Depressive disorder: causes
The exact causes of depression are unknown. Like many psychiatric disorders, scientists believe a combination of factors may contribute to the development of depression. Patients with depression have physical changes in their brain structure, but the exact significance of the changes still needs to be explored. There is a genetic component to depression, and people with a biological relative with the disorder are more likely to develop it themselves. Depression can also be triggered by traumatic life events or hormonal changes.
Depressive disorder: symptoms
Symptoms of depression can include feelings of sadness/emptiness, irritability, loss of interest, sleep disturbances (sleeping too much or too little), lack of energy, changes in appetite, restlessness, feelings of worthlessness/guilt, trouble concentrating, thoughts of death/suicide, and unexplained physical pains.
Depressive disorder: diagnosis
A psychological evaluation is the main method for diagnosing depression. In order to qualify for a clinical diagnosis, a patient must have five or more of the previously noted symptoms over a period of 2 weeks or longer. One of the symptoms must be either depressed mood or loss of interest, and the symptoms must be severe enough to affect daily life.
Clinicians may also perform a physical exam to ensure the depression isn’t being caused by an underlying physical problem.
Depressive disorder: treatments
Most people with depression benefit from a combination of medication and psychotherapy. Antidepressant options include selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), atypical antidepressants, tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs). Patients may need to try several medications and dose adjustments before they find the one they respond to best.
Various types of psychotherapy can be beneficial for patients with depression, including cognitive behavioral therapy, interpersonal therapy, dialectic behavioral therapy, acceptance and commitment therapy, and mindfulness techniques.
Other treatment options include electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS), which are typically recommended for patients who don’t respond to medication.
Seasonal affective disorder: causes
Several factors may contribute to the development of seasonal affective disorder (SAD). Reduced levels of sunlight during winter can upset circadian rhythm and serotonin levels, which may trigger depression. Melatonin levels can also be disrupted as the seasons change, which can affect sleep patterns and mood.
Seasonal affective disorder: symptoms
SAD is considered a subtype of major depression, but the symptoms only occur during certain seasons. Symptoms can be mild at the beginning of the season and worsen over time. Symptoms of SAD include depressed mood, hopelessness, low energy, loss of interest, sleep disturbances, appetite changes, feeling sluggish, trouble concentrating, and thoughts of death or suicide.
Some symptoms are specific to winter-onset SAD, such as irritability, fatigue, trouble getting along with others, hypersensitivity to rejection, heaviness in the limbs, sleeping too much, changes in appetite, and weight gain.
Other symptoms are specific to summer-onset SAD, including insomnia, weight loss, decreased appetite, agitation, and anxiety.
Seasonal affective disorder: diagnosis
To distinguish SAD from other types of depression, the patient must experience certain criteria over at least the last 2 years. The depression must begin during a specific season and end in another season. The depression must also recur in that specific season more years than not. During seasons where the patient usually feels normal, there can be no episodes of depression.
Usually, SAD begins in winter, called winter-onset SAD. In some cases, however, it begins in summer and is called summer-onset SAD.
Seasonal affective disorder: treatments
For winter-onset SAD, light therapy is often the first line of treatment. The patient sits several feet away from a light therapy box that mimics outdoor light. The light appears to trigger changes in brain chemicals and appears to be effective in most cases of winter-onset SAD.
Patients with SAD can also be treated with antidepressants or psychotherapy.
Dysthymic disorder: causes
The causes of dysthymia are similar to depression. People with dysthymia show changes in their brain structure, but the exact significance of these changes is not yet known. People with biological relatives who have dysthymia have an increased likelihood of developing the disorder. It can also be triggered by environmental stressors.
Dysthymic disorder: symptoms
The symptoms of dysthymia are similar to those of depression, but notably do not include pervasive thoughts of death and suicide. Symptoms of dysthymia can include loss of interest, sadness, hopelessness, lack of energy, low self-esteem, trouble concentrating, irritability, decreased productivity, avoidance of social situations, feelings of guilt, change in appetite, and sleep disturbances (sleeping too much or too little).
The intensity of these symptoms can change over time, but they typically don’t go away for more than 2 months at a time.
Dysthymic disorder: diagnosis
In order to qualify for a clinical diagnosis of dysthymia, adults must experience depressed mood most of the day for at least 2 years. For children, they must experienced depressed mood or irritability most of the day for at least 1 year. Additionally, patients must exhibit two or more of the symptoms previously mentioned, and they must interfere with daily life.
Dysthymic disorder: treatments
Dysthymia is usually treated with medication, psychotherapy, or a combination of the two. Antidepressants commonly used to treat the disorder include SSRIs, SNRIs, and TCAs. Patients may have to try several medications before they find one that works for them.
Psychotherapy for dysthymia should focus on decision making, reducing negative behavior patterns, and improving the patient’s ability to function in interpersonal situations.
Cyclothymic disorder: causes
Like most mood disorders, scientists are unsure of the exact cause of cyclothymia. It may be caused by a combination of genetics, brain chemistry, and environmental factors.
