Mood Disorders An occasional bout with the blues, a feeling of sadness of downheartedness, is common among healthy people and

considered to be a normal response to everyday disappointments in life. But it is short lived. Depression Is likely the oldest and still one of the most frequently diagnosed psychiatric illnesses. Pathologic depression occurs when adaptation is ineffective. Core concept: A. Mood: o Mood is also called affect. Mood is a pervasive and sustained emotion that may have a major influence on a persons perception of the world. Examples of mood include depression, joy, elation, anger and anxiety. Affect is described as the emotional reaction associated with experience. B. Depression: o An alteration in mood that is expressed by feelings of sadness, despair and pessimism. Depression may include symptoms of depressed mood, feelings or hopelessness and helplessness, decreased interest in usual activities, disinterest in relationship with others or cycles of depression and mania. Changes in appetite and sleep patterns are common. o Pessimism is a state of mind in which one anticipates negative outcomes. C. Mania o An alteration in mood that is expressed by feelings of elation, inflated self-esteem, grandiosity, hyperactivity, agitation and accelerated thinking and speaking. Mania can occur as a biological (organic) or psychological disorder, or as a response to substance use or a general medical condition. Historical perspective Many ancient cultures such as Babylonian, Egyptian, and Hebrew have believed in he supernatural or divine origin of depression and mania. The Old Testament states in the book of Samuel that King Sauls depression was inflicted by an evil spirit sent from God to torment him. Hippocrates Believed that melancholia was caused by an excess of black bile, a heavily toxic substance produced in the spleen or intestine, which affected the brain. Melancholia is a severe form of depressive disorder in which symptoms are exaggerated, and interest or pleasur in virtually all activities are lost. Epidemiology Major depression is one of the leading causes of disability in the United States. During their life time 10 to 25% of women and 5 to 12 % of men will become clinically depressed. Researchers consider depression as the common cold of psychiatric disorders and this generation as an age of melancholia. Gender Depression is higher in woman than it is in men by about 2 to 1. The incidence of bipolar is roughly equal, with a ratio of women to men of 1.2 to 1.

Age Depression is higher in young women and has a tendency to decrease with age. The opposite is seen in men. Studies have shown that widowhood has a stronger effect on depression for men than for women. The average age of onset for a first manic episode is the early twenties.

Social Class Bipolar disorder appears to occur more frequently among the higher socioeconomic classes. Race and Culture Studies have shown no consistent relationship between race and effective disorder. Problems: clinicians tend to under diagnose mood disorders and to overdiagnose mood disorders and to over diagnose schizophrenia in clients who have racial or cultural backgrounds different from their own. This misdiagnosis may result from language barriers between clients and physician who are unfamiliar with cultural aspects of nonwhite clients language and behaviors. Marital Status The highest incidence of depressive symptoms has been indicated in individuals without close interpersonal relationships and in persons who are divorced or separated. Seasonality Seasonal patterns have been found to be associated with mood disorders. Two prevalent periods of seasonal involvement include one in the spring and one in the fall. This pattern tends to parallel the seasonal pattern for suicide, which shows a large peak in the spring and a smaller one in October. The DSM IV TR Describes the essential feature of these disorders as a disturbance of mod, characterized by a full or partial manic or depressive syndrome that cannot be attributed to another mental disorder. Mood disorders are classified under to major categories: depressive disorders and bipolar disorders. Major Depressive Disorder Is characterized by depressed mood or loss of interest or pleasure in usual activities. Impaired social and occupational functioning that has existed for at least 2 weeks, no history of manic behavior, and symptoms that cannot be attributed to use of substance or a general medical condition. Major depressive disorder may be further classified as follows: 1. Single Episode or Recurrent: a single episode specified is used for an individuals first diagnosis of depression. Recurrent is specified when the history reveals two or more episodes of depression. 2. Mild, moderate or severe. These categories are identified by the number and severity of symptoms.

3. With Psychotic Features. The impairment of reality testing is evident. The individual experiences delusions or hallucinations. 4. With Catatonic Features. This Category identifies the presence of psychomotor disturbances, such as severe psychomotor retardation, with or without the presence of waxy flexibility or stupor, or excessive motor activity. 5. With Melancholic Features. This is a typical severe form of depressive episode. Symptoms are exaggerated. Even temporary reactivity to usually pleasurable stimuli is absent. History reveals a good response to antidepressants or somatic therapy. 6. Chronic. This applies when the current episode of depressed mood has been evident continuously for at least the past 2 years. 7. With Seasonal Pattern. This diagnosis indicates the presence of depressive symptoms during the fall or winter months. This diagnosis is made when the number of seasonal depressive episodes is substantially higher than the number of non-seasonal episodes that have occurred over the individuals lifetime. AKA seasonal affective disorder. Risk Factors for depressive disorders 1. Biological factors Depressive illness may be related to a deficiency of the neurotransmitters norepinephrine, serotonin and dopamine, at the functionally important receptor sites of the brain. 2. Family genetics Major depression is 1.5 to 3 times more common among first degree biological relatives of people with the disorder than among the general population. 3. Gender higher rate for women 4. Medication usage: Drugs that have a direct effect on the central nervous system can produce a depressive syndrome such as anxiolytics, antipsychotics, and sedative hypnotics. Propranolol and Reserpine are antihypertensive medications that have been known to produce depressive symptoms. Also Accutane has been found to have an association with depression. 5. Hormonal disturbance: Depression is linked with dysfunction of the adrenal cortex and is commonly observed in both Addison and Cushings syndrome. Numerous endocrine disorders have been associated with depression. An excess of estrogen or a high estrogen to progesterone ratio during the luteal phase of the menstrual cycle is responsible for premenstrual syndrome. 6. Nutritional Deficiencies Deficiencies in Vitamin B1(thiamine), Vitamin B6, Vitamin B12, niacin, vitamin C, iron, folic acid, zinc, calcium and potassium may produce symptoms of depression. Psychosocial Theories Freud observed that melancholia occurs after the loss of a loved object, either actually by death or emotionally by rejection, or the loss of some other abstraction of value to the individual. Freud indicated that in melancholic clients, the depressed patients rage is internally directed because of identification with the loss object.