Psychopathology II

Chapter 7: Mood Disorders and Suicide

A Successful “Total Failure”:
Margaret, a successful businesswoman, faced a sudden and emotionally devastating
separation from her husband, leading to severe psychological distress. Despite her
achievements, she spiralled into major depressive disorder, exhibiting uncontrollable weeping,
self-doubt, impaired decision-making, and increased alcohol consumption. Her family
intervened, prompting her to seek help from a clinical psychologist, who diagnosed her with
major depressive disorder and a concurrent drinking problem. The psychologist initiated
treatment to address these issues and alleviate her symptoms.

What Are Mood Disorders?

Mood disorders involve much more severe alterations in mood for much longer periods of
time. Mood disorders are also known as affective disorders.
Mood disorders are diverse in nature, as is illustrated by the many types of depression
recognized in the DSM-5. Nevertheless, in all mood disorders, extremes of emotion or affect
—soaring elation or deep depression—dominate the clinical picture. Other symptoms are also
present, but the abnormal mood is the defining feature. Other symptoms or co-occurring
disorders may also be present.

Mood Disorders: An Overview

The two key moods involved in mood disorders are mania, often characterized by
intense and unrealistic feelings of excitement and euphoria, and depression, which usually
involves feelings of extraordinary sadness and dejection.
Mood disorders vary, with some individuals experiencing separate periods of
depression or mania, while others undergo both types of episodes. Typically, normal mood
states can exist between these episodes. The conventional view places manic and depressive
states at opposite ends of a mood continuum with normal mood in the middle. However, there
are cases where individuals simultaneously exhibit symptoms of both mania and depression,
resulting in rapidly alternating moods within a single episode, known as mixed episodes.

Types of Mood Disorders

Unipolar depressive disorders: Only depressive episodes
Bipolar depressive disorders: Manic and depressive episodes
The most common form of mood disturbance involves depression. To be diagnosed with
major depressive disorder, a person must be markedly depressed or lose interest in formerly
pleasurable activities (or both) for at least two weeks. Other symptoms such as changes in
sleep or appetite, or feelings of mood disorders and suicide worthlessness must also be
present.
A manic episode is characterized by a significantly elevated or euphoric mood, occasionally
accompanied by bursts of intense irritability or even violence, especially when others resist
the person's manic impulses. This heightened mood must persist for at least a week, along
with three or more additional symptoms occurring simultaneously. These symptoms
encompass increased goal-directed activity, inflated self-esteem, accelerated mental activity
(such as "flight of ideas" or "racing thoughts"), decreased need for sleep, and psychomotor
agitation.
Milder symptoms resembling those of a manic episode may lead to a diagnosis of a
hypomanic episode, characterized by abnormal elevation, expansiveness, or irritability
lasting at least 4 days. The person must exhibit at least three other symptoms similar to mania
but to a lesser extent (e.g., inflated self-esteem, decreased need for sleep, flights of ideas,
pressured speech, etc.). While the symptoms are similar to manic episodes, hypomania is
associated with less impairment in social and occupational functioning, and hospitalization is
typically not necessary.

The Prevalence of Mood Disorders

Major mood disorders (unipolar major depression), particularly major depressive
disorder (MDD), are highly prevalent, occurring 15 to 20 times more frequently than
schizophrenia and nearly as often as all anxiety disorders combined. MDD, characterized by
major depressive episodes, is the more common type. Recent data from the National
Comorbidity Survey-Replication (NCS-R) indicate lifetime prevalence rates of unipolar major
depression at almost 17%, with 12-month rates (1 year prevalence) approaching 7%,
suggesting an apparent increase in occurrence in recent decades.
Moreover, rates for unipolar major depression are always much higher for women
than for men (usually about 2:1). These differences occur in most countries around the
world; the few exceptions are developing and rural countries such as Nigeria and Iran. In the
United States, this sex difference starts in adolescence and continues until about age 65, when
it seems to disappear. Yet among school children, boys are equally likely or slightly more
likely to be diagnosed with depression.
Bipolar disorder, characterized by both manic and depressive episodes, is less
prevalent compared to unipolar major depression. The National Comorbidity Survey-
Replication (NCS-R) suggests a lifetime risk of approximately 1% for the classic form of
bipolar disorder, with no significant difference in prevalence rates between men and
women.

Unipolar Depressive Disorders

Mild, brief depression can be normal and adaptive. Sadness, hopelessness, and pessimism are
common human experiences. Usually, normal depressions would be expected to occur in
people undergoing painful but common life events such as significant personal, interpersonal,
or economic losses.
Other Forms of Depression (Depressions That Are Not Mood Disorders)
Not all of depressions will be severe enough to be considered as mood disorders. In
most cases, symptoms are short-term and time limited. However, when severe symptoms are
experienced for an extended period of time, the diagnosis will be one of mood disorder.
1. Loss and grieving process: Grief is typically seen as a challenging psychological
process following the death of a loved one, often perceived as more difficult for men
than women. Bowlby identified four phases of normal grief response: numbing and
disbelief, yearning and searching, disorganization and despair, and eventual
reorganization. Traditionally, DSM-IV-TR suggested refraining from diagnosing major
depressive disorder within the first two months of bereavement. However, this 2-
month exclusion has controversially been removed in DSM-5. Uncomplicated grief is
considered adaptive, but recent studies indicate about 50 percent of bereaved
individuals exhibit resilience, showing minimal and short-lived symptoms without
emotional maladjustment, challenging previous assumptions.
2. Postpartum “blues”: Postpartum depression, occasionally affecting both mothers and
fathers, can have adverse effects on child outcomes. Contrary to past beliefs, recent
evidence suggests that postpartum major depression in mothers is less common than
previously thought, with "postpartum blues" being more prevalent. Postpartum blues,
characterized by changeable mood, crying, sadness, irritability, and occasional
happiness, affect 50 to 70 percent of women within 10 days of childbirth and often
subside naturally. Hypomanic symptoms are also frequently observed alongside
depression-like symptoms. Major depression in the postpartum period is not more
common than expected for women of the same age and socioeconomic status who
haven't recently given birth. While hormonal adjustments and changes in serotonergic
and noradrenergic functioning may play a role, the psychological component,
including social support, adaptation challenges, and personal or family history of
depression, is crucial in understanding postpartum blues or depression.