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Mood Disorders

The Surgeon General of the United States reports that in 1 year, about 7 percent of Americans suffer from mood disorders. Mood Disorders are a group of mental disorders marked by depression or mania. They are characterized by periods of depression, which may alternate, with periods of elevated mood. While many people go through sad or happy moods from time to time, people with mood disorders reach extreme highs and devastating lows that significantly impair their functioning. Mood disorders are outside the bounds of normal fluctuations from sadness to joy. Duration is also a factor. While it is possible to become excited or elated at certain moments, people with a mood disorder can sustain that feeling for several days severely impacting their ability to relate and function.

A mood disorder is a condition whereby the prevailing feeling is distorted or inappropriate to current life circumstances. For example, feeings of grief and sadness are considered to be normal parts of bereavement after the death of a loved one. Unless very specific criteria were met, that feeling of sadness would not be enough to diagnose depression. Just as the excitement of an amusement park or celebration does not equate mania. It should also be noted that certain medical conditions have been known to cause incongruent delusions and moods. Just as drugs and alcohol can influene mood. Ruling out a mood disorder caused by a medical condition or subsance is important. When considering the diagnosis of mood disorder, duration, intensity, and appropriatness to circumstance along with impact on functioning must be considered. These fators are outlined in the criteria listed below which is translated from the Diagnostic and Statistical Manual of Mental Disorders (DSM) fourth edition or DSM IV. The two major types of mood disorders are depression and bipolar disorder.

Major Depression

DSM-IV criteria for major depressive episode:

Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

  • Depressed mood most of the day, nearly every day, as indicated by either subjective report or observation made by others
  • Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day</li
  • Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day
  • Insomnia or hypersomnia nearly every day
  • Psychomotor agitation or retardation nearly every day
  • Fatigue or loss of energy nearly every day
  • Feelings of worthlessness or excessive or inappropriate guilt nearly every day
  • Diminished ability to think or concentrate, or indecisiveness, nearly every day
  • Recurrent thoughts of death, recurrent suicidal thoughts or intent

Major Depression (recurrent)

Diagnosis of Major Depressive Disorder, Single Episode

For a major depressive episode a person must have experienced at least five of the nine symptoms below for the same two weeks or more, for most of the time almost every day, and this is a change from his/her prior level of functioning. One of the symptoms must be either (a) depressed mood, or (b) loss of interest.

Symptoms of Depression

  • A significantly reduced level of interest or pleasure in most or all activities
  • A considerable loss or gain of weight
  • Difficulty falling or staying asleep or sleeping more than usual
  • Behavior that is agitated or slowed down
  • Feeling fatigued, or diminished energy
  • Thoughts of worthlessness or extreme guilt
  • Ability to think, concentrate, or make decisions is reduced
  • Frequent thoughts of death or suicide or attempt of suicide
  • The person’s symptoms do not indicate a mixed episode
  • The person’s symptoms are a cause of great distress or difficulty in functioning at home, work or other important areas
  • The person’s symptoms are not caused by substance use or a medical disorder
  • The person’s symptoms are not due to normal grief or bereavement over the death of a loved one, they continue for more than two months, or they include great difficulty in functioning, frequent thoughts of worthlessness, thoughts of suicide, symptoms that are psychotic, or behavior that is slowed down

Another disorder does not better explain the major depressive episode

The person has never had a manic, mixed, or a hypomanic episode

  • Major depression with psychotic symptoms
  • This is a condition in which depression is associated with absence of contact with reality (psychosis)
  • Dysthymia

Presence, while depressed, of two (or more) of the following:

  • poor appetite or overeating
  • Insomnia or hypersomnia
  • Low energy or fatigue
  • Low self-esteem
  • Poor concentration or difficulty making decisions
  • Feelings of hopelessness