. Manic and depressed mood states can range in severity from benign to fatal. Mood disorders affect emotional, behavioral, and cognitive functioning.

The DSM-5 splits mood disorders into two categories: depressive disorders and bipolar and related disorders.

Depressed moods include: sad, low, blue, empty, hopeless, anhedonic, or irritable.

Manic/hypomanic moods include: euphoric, elevated, expansive, or irritable.

DSM-5 diagnostic criteria

Mood disorders criteria

• Episodic - departure from baseline - a clear change from typical way you behave - also, these symptoms are present during discrete periods that can be clearly distinguishable
• Time criteria - how much of the time, for how long
  • Major depressive episode - 2 weeks, most of the day on most days
• Distress/impairment

Depressive episode

A depressive episode is defined as the following:

• Criterion A: Need to satisfy 5 or more of 9 symptoms
  • For at least two weeks and represent a change from previous functioning (observably)
  • (1) Depressed mood, most of the day, nearly every day
  • (2) Markedly diminished interest or pleasure in all or almost all activities most of the day nearly every day
  • Primary mood criterion - one symptom must be either (1) or (2) - i.e. must be either depressed mood or loss of interest/pleasure
  • (3) Significant weight gain/loss - decrease/increase in appetite almost every day
    • Around 5% weight change in a month’s time
  • (4) Insomnia or hypersomnia nearly every day
    • Lack of sleep or sleeping too much
  • (5) Psychomotor agitation/retardation nearly every day, observable by others (not just subjective feelings or restlessness or being slowed down)
    • Either being slowed down or feeling agitated
  • (6) Fatigue or loss of energy nearly every day
    • have trouble moving around
  • (7) Feelings of worthlessness or excessive/inappropriate guilt nearly every day
  • (8) Difficult to think/can’t concentrate or indecisiveness every day
    • If student has trouble focusing in class, it might be depression instead of ADHD
  • (9) Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt, or a specific plan for committing suicide
• Criterion B - the symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
  • Some part of your life feels like it’s falling apart
  • Getting in the way of how you live your life
• Criterion C - the episode is not attributable to the physiological effects of a substance or another medical condition
  • For instance, diabetes might cause depressive symptoms
  • These need to be ruled out before depressive episode

Hypomanic episode

• Criterion A - distinct period of abnormally and persistently elevated, expansive, or irritable mood AND abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day
• Criterion B - during the period of mood disturbance and increased energy/activity, [3 (or more) of the following symptoms if expansive, 4 if the mood is only irritable] have persisted, represent a noticeable change from usual behavior, and have been present to a significant degree:
  • (1) Inflated self-esteem or grandiosity
    • Full of yourself
  • (2) Decreased need for sleep
  • (3) More talkative than usual or pressure to keep talking
  • (4) Flight of ideas or thoughts racing
    • Expression of ideas in speech are not logically connected well
  • (5) Distractibility (reported or observed)
  • (6) Big increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
  • (7) Excessive involvement in activities that have a high potential for painful consequences (unrestrained buying sprees, sexual indiscretions, foolish business investments)
• Criterion C - The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic
• Criterion D - The disturbance in mood and change in functioning are observable by others
• Criterion E - The episode is NOT severe enough to cause marked impairment in social or occupational functioning or necessitate hospitalization. If there are psychotic features, the episode is, by definition, manic.
• Criterion F - The episode is not attributable to the physiological effects of a substance
  • Coffee, nicotine, ADHD medications, cocaine, etc.

Manic episode

• Criterion A - a distinct period of abnormally and persistently elevated, expansive, or irritable mood AND abnormally and persistently increased goal-directed activity or energy, lasting at least one week (as opposed to 4 days in hypomanic episodes) and present most of the day, nearly every day (or for any duration if hospitalization is necessary - no one week requirement)
• Criterion B - 3 of 7 symptoms, 4 of 7 if only irritable - at a level more extreme than hypomania
  • (1) Inflated self-esteem or grandiosity
    • Full of yourself
  • (2) Decreased need for sleep
  • (3) More talkative than usual or pressure to keep talking
  • (4) Flight of ideas or thoughts racing
    • Expression of ideas in speech are not logically connected well
  • (5) Distractibility (reported or observed)
  • (6) Big increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
  • (7) Excessive involvement in activities that have a high potential for painful consequences (unrestrained buying sprees, sexual indiscretions, foolish business investments)
• Criterion C - the mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features
• Criterion D - The episode is not attributable to the physiological effects of a substance or to another medical condition

Mood disorder list

• Depressive disorders
  • Major depressive disorder
    • Multiple depressive episodes
    • No hypomanic/manic episodes
    • Severity specifiers - how severe was it? How recent was it? Was there psychosis?
    • Chronicity specifiers - how frequently does it happen?
    • Remission specifiers - is it in partial or full remission?
    • Considered recurrent, might become more severe over time
    • With treatment, will be fixed
    • Episodic - waxes and wanes
    • After one episode happening, likelihood of recurrence after 1st is 50%, after 2nd 70%, after 3rd 90%
    • Associated with many health risks, including elevated risk of heart attack (4x greater over 12 years)
  • Depression
    • The “common cold” of mental illness
    • In a year, 5.8% of men and 9.5% of women report depression worldwide (WHO, 2002)
    • Depression is the most common complaint of people seeking mental health treatment
  • Dysthymic disorder/Dysthymia
    • Less severe than major depressive disorder
    • Chronic, relatively continual (instead of clear episodes)
      • Symptoms most of the day, more days than not, for minimum of 2 years
    • Can have coexisting major depression
      • Yearly, 10% of dysthymia patients have their first major depressive episode
      • Dysthymic disorder complicates treatment of depression

• Bipolar disorders
  • Bipolar I
    • Only requirement: one manic episode
    • Only manic, not hypomanic
    • Mania typically followed by depression, but depressive episode no longer required in DSM-5
    • Diagnostic coding elaborate
      • Current or most recent episode (MRE): manic, hypomanic, or depressed?
      • Severity: mild, moderate, severe, or with psychotic features
    • Specifiers with
      • Anxious distress
      • Mixed features
      • Rapid cycling - 4 or more mood changes in a year
      • Melancholic features
      • Atypical features
      • Mood-congruent psychotic features
      • Mood-incongruent psychotic features
      • Catalonia
      • Peripartum onset (postpartum)
      • Seasonal pattern (seasonal affective disorder)
  • Bipolar II
    • Requirements
      • One hypomanic episode (or more)
      • One depressive episode (or more)
      • No manic episodes
  • Bipolar disorder - high creativity
  • Depression among college students
    • 50% report experienced depression since coming to college
    • 9% report having thoughts of suicide
    • 1% have attempted suicide since coming to college
  • Suicidality is a symptom of depression
  • Men more likely to complete suicide than women due to the methods they choose being more violent