Mood Disorders

Together, mood disorders are the largest cause of disability worldwide, but effective treatments are available.^[2]

Key takeaways

• Mood disorders are common mental health conditions that change your emotional state

• There are two main categories of mood disorders: depressive and bipolar. Depressive mood disorders are associated with sustained low mood, while bipolar mood disorders fluctuate between high and low mood

• Mood disorders are primarily treated through medication and psychotherapy

Understanding mood disorders

Moods are pervasive and sustained emotional states. This differs from feelings, where you might be happy, sad, or angry, as these feelings will change over time, especially as things happen around you. When you have a mood disorder, you experience emotional states that aren’t directly connected to the things going on in your life.^[1]Though mood is an internal experience, it can affect your behavior.

Types of mood disorders

There are two main types of mood disorders: depressive mood disorders and bipolar mood disorders.^[3]Depressive (sometimes called unipolar) mood disorders are characterized by a very low mood, which can lead to a loss of interest in normal activities and difficulties in carrying out daily tasks.^[4]Bipolar mood disorders usually include periods of depression or depressive symptoms, but these are interspersed with periods of high moods known as hypomania or mania.^[5]

Depressive mood disorders

Depressive mood disorders involve periods of unusually low mood. These can be short and predictable, such as those found in premenstrual dysphoric disorder, or long-lasting, such as in major depressive disorder.

Major depressive disorder (MDD)

Major depressive disorder is the illness most people would characterize as ‘depression’. It is a period of sustained low mood that lasts for at least two weeks.^[6]

Disruptive mood dysregulation disorder (DMDD)

DMDD is a mood disorder found in children and young people. It is characterized by frequent angry outbursts.^[7]

Persistent depressive disorder (dysthymia)

Dysthymia is an extended period of low mood that does not reach the threshold for MDD. For adults, the low mood must have lasted for at least two years.^[8]

Premenstrual dysphoric disorder (PMDD)

PMDD is characterized by a period of low mood or emotional instability that occurs consistently around a patient's menstrual cycle.^[9]

Postpartum or peripartum depression

Postpartum depression is a period of low mood occurring during pregnancy or the first year following the birth of a child.^[10]

Seasonal affective disorder (SAD)

SAD is a period of low mood that is linked to seasonal changes. Most often, SAD symptoms appear during the winter months, but some patients can experience SAD only during the summer.^[11]

Bipolar mood disorders

Bipolar mood disorders involve periods of extremely high mood, excess energy, and/or agitation. In the majority of cases, depressive episodes will occur between manic and hypomanic episodes. Bipolar disorders are classified according to their severity, although all bipolar disorders are serious illnesses requiring treatment.^[12]

Bipolar I disorder

This is the most severe type of bipolar disorder, involving episodes of full mania. Bipolar I disorder often requires hospital treatment.

Bipolar II disorder

Bipolar II disorder is less severe than bipolar I disorder, involving hypomanic episodes.

Cyclothymic disorder

Cyclothymic disorder is a milder form of bipolar disorder. People with cyclothymia have similar hypomanic symptoms to those with bipolar II disorder, but their depressive episodes are less severe.

Symptoms of mood disorders

There are two categories of symptoms of mood disorders: depressive and manic or hypomanic. Depressive symptoms are found in depressive mood disorders and during depressive episodes of bipolar disorders. Manic or hypomanic symptoms are exclusively found in bipolar disorders.^[13]

Depressive symptoms of mood disorders

Common symptoms of a depressive mood disorder or a depressive episode in a bipolar mood disorder include

• Feeling sad, low, or emotionally flat

• Feeling tired or lethargic

• Changes in eating and sleeping patterns, either increasing or decreasing

• Loss of pleasure and enjoyment in normal activities (anhedonia)

• Feeling hopeless, worthless, or lost

• Crying

• Difficulty concentrating or making decisions

• Feeling guilty or irritable

• Suicidal thoughts (suicidal ideation)

Manic or hypomanic symptoms of mood disorders

For those with a bipolar mood disorder, manic or hypomanic symptoms will also be present. These include:

• Inflated self-esteem

• Talking more than usual or speaking extremely quickly

• Sleeping less than usual or feeling as though you don’t need to sleep

• Feelings of invulnerability

• Being very easily distracted

• Being unusually active

• Increased risk-taking, especially in activities that may have negative consequences

• Psychosis, in severe cases of mania

For some, manic and hypomanic symptoms of a mood disorder may be less distressing than depressive symptoms. People with a bipolar mood disorder might not realize that they are experiencing these symptoms.^[14]

Mood disorders and suicidal ideation

One common and highly distressing symptom of a depressive mood disorder is suicidal ideation, which involves having thoughts about death or suicide.^[15]These thoughts can be fleeting, or they can become a constant preoccupation. They can be active or passive, and in some cases, they can feel involuntary and intrusive, which may be scary for the person experiencing them.

Passive suicidal ideation involves thinking about suicide or death without making a plan, having intent, or taking any action. If someone makes a plan to take their own life, collects the means to do so, or begins to prepare for suicide by giving away possessions, for example, this is considered active suicidal ideation. Intrusive suicidal ideation, where someone doesn’t want to take their own life but has repeated thoughts about doing so, can be especially difficult.

Suicidal ideation can also be difficult for loved ones or carers to cope with. It may be tempting to avoid talking about suicide or self-harm, with many people afraid that asking someone with depression about suicide might increase the risk of them taking their own life. This is not the case, and evidence suggests that giving people the opportunity to talk about suicidal ideation can be helpful rather than harmful.^[16]

Suicidal ideation is a serious symptom of a mood disorder. Anyone experiencing this symptom should seek help urgently. Call 911 if you or someone close to you is at immediate risk. Otherwise, if you’re already connected with a healthcare provider, reach out and let them know what is going on, and make the earliest appointment to speak to them. If you don’t have a provider or are unable to contact them, 24/7 helplines, including the Suicide & Crisis helpline on 988, which you can call or text, are always available and can provide further support and connect you with local resources and providers.

