Mood Disorders

Introduction

  • How can we understand booming rates of mood disorders?

  • At what point does suffering become pathological?

  • Can “illness” serve a purpose?

  • Everyone experiences mood. Changes in mood are a fundamental part of what it means to be human

  • Mood is often defined as a temporary mindset that can influence how we understand and process situations

  • Ideas about mood change over time and vary across contect and social circumstances

    • Ex. The joy of being a new parent is different from the joy of completing a univeristy degree

Classification of Mood Disorders

  • Melancholia: profound sadness

  • Mania: excitement

Depressive Disorders

  • Major Depressive Disorder (MDD) involves severely low mood

    • The DSM describes MDD as “one or more major depressive episodes without mania.” 

    • To be diagnosed, physicians also look for several adjunctive symptoms…

      • Sense of guilt

      • Sense of worthlessness

      • Anhedonia

      • Low energy

      • Poor concentration

      • Changes in appetite

      • Substantial weight loss/gain

      • Insomnia or hypersomnia

      • Psychomotor agitation or retardation (fast / slow movement)

      • Thoughts of death / suicide

    • These above symptoms must persist for a minimum of two weeks to be diagnosed with MDD

    • Before DSM-5, the diagnostic criteria of depression included what was called the “bereavement exclusion.” This meant that those who exhibited MDD symptoms should be exempted from a diagnosis if their depressive symptoms occurred shortly after the death of a loved one

    • Persistent Depressive Disorder - similar to MDD, but those who with persistent depressive disorder do not exhibit as many symptoms as those with MDD

      • Chronic, but milder, depression

  • Depression and Sadness

    • For those who argue that depression and sadness are not simply two points on a continuum of misery, but rather distinct phenomena (feelings vs. disease), what separates the two?

      • Sadness is limited

      • Depression is pervasive and persistent. It doesn’t have a clear/understandable stimulus

        • Involves impaired social / occupational functioning (impacts a person’s work life and/or personal life)

        • Sensation difference, “like being consumed by a black cloud”

      • Are there biomarkers for depression (so that we could definitely tell who has it and who is just sad)?

  • Premenstrual Dysphoric Disorder is classified as a significantly distressing form of premenstrual syndrome (PMS)

    • In PMDD, women experience distressing symptoms during the period between ovulation and menstruation (the luteal phase)

    • In most menstrual cycles, 5+ symptoms in a week before menses

    • PMDD Controversies

      • What is the line between PMDD and PMS?

        • What does it mean to tell people that something thar naturally happens as a result of their bodily processes is “disordered?”

        • PMDD was only included in the DSM after Sarafem was launched

        • Many of the symptoms overlap with PMS (changing mood, irritability, and appetite change), although PMDD is theoretically distinguished from PMS on the basis of its severity and impact on daily functioning

  • Disruptive Mood Dysregulation Disorder (DMDD): describes children who frequently exhibit behaviours such as extreme anger or irritability in situations where it is considered unwarranted

    • Recurrent temper outbursts grossly disproportionate to situation

    • Between outbursts, children may seem irritable and angry

    • Observed in 2 of 3 settings: parents, teachings, peers

    • This diagnosis is specific to children between the ages of 6 and 18 years old

    • DMDD Controversies

      • A broader trend of medicalizing childhood? Diagnostic increases since 1990: 3x ADHD, 20x autism, 40x childhood bipolar disorder

      • Do we “need” it? ODD: “an ongoing pattern of anger guided disobedience, hostilely defiant behaviour toward authority figures that goes beyond the bounds of normal childhood behaviour”?

      • An “untested diagnosis”

        • It was developed through basic group work, etc.

      • Members of the DSM group on childhood mental illness resigned in protest. 

        • Frances: the “number one diagnosis to ignore” because it’d violate the Hippocratic oath to ‘do no harm!’ He thought it would do more harm than good

The “Great Depression”

  • From 1 / 10 000 to 1 / 10. Diagnosed younger than ever, depression causes 10% of global disability. How can we explain this massive shift?

    • Modernisation?

    • Does modern parenting prevent people from experiencing the “good uses” of feeling sad?

    • Greater individualism and isolation?

  • Alternatively, is this a false epidemic?

    • Notion that “negative feelings” should be avoided at all costs?

    • Not more depressed, but diagnostic changes mean it’s easier to be diagnosed than in the past?

    • Greater awareness, decreased stigma?

    • Cultural shifts mean that misery must borrow from cultural capital of science to be legitimised? 

  • Bipolar Disorder: involves a person experiencing both episodes of mania and episodes of depression

  • DSM: cycling between depressive and manic episodes

    • Hypomania: refers to a milder form of mania

      • Those with hypomania experience an elevated mood wbut with less functional impairment than a full-blown manic episode

      • People with hypomania report symptoms such as…

        • Decreased need for sleep

        • Higher energy and self-confidence

        • Overly optimistic attitude

    • Mania is more severe, many include psychotic symptoms, and is more likely to lead to incarceration or hospitalisation

    • There are 3 types of bipolar disorder according to DSM-5:

      • Bipolar l: involves depression and mania

      • Bipolar ll: involves hypomania and a greater burden of depressive symptoms

      • Cyclothymic Disorder: mildest form of bipolar disorder, involving swings between mild depression and hypomania

Treatment of Mood Disorders

  • Cognitive-behavioural therapy is perhaps the most established form of psychotherapy for depression, having been widely used for several decades

    • This approach aims to alter negative thought patterns that may determine how we feel and behave

  • Psychopharmaceutical are also used by people being treated for both bipolar disorder and MDD

  • Electroconvulsive therapy involves passing electric currents through the brain to produce small seizures

    • Although considered safe, ECT has side effects, most notably short-term memory loss

Clinical Perspectives: Antidepressants

  • Antidepressant medications are typically considered as a first-line treatment for depression

  • Beyond mood disorders, SSRIs are also frequently used in the treatment of other mental health problems, like anxiety