Mood disorders

Treatment for mood disorders depends on the client's diagnosis. Fortunately, there is now a wide variety of medications to help regulate brain chemistry. Newer FDA-approved medications are now available for treating mood disorders in children and adolescents, too.

Types of mood disorders

Mood disorders include dysthymia, major depressive disorder (MDD) and bipolar disorder. However, mood disorders frequently co-exist with generalized anxiety. Approximately 15-30% of people with major depression also have panic attacks. Mood disorders are also correlated to alcohol and substance abuse. Stimulants such as cocaine can cause a temporary elevation in mood, which is followed by depression. Diagnosing mood disorders can be problematic in the presence of substance abuse, physical illness, or other psychiatric illnesses. While anxiety is a feeling and is often found to co-exist with mood disorders, it is not a mood disorder itself.

Major depressive disorder (MDD)

About 20% of Americans experience a major depressive episode at one time in their lives. These episodes are characterized by pervasive low mood, feelings of worthlessness or guilt, difficulty making decisions, sleep and appetite changes, fatigue and loss of interest in pleasurable activities, and sometimes recurring thoughts of death or suicide.  MDD is characterized by at least one, and usually recurrent, major depressive episodes.

Bipolar disorder

Bipolar disorder affects between 1-3% of U.S. adults. It is characterized by extreme highs and lows in mood and energy. Bipolar I includes a more severe form of mania and can include psychotic features. Bipolar II is characterized by hypomania and the depressive episodes may more troublesome than the highs.

Cyclothymia

Cyclothymia is a mild mood disorder with ups and downs similar to bipolar disorder but not as severe. Cyclothymia usually develops during the teen years and sufferers may be viewed as moody or difficult, but not as needing medical help. Untreated cyclothymia can escalate into bipolar I or bipolar II, especially if the individual self-medicates his mood swings with alcohol or street drugs. Symptoms during a manic phase can include racing thoughts, little need for sleep, rapid speech, and being argumentative. During a depressive phase, the same individual will have low energy, lack focus, and may feel worthless or guilt-ridden.

Persistent depressive disorder (dysthymia)

Dysthymia is a chronic low mood accompanied by at least two other symptoms of depression. Dysthymia does not have the deep lows of major depression, but it causes an individual to lose interest in things and people around them. Dysthymia can be present for years as a low-grade depression.

Seasonal affective disorder (SAD)

SAD usually occurs during the fall and winter, and has been linked to serotonin and melatonin imbalances. It is most common in women and young adults. Sufferers typically oversleep, crave carbs, and isolate. Light therapy, vitamin D, and psychiatric medications can be helpful in the treatment of SAD.

Disruptive Mood Dysregulation Disorder (DMDD)

Disruptive Mood Dysregulation Disorder occurs in childhood. It is a condition characterized by extreme irritability, and frequent and intense outbursts of anger. 

 

More about bipolar disorder

Bipolar disorder distorts a person's moods and perceptions. Untreated, bipolar disorder usually worsens over time. However, bipolar disorder is treatable and many people with the disorder lead successful lives. It's important to understand that bipolar disorder is an illness. It is not just being overly emotional or a "drama queen. People with bipolar disorder are victimized by their brain chemicals, which makes it difficult for them to trust their own perceptions. The elevated mood of a manic phase can feel "amazing," which tempts many people to go off their medication when their mood is up. Inevitably, things come crashing down and the person either spirals out of control or plummets into depression. Untreated, bipolar disorder usually worsens over time. However, bipolar disorder is treatable and many people with the disorder lead successful lives. It is important to work with your doctor to avoid manic phases as well depressive ones.

Medications used to treat bipolar disorder

Mood stabilizers help prevent wild swings into mania and depression. Some of them are anticonvulsants that are also used to treat epilepsy or severe migraines. Lithium is one of the oldest mood stabilizers and has been shown to be effective at treating mania. Carbamazepine (Carbatrol, Epitol, Equetro, Tegretol) is an anticonvulsant that can interact with many other medications, including thyroid medicines and blood thinners. Lamotrigine (Lamictal) can be useful in treating bipolar disorder with pronounced depressive episodes. Valproic acid (Depakene, Stavzor)  can inhibit clotting and can interact with NSAIDs like ibuprofen and also aspirin, but has shown efficacy in preventing manic phases. A derivative of valproic acid is Divalproex sodium (Depakote), another anticonvulsant that is frequently used to treat bipolar mania.

Antidepressants are used with caution in the treatment of depression in bipolar disorder because traditional antidepressants can trigger a manic episode, particularly in people with bipolar I disorder. Even so, antidepressants can sometimes be used to help individuals with bipolar depression. 

Antipsychotics are used both as a short-term treatment for psychosis associated with bipolar disorder and as a long-term maintenance treatment to prevent future episodes of mania or depression. Some are specifically shown to be effective for certain episodes (depressed, manic, or mixed). They are sometimes taken with a mood stabilizer to help prevent mania. Antipsychotics used in the treatment of bipolar disorder include aripiprazole (Abilify), asenapine (Saphris), cariprazine (Vraylar), lurasidone (Latuda), olanzapine (Zyprexa), quietiapine (Seroquel), risperidone (Risperdal) and ziprasidone (Geodon). 

Benzodiazepines are sometimes prescribed to help treat insomnia and agitation in people with bipolar disorder. Common benzodiazepines include alprazolam (Xanax), clonazepam (Klonopin), diazepam (Valium), and lorazepam (Ativan). These are best used on a short-term and “as needed” basis due to the risk of addiction.

Sleep medications such as eszopiclone (Lunesta) and zaleplon (Sonata) are less habit-forming than benzodiazepines and cause fewer problems with memory and cognition.

More about depression

Depression can be an appropriate mood as when one is grieving. It must be distinguished from a major depressive episode as described above. Major depressive episodes can occur in the clinical conditions of MDD, bipolar disorder, and seasonal affective disorder. Depression is the most common mood disorder, affecting more than 6% of U.S. adults. It is characterized by a low mood, apathy, and feelings of  worthlessness. Depression ranges from the darkest depths to seasonal periods of the blues. The World Health Organization estimated that MDD was the 11th greatest cause of disability in the world. In children and adolescents, the mood may be irritable rather than sad. In children, separation anxiety may occur.

Medications used to treat depression

Medications used to treat depression include SSRIs, SNRIs, TCAs, and MAOIs. Bupropion (Wellbutrin, Aplenzin), mirtazapine (Remeron), trazodone (Desyrel) are also used to treat depression.  Transcranial magnetic stimulation can be useful in people who do not respond to antidepressants or cannot tolerate the side effects.

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