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A mood disorder is the term given for a group
of diagnoses in the Diagnostic
and Statistical Manual of Mental Disorders (DSM IV TR)
classification system where a disturbance in the person's mood is
hypothesized to be the main underlying feature.
The classification is known as mood (affective) disorders
in ICD 10.
English psychiatrist Henry Maudsley proposed an overarching
category of affective disorder.
The term was then replaced by mood disorder, as the latter
term refers to the underlying or longitudinal emotional state, whereas
the former refers to the external expression observed by
Two groups of mood disorders are broadly recognized; the
division is based on whether the person has ever had a manic or hypomanic episode. Thus, there are depressive
disorders, of which the best known and most researched is major depressive disorder
(MDD) commonly called clinical depression or major depression, and
disorder (BD), formerly known as "manic depression" and
described by intermittent periods of manic and depressed episodes.
- Major depressive
disorder (MDD), commonly called major
depression, unipolar depression, or clinical depression, where a
person has two or more major depressive episodes.
Depression without periods of mania is sometimes referred to as
unipolar depression because the mood remains at one
emotional state or "pole".
Diagnosticians recognize several subtypes or course
- Atypical depression
(AD) is characterized by mood reactivity (paradoxical
anhedonia) and positivity, significant weight gain or increased appetite ("comfort
eating"), excessive sleep or somnolence (hypersomnia), a sensation of heaviness in
limbs known as leaden paralysis, and significant social impairment
as a consequence of hypersensitivity to perceived interpersonal
Difficulties in measuring this subtype have led to questions of its
validity and prevalence.
major depression (PMD), or simply psychotic
depression, is the term for a major depressive episode,
particularly of melancholic nature, where the patient experiences
psychotic symptoms such as delusions or, less commonly, hallucinations.
These are most commonly mood-congruent (content coincident with
- Postpartum depression
(PPD) is listed as a course specifier in DSM-IV-TR; it
refers to the intense, sustained and sometimes disabling depression
experienced by women after giving birth. Postpartum depression,
which has incidence rate of 10–15%, typically sets in within three
months of labor, and
lasts as long as three months.
- Seasonal affective
disorder (SAD), also known as "winter depression"
or "winter blues", is a specifier. Some people have a seasonal
pattern, with depressive episodes coming on in the autumn or
winter, and resolving in spring. The diagnosis is made if at least
two episodes have occurred in colder months with none at other
times over a two-year period or longer.
- Dysthymia, which is a chronic,
different mood disturbance where a person reports a low mood almost
daily over a span of at least two years. The symptoms are not as
severe as those for major depression, although people with
dysthymia are vulnerable to secondary episodes of major depression
(sometimes referred to as double depression).
Disorder Not Otherwise Specified
(DD-NOS) is designated by the code 311 for
depressive disorders that are impairing but do not fit any of the
officially specified diagnoses. According to the DSM-IV, DD-NOS
encompasses "any depressive disorder that does not meet the
criteria for a specific disorder." It includes the research
diagnoses of recurrent brief depression, and minor
depressive disorder listed below.
- Recurrent brief
depression (RBD), distinguished from major
depressive disorder primarily by differences in duration. People
with RBD have depressive episodes about once per month, with
individual episodes lasting less than two weeks and typically less
than 2–3 days. Diagnosis of RBD requires that the episodes occur
over the span of at least one year and, in female patients,
independently of the menstrual cycle.
People with clinical depression can develop RBD, and vice versa,
and both illnesses have similar risks.
depressive disorder, or simply minor depression, which
refers to a depression that does not meet full criteria for major
depression but in which at least two symptoms are present for two
- Bipolar disorder
(BD), a mood disorder formerly known as "manic
depression" and described by alternating periods of mania and depression (and in some cases rapid
cycling, mixed states, and psychotic symptoms). Subtypes include:
- Bipolar I is distinguished by the
presence or history of one or more manic episodes or mixed episodes with or without major
depressive episodes. A depressive episode is not required for the
diagnosis of Bipolar I disorder, but depressive episodes are often
part of the course of the illness.
- Bipolar II consisting of recurrent
and depressive episodes.
- Cyclothymia is a different form of
bipolar disorder, consisting of recurrent hypomanic and dysthymic episodes, but no
full manic episodes or full major depressive episodes.
- Bipolar Disorder Not Otherwise Specified
(BD-NOS), sometimes called "sub-threshold" bipolar,
indicates that the patient suffers from some symptoms in the
bipolar spectrum (e.g. manic and depressive symptoms) but does not
fully qualify for any of the three formal bipolar DSM-IV diagnoses
- It is estimated that roughly one percent of the adult
population suffers from bipolar I, roughly one percent of the adult
population suffers from bipolar II or cyclothymia, and somewhere
between two and five percent suffer from "sub-threshold" forms of
A mood disorder can be classified as substance-induced if its
etiology can be traced to the direct physiologic effects of a psychoactive
drug or other chemical substance, or if the development of the
mood disorder occurred contemporaneously with substance intoxication or withdrawal. Alternately,
an individual may have a mood disorder coexisting with a substance abuse
disorder. Substance-induced mood disorders can have features of a
manic, hypomanic, mixed, or depressive episode. Most substances can
induce a variety of mood disorders. For example, stimulants such as amphetamine (Adderall,
Dexedrine; "Speed"), methamphetamine (Desoxyn; "Meth",
"Crank", "Crystal", etc), and cocaine ("Coke", "Crack", etc) can cause manic,
hypomanic, mixed, and depressive episodes.
High rates of major depressive disorder occur in heavy drinkers
and those with alcoholism. Controversy has previously
surrounded whether those who abused alcohol and developed
depression were self-medicating their pre-existing depression, but
recent research has concluded that, while this may be true in some
cases, alcohol misuse directly causes the development of depression
in a significant number of heavy drinkers.
 High rates of suicide also
occur in those who have alcohol-related problems. It is
usually possible to differentiate between alcohol-related
depression and depression which is not related to alcohol intake by
taking a careful history of the patient.
Depression and other mental health problems associated with alcohol
misuse may be due to distortion of brain chemistry, as they tend to
improve on their own after a period of abstinence.
Long term use of benzodiazepines
which have a similar effect on the brain as alcohol and are also associated with
depressive disorder can also develop as a result of chronic use of
benzodiazepines or as part of a protracted withdrawal syndrome.
Benzodiazepines are a class of medication which are commonly used
to treat insomnia, anxiety and muscular spasms. As with alcohol,
the effects of benzodiazepine on neurochemistry, such as decreased
levels of serotonin and norepinephrine, are believed to be
responsible for the increased depression. Major
depressive disorder may also occur as part of the benzodiazepine
withdrawal syndrome. In a
long-term follow-up study of patients dependent on benzodiazepines,
it was found that 10 people (20%) had taken drug overdoses while on
chronic benzodiazepine medication despite only two people ever
having had any pre-existing depressive disorder. A year after a
gradual withdrawal program, no patients had taken any further
Depression resulting from withdrawal from benzodiazepines usually
subsides after a few months but in some cases may persist for 6–12
Redfield Jamison and others have explored the possible links
between mood disorders—especially bipolar disorder—and creativity. It has been
proposed that a "ruminating personality type may contribute to both
[mood disorders] and art." The
relationship between depression and creativity appears to be
especially strong among female poets.
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