Cyclothymic disorder: symptoms
The symptoms of cyclothymia are similar to those of types I and II bipolar disorder but are less extreme. People with cyclothymia experience phases of hypomanic symptoms (but not a full-blown hypomanic episode). Hypomanic symptoms may include euphoria, extreme optimism, inflated self-esteem, poor judgment, rapid speech, racing thoughts, aggressive behavior, acting inconsiderate towards others, agitation, excessive physical activity, risky behavior, increased sex drive, inability to concentrate, spending money in excess, and decreased need for sleep.
People with cyclothymia also experience phases of depressive symptoms (but not full-blown depression), whose symptoms may include sadness, hopelessness, anxiety, feelings of guilt, problems sleeping, change in appetite, fatigue, loss of interest, decreased sex drive, trouble concentrating, irritability, unexplained physical pain, and thoughts of suicide.
Cyclothymic disorder: diagnosis
Cyclothymia is considered a relatively rare mood disorder. Left untreated, it can worsen into type I or II bipolar disorder.
In order to be clinically diagnosed with cyclothymia, symptoms must last for at least 2 years, with periods of stability lasting less than 2 months on average. The symptoms must interfere with the patient’s functioning.
Patients also cannot have manic episodes, major depression, or schizoaffective disorder in order to fit the diagnostic criteria for cyclothymia.
Cyclothymic disorder: treatments
Patients with cyclothymia require lifelong treatment in order to reduce the severity of symptoms and to prevent the condition from worsening to bipolar disorder.
Medications are typically the first line of treatment to help stabilize hypomanic and depressive phases. Patients with cyclothymia can be treated with mood stabilizers, antipsychotics, anti-anxiety medications, and antidepressants. People with cyclothymia typically should not take antidepressants alone because they can worsen mania.
Several types of psychotherapy can also be beneficial, including cognitive behavioral therapy, family therapy, group therapy, and interpersonal social rhythm therapy.
Bipolar disorder: causes
Like other mood disorders, the exact cause of bipolar disorder remains unknown. Several factors may contribute to its development, including differences in brain structure, neurotransmitter imbalances, and inherited traits. People have an increased risk of developing the disorder if a first-degree relative also has it. Scientists are currently trying to pinpoint the genes that may be involved in the development of bipolar disorder.
Bipolar disorder: manic/hypomanic episodes
Symptoms of mania include an inflated sense of self-esteem, decreased need for sleep, talking more than usual, racing thoughts, inability to concentrate, increased goal-directed activity, and engaging in risky behavior.
To qualify for a manic or hypomanic episode, a person must have at least three of these symptoms during a period of elevated mood and increased energy. If the person’s mood is irritable rather than elevated, they must have at least four symptoms.
Manic periods last at least a week and must be severe enough to noticeably impair functioning. In some cases, the person may need to be hospitalized or may experience psychosis.
Hypomanic episodes, on the other hand, are less severe than manic episodes. While the symptoms are still noticeable in hypomania, they do not significantly impair functioning.
Bipolar disorder: depressive episodes
Patients with bipolar disorder may also experience major depressive episodes. A major depressive episode lasts for at least 2 weeks and includes at least five of the following symptoms: depressed mood, loss of interest, change in appetite, sleep disturbances (sleeping too much or too little), restlessness, fatigue, feelings of guilt, trouble concentrating, and thoughts of death or suicide.
At least one of the symptoms must be depressed mood or loss of interest. The symptoms must be severe enough to impair daily functioning.
Bipolar disorder: diagnosis
In order to determine if a patient has bipolar disorder, clinicians should perform a psychological evaluation that can include a self-assessment questionnaire or, with the patient’s permission, information from family and friends. Clinicians may also ask patients to keep a daily chart of their moods and sleep patterns to better determine a treatment approach.
To be clinically diagnosed with bipolar I disorder, a patient must have at least one manic episode. They may also experience hypomanic episodes or major depressive episodes.
A patient can be diagnosed with bipolar II disorder if they have had at least one major depressive episode that lasted for at least 2 weeks in addition to at least one hypomanic episode lasting at least 4 days.
Unlike in bipolar I disorder, patients with bipolar II disorder do not experience manic episodes.
Bipolar disorder: treatments
Typically, patients with bipolar disorder are immediately treated with medication to get their symptoms under control. After the initial treatment, clinicians can work with their patients to determine the best long-term treatment. Patients with bipolar disorder require maintenance treatment even when they are in periods of remission in order to prevent relapse.
Medications used to treat bipolar disorder include mood stabilizers, antipsychotics, antidepressants, antidepressant-antipsychotics, and anti-anxiety medications.
Several kinds of psychotherapy can be beneficial, including cognitive behavioral therapy, psychoeducation, interpersonal and social rhythm therapy, and others.
For those who do not respond to other treatments, ECT or TMS are other options for alleviating depressive symptoms.
The category of mood disorders includes psychiatric disorders with a primary symptom of disturbance in mood that is inconsistent with circumstances. It is estimated that nearly 21 million adults in the United States have a mood disorder. Usually, people with mood disorders can be successfully treated through medications and/or psychotherapy. Click through the slideshow to read more information on some of the most common mood disorders and how to treat them.
Compiled by Hannah Dellabella