Never dismiss suicidal ideation (your own or someone else’s) as attention-seeking or a cry for help. It is highly dangerous and a clear sign that help is needed.

Risk factors & causes of mood disorders

There is no single cause of mood disorders. Most mood disorders are the result of a combination of factors, including genetic, biological, social, and psychological. Prolonged changes in mood and depression-like symptoms can also occur as a side effect of many medications.

Mood disorders have a strong genetic component, meaning that the risk of developing one is greater if you have a parent, sibling, or other close relative who has received a similar diagnosis. Bipolar mood disorders may be more heritable than depressive mood disorders.^[17]

Other risk factors include adverse childhood experiences, such as neglect or abuse, having a previous diagnosis of a mood disorder, or living with a chronic disease, such as cancer or HIV.^[18]

Diagnosing mood disorders

Mood disorders are typically diagnosed by a mental health professional, such as a psychiatrist, clinical psychologist, or licensed therapist. They will conduct a psychiatric evaluation and clinical interview to understand the symptoms you’re facing.

They may ask questions about other medical conditions or medications you might be taking. This is to ensure that your symptoms aren’t the result of a different illness or a side effect of something you are taking. They may also ask for blood tests to see whether you are low in specific vitamins or nutrients, which can have a significant effect on your mood.

If you think you might have a depressive mood disorder, it can seem strange to be asked about times in your life when you might have felt extremely energetic or excitable. Clinicians will often ask about this in detail because many people with a bipolar mood disorder are unaware that episodes of feeling elated can also be symptoms. This is especially true for hypomanic symptoms, which can be more subtle.

When to seek a diagnosis

It’s important to seek help as soon as you suspect you might have a mood disorder. Mood disorders are typically easier to treat if they are diagnosed early, so book an appointment with your doctor or healthcare provider to discuss your symptoms.

Therapeutic treatment for mood disorders

Psychotherapy, also known as talk therapy, is considered to achieve similar results to medication for patients with depression. It can be used alone or in combination with antidepressants.^[19]

Common types of psychotherapy offered to people with depressive mood disorders include cognitive behavioral therapy (CBT), interpersonal psychotherapy (IPT), problem-solving therapy, and psychodynamic therapy.^[19][20]

For people with bipolar mood disorders, the first line of treatment is medication.^[21]Psychotherapy can help minimize the disruption of any residual symptoms.

Medication treatment for mood disorders

Medication for treating mood disorders is generally highly effective. Both depressive and bipolar disorders can be treated with a combination of medications.

Depressive symptoms are typically treated with antidepressants. There are several different types of antidepressants, each with a slightly different way of working. If one doesn’t work well, doctors will often prescribe a different type.

The main types of antidepressants include^[22]

• Selective serotonin reuptake inhibitors (SSRIs)

• Serotonin norepinephrine reuptake inhibitors (SNRIs)

• Tricyclic antidepressants

• Monoamine oxidase inhibitors (MAOIs)

• Serotonin modulators

• Atypical antidepressants

There is some evidence that antidepressant medications are less effective for people with a bipolar mood disorder, even during their depressive episodes.^[23]Some antidepressant medications can also trigger a manic or hypomanic episode in someone with a bipolar mood disorder.^[24]As a result, antidepressants may be prescribed with mood stabilizers to avoid causing manic symptoms.^[25]

Manic or hypomanic symptoms of a bipolar mood disorder need different kinds of treatments. Medications commonly used to treat these include

• Antipsychotics, such as haloperidol or risperidone

• Mood stabilizers, including lithium and valproate

Alternative treatment for mood disorders

Less common treatments for mood disorders include transcranial magnetic stimulation (TMS) and electroconvulsive therapy (ECT). TMS is a less invasive procedure, but both of these treatments are usually only used when other types of treatment have been ineffective.^[26]

Light therapy is used to help reduce the symptoms of SAD. For people who experience SAD symptoms during the winter months, intense light is used to replace the natural sunlight they are missing. Evidence for the effectiveness of lightboxes is limited, but they can be used at home without significant side effects, making them a simple, affordable treatment.^[27]

Self-care for mood disorders

Mood disorders are common mental health conditions. People with one of these disorders can’t simply ‘snap out’ of their illness or think themselves healthy again. Despite this, there are some steps that can help reduce symptoms, especially in combination with medication or psychotherapy.

Exercise can help reduce symptoms of depressive mood disorders, or during depressive episodes, for those with a bipolar mood disorder. It’s unclear exactly how exercise has an antidepressant effect, but studies point to increased serotonin, norepinephrine, and brain-derived neurotrophic factor as possible causes.^[28][29]

Despite the benefits of exercise in depressive mood disorders, it’s not always accessible. Depressive symptoms, including fatigue and low motivation, can make exercise feel unachievable.^[30]Any additional movement can help, however, so aim to include it where you feel you can.

A nutritious diet and a consistent sleep schedule can also help make the symptoms of mood disorders feel more manageable. You should also avoid drugs and alcohol, which can make symptoms worse.

Many people with a mood disorder find mindfulness or meditation to be helpful. These practices encourage you to focus on the present moment, improve your awareness of your own emotions, and accept your thoughts and feelings. Taking some time out to write down your thoughts and feelings in a journal can also be a valuable tool, allowing you to notice patterns in your mood and potential triggers for your mood disorder.

Final thoughts

Mood disorders can be debilitating, causing difficulties in your work, personal, and social life. They can be managed, however, through medication, psychotherapy, or a combination of the two. It is better to seek help early than struggle silently.