by J.E.View other articles by J.E
Mood refers to a sustained emotion that colours the way we view life. Rather than being a momentary reaction or state of the day, mood is generally stable across several days and weeks.
A mood disorder (also known as affective disorder) is a pattern of illness due to persistent abnormal mood. Although abnormal mood can be associated with other disorders, the main underlying feature in mood disorders is a disturbance in the patient’s mood.
Mood disorders are generally grouped into two main categories: bipolar disorders and depressive disorders. Mood disorders are characterised by different mood episodes- periods of time when a patient feels abnormally happy or sad. So, mood episodes can be considered the “building blocks” of mood disorders. For the purposes of clinical diagnosis, there are 4 types of mood episodes:
- Depressive episode- low mood
- Manic episode- elevated mood
- Hypomanic episode-mild elevated mood
- Mixed episode- when symptoms of both a depressive and manic/hypomanic episode are present
Other symptoms may be present and significant enough that they are worth mentioning within the diagnosis- such as anxiety symptoms or panic attacks. Sometimes there are subgroups within the same mood disorder that can explain better the symptoms of a particular patient-such as seasonal pattern, rapid cycling, or a melancholic type of depression.
Bipolar disorder is a mental health problem characterised by a switch between elevated and depressed mood, intercalated by periods of “normal” mood. The severity and length of the episodes are variable, although depressive episodes tend to be more frequent and last for longer than manic/hypomanic episodes. These extreme moods can be accompanied by psychotic symptoms (having unusual/unrealistic beliefs or perceiving things that are not there).
MANIC EPISODE (MANIA)
Mania can last for a week or more and has a severe negative impact on the ability to do your usual day to day activities- sometimes you may even need to stop these completely. If severe, hospitalisation may be needed.
During a manic episode-
You might FEEL:
- Happy, euphoric, a sense of well being
- Uncontrollably excited
- Irritable or agitated
- Increased sexual energy
- Easily distracted, racing thoughts, unable to concentrate
- Very confident or adventurous
- Like you are untouchable or can’t be harmed
- Like you can perform physical and mental tasks better than normal
- That you can see or hear things that other people can’t
You might BEHAVE:
- More active than usual
- Talking a lot, speaking quickly, not making sense to others
- Being very friendly
- Saying or doing things that are inappropriate or out of character
- Sleeping very little or not at all
- Being rude or aggressive
- Misusing drugs or alcohol
- Spending money excessively
- Losing social inhibitions
- Taking risks with your own safety
HYPOMANIC EPISODE (HYPOMANIA)
Like mania; but 3 key differences:
- It can feel more manageable- not severe enough to cause significant problems with social or work function
- It lasts for a shorter time
- It doesn’t include any psychotic symptoms
While hypomania is less severe than mania, it can still have a disruptive effect on your life. People may notice a change in your mood and behaviour.
Many people find a depressive episode harder to deal with than a manic or hypomanic episode and this is the most frequent reason why you might seek help from your GP or mental health service -
How you might FEEL:
- Down, upset, tearful
- Restless, agitated, irritable
- Guilty, worthless
- Empty, numb
- Isolated, unable to relate to others
- No pleasure in life or things you used to enjoy
- A sense of unreality
- No confidence, low self-esteem
- Hopeless, despairing
- Suicidal- thoughts of death, suicide plan, attempted suicide
- Slowed speech and movement
How you might BEHAVE:
- Avoiding social events and activities you used to enjoy
- Self-harming, suicidal behaviour
- Difficulty speaking or thinking clearly
- Losing interest in sex
- Difficulty in remembering or concentrating on things
- Using more tobacco, alcohol, or drugs than usual
- Insomnia or sleeping too much
- Feeling tired all of the time
- No appetite/ weight loss or increased appetite/ weight gain
- Aches and pains with no obvious physical cause
- Moving very slowly or restless and agitated
You may experience psychotic symptoms.
This is characterised by either a mixture of (or very rapid alternation between)(hypo)manic and depressive symptoms. It may sound very strange that you can have symptoms of both low and elevated mood at the same time. However, this is not uncommon for people with bipolar disorder. It can be very frightening and unpleasant.
Psychosis is more common during a manic than a depressive episode. It is when you perceive or interpret reality in a very different way to people around you. You may lose touch with reality and may also have disorganised thinking and speech. You may experience delusions (having strongly held beliefs that others don’t share, and which are generally unusual within your cultural background) and/or hallucinations (experiencing things that others around you don’t).
You may FEEL:
- Your thoughts are being read
- Your thoughts are not your own
- You are being watched or controlled- this is termed paranoia
- You are powerful and able to influence things that are outside your control
- You have insights, divine experiences, magic powers
- Voices which you hear either inside your head or through your ears
- Seeing visual disturbances
- Other unexplained sensations- smells, taste, touch
Bipolar disorder is broadly classified into 2 different types:
Bipolar Type I disorder
Bipolar Type II disorder
Patients have similar symptoms, but the important distinction is the degree of disability and discomfort imposed by the high phase.
Bipolar Type I disorder-this is when you have had a manic or mixed episodes lasting longer than 1 week, at least once in your life. You may or may not also experience a depressive episode. You can have dramatic and wild mood swings from high spirits, to being quickly annoyed or angry, to feeling sad and hopeless. There are often periods of normal mood in between these symptoms.
Bipolar Type II disorder- this is when you have at least 1 hypomanic and 1 depressive episode. There is no history of mania or mixed episodes. The depression lasts at least 2 weeks and the hypomania at least 4 days in a row.
This occurs if you experience 4 or more depressive, manic, hypomanic, or mixed episodes within a year. You may feel stable for a few weeks between episodes, or your mood can change as quickly as within the same day, or same hour.
A persistent instability of mood that usually develops early in adult life and has a chronic course. Mood at times may be normal and stable for months at a time.
You are chronically either mildly elated or depressed; but don’t meet the criteria for a manic, mixed, or major depressive episode. Cyclothymia frequently fails to come to medical attention as the mood swings are relatively mild and their impact on your day-to-day function is little.
You have experienced changes in your mood between mild elation and depression for over 2 years for this diagnosis to be considered.
Your symptoms are not severe enough to meet the criteria for diagnosis of Bipolar I or Bipolar II disorder. Cyclothymia not infrequently progresses into bipolar disorder.
People can suffer one or more episodes of depression, just as described higher up in the document.
You may experience significant anxiety associated with depression. A different diagnosis is mixed depressive and anxiety disorder which is characterised by symptoms of both depression and anxiety more days than not for a period of 2 weeks or more. However, these symptoms aren’t severe enough to diagnose a depressive episode or an anxiety disorder.
You have never experienced a manic, hypomanic, or mixed episode- which would indicate the presence of a bipolar disorder.
Persistent Depressive disorder or DYSTHYMIA
A chronic or long-lasting type of depression in which mood is low most of the time for a long time. Symptoms must be present without relief for more than 2 months for at least 2 years and can last longer.
During the 1st 2 years of persistent depressive disorder, there has never been a period of 2 weeks during which the symptoms are sufficient to meet the criteria for a depressive episode. There is no history of mania, hypomania, or mixed episodes.
Other terms used:
Not all patients have exactly the same constellation of symptoms and your doctor might use the terms below to better define your depressive disorder:
You may have an increase in appetite or weight, may sleep excessively, and may have an improvement of mood when something good happens.
You may lose pleasure in nearly all activities and feel no better when something good happens. Mood is usually worse in the morning. You may suffer with insomnia, loss of appetite or weight, feelings of guilt, and slowed psychomotor activity.
You may have immobility or stupor, repeated movements that appear to have no purpose, mutism (no speech).