Mood disorders
Mood disorders are one of the most prevalent types of psychiatric disorders. Clinically mood disorders are classified and defined in Diagnostic and statistical manual (DSM) of the American Psychiatric Association [1] and include major depressive disorder, dysthymic disorder, and bipolar disorder.
Clinical depression (also called major depressive disorder or unipolar depression) is relatively common and is characterized by a persistent lowering of mood, loss of interest in usual activities and diminished ability to experience pleasure. While the term “depression” is commonly used to describe a temporary decreased mood when one feels “blue” or “down,” clinical depression is a serious illness that involves the body, mood, and thoughts that cannot simply be willed or wished away. It is often a disabling disease that affects a person’s work, family and school life, sleeping and eating habits, general health and ability to enjoy life. The course of clinical depression varies widely: depression can be a once in a lifetime event or have multiple recurrences, it can appear either gradually or suddenly, and either last for few months or be a life-long disorder. Having clinical depression is a major risk factor for suicide.
Dysthymic disorder is a milder form of chronic depression. The essential symptom involves the individual feeling depressed almost daily for at least 2 years, but without the more severe symptoms present in a major depressive episode. Low energy, disturbances in sleep or in appetite and low self-esteem typically contribute to the clinical picture as well. Individuals have often experienced dysthymia for many years before it is formally diagnosed. People around them come to believe that the sufferer is “just a moody person,” thus delaying or foregoing medical attention altogether.
Bipolar disorder (BPD) is not a single disorder but a category of mood disorders defined by the presence of one or more episodes of abnormally elevated mood, clinically referred to as mania. This condition was formally known as manic-depressive illness, but BPD is now preferred. Having a manic episode is more severe and long-lasting than being “moody” or even having “mood swings.” A true mania lasts (include duration and symptoms) at least 1 week. Individuals who experience manic episodes also commonly experience depressive episodes or symptoms, or mixed episodes that present with features of both mania and depression. These episodes are normally separated by periods of normal mood, but in some patients, depression and mania may rapidly alternate, known as rapid cycling. The disorder has been subdivided into bipolar I, bipolar II and cyclothymia based on the type and severity of mood episodes experienced.
Clinical depression is more common in women
In any given year, 10–14 million people experience clinical depression; women 18–45 years of age account for the largest proportion of this group. Clinical depression can develop in anyone, regardless of race, culture, social class, age or gender. However, across virtually all cultures and socio-economic classes, women are more likely than men to experience depression. Underlying this diathesis may be biologic factors, especially hormonal influences, though these have yet to be elucidated. In contrast, bipolar disorder occurs equally in males and females. For many years, pregnancy was believed to be protective against relapse of bipolar episodes. However, recent studies have suggested that relapse rates during pregnancy are significant if the woman chooses to discontinue medication.
Moreover, not surprisingly, sexual and physical abuse are major risk factors for depression. Women are twice as likely as men to have experienced sexual abuse. A recent study found that three out of five women diagnosed with depressive illnesses had been victims of abuse. Clinicians should bear in mind a history of potential abuse when encountering patients with major depression.
Pregnancy increases the risk for mood disorders
Recent research reveals that over 10% of pregnant women and approximately 15% of postpartum women experience depression. As many as 80% of women experience the “postpartum blues,” a brief period of mood symptoms that is considered normal following childbirth and typically resolves in 2–3 weeks.
However, major clinical depression may be precipitated by the related hormonal and biologic changes associated with pregnancy or the postpartum period and should not be dismissed as “the blues.” Postpartum depression includes all the major signs and symptoms of major depressive disorder, and is frequently accompanied by profound anxiety. If there has been a history of mood disorder, there is a threefold increase in risk for depression during or following a pregnancy. Once a woman has experienced an episode of postpartum depression, her risk of having another episode is about 70%. In addition, the first episode of bipolar disorder in women frequently occurs following the birth of a child. Thus pregnancy represents a particularly vulnerable time for the occurrence of mood disorders.
Although technically not a mood disorder, postpartum psychosis is a medical emergency in which the woman may inflict harm upon herself and/or her baby secondary to paranoid delusions. The true risk of postpartum psychosis lies in infanticide, which occurs in roughly 4% of cases. The prevalence of postpartum psychosis itself is about one in 1000 pregnancies. It presents as a manic episode, with excessive agitation, irritability, and decreased need for sleep, as well as psychotic features of paranoia, hearing voices, and delusions.
Anxiety disorders are the most prevalent of the psychiatric disorders. Just as a transient depressed mood is a normal reaction to life events, anxiety is a normal reaction to stress. It helps one deal with a tense situation, focus on a particular task or heighten attention and awareness. In general, it is an adaptive response that helps an individual to deal with particular situations. But when anxiety becomes an excessive, irrational dread of everyday situations, it is a seriously disabling disorder.
Excessive anxiety is an unpleasant emotional state. Anxiety is characterized by worry, doubt and painful awareness that one is powerless to control situations. In contrast to fear, anxiety is irrational. The anxious person is hypervigilant, tense and insecure in most situations. Their heightened negative state leads to some of the bodily complaints that can be particularly prominent. These include excess sweating, trembling, dizziness, heart palpitations, shortness of breath, gastrointestinal upset, hot flashes, dry mouth, increased urination, fatigue and restlessness. The anxiety episodes can become so intense that individuals believe they are actually “going crazy” or will die.
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