A young college student once complained of episodes of “mood swings.” He said he often felt “very low” and experienced decreased energy, difficulty in concentrating, problems falling and staying asleep, decreased appetite, weight loss and a feeling that he was not doing “well enough” in life. He didn’t want to socialise and had stopped attending college too. His family also said that he would go through phases of being very irritable and moody. He would talk too much, come up with grand (and unfeasible) plans for the future, was excessively energetic and drive recklessly; this state had lasted for two months and was possibly triggered by his moving to a new city. Later, he was diagnosed as having bipolar illness. He responded well to treatment and with continued medication, counselling, lifestyle modifications and a supportive family, soon overcame the problem.
This isn’t an isolated case. Mood is a pervasive and sustained internal emotional state that colours the person’s perception of the world. A mood can be normal, elevated, depressed or irritable etc. Mood disorders are a group of clinical conditions characterised by loss of a sense of control over moods and subjective experience of great distress. There is impairment in the person’s day to day functioning in areas like work, social interactions and relationships.
There are two types of mood disorders: depressive disorders and bipolar disorders.
- Major depression: This is the most common mood disorder. The symptoms include persistent upset mood, decreased interest in day to day activities, sleep and appetite disturbances, decreased concentration and energy, and feelings of hopelessness and helplessness. Physical symptoms such as headaches, body aches and pain in the abdomen may occur too. In severe cases, the individual may experience recurrent suicidal thoughts and may even make suicide attempts.
- Minor depression: Symptoms are similar to major depression but fewer in number.
- Dysthymia: This is characterized by a low grade, chronic depression lasting for at least two years.
- Atypical depression: Characterized by “mood reactivity”, that is, temporary bjustifyening up of the mood in response to positive events, increased appetite and sleep requirements, and extreme sensitivity to rejection.
- Post-partum depression: Prevalent among women, following childbirth.
- Pre-menstrual depression: Characterized by depressive symptoms in the pre-menstrual phase.
- Perimenopausal depression: Significant depressive symptoms can occur around the same time as menopause.
This disorder is characterised by a distinct period of abnormal mood, which could be either euphoric, expansive or irritable, accompanied by three or four of the following: distractibility, inflated self-esteem, grandiose ideas, excessive talkativeness, racing thoughts, needing less sleep than usual and increase in goal-directed activity. For example, taking on too many projects at the same time; poor judgement leading to reckless behaviour, such as spending sprees; reckless driving or promiscuity and denial that anything is wrong. This lasts for at least a week and affects the person’s day to day functioning; it is called a “manic episode”.
- Hypomania: This is a less severe form of mania, with similar symptoms, lasting at least four to seven days. It’s often a stage in the development of mania.
- Bipolar I disorder: It is characterized by at least one manic episode (depressive episodes may or may not occur during the course of the illness).
- Bipolar II disorder: It is characterized by at least one hypo-manic episode, with or without depressive episodes.
- Cyclothymia: This is a milder form of bipolar disorder, with the presence of numerous periods of hypo-manic symptoms that last over at least two years.
Mood disorders are caused by imbalances in the brain’s chemical activity. Hormonal factors may play a role. Environmental factors can trigger or cushion against the onset of mood disorders.
Treatment of mood disorders
- Accurate diagnosis is the first step towards treating the disorder. Hence, self-awareness regarding symptoms of mood disorders is important. Underlying medical illnesses must be ruled out, as depressive symptoms can occur in hypothyroidism, some infections, and with the use of certain medications such as steroids.
- Treatment includes a combination of medication, psychotherapy and lifestyle changes, such as stress reduction, adequate rest and regular exercise.
The most important thing, however, is to remember that proper, timely treatment can help most people cope with the problem and lead productive, fulfilling lives.