Mood Disorders Overview

Mood Disorders Lecture Notes

• Mood disorders are experiencing significant increases in prevalence.
• Key questions in studying mood disorders include: how rising rates of mood disorders can be understood, the point at which suffering becomes pathological, and whether or not "illness" has a purpose.

Major Depressive Disorder (MDD)

• DSM-5 criteria for MDD: One or more major depressive episodes without manic episodes.
• Five or more symptoms present during a two-week period.
• Symptoms include depressed mood, anhedonia, significant weight changes, sleep disturbances (insomnia or hypersomnia), psychomotor agitation or retardation, fatigue, feelings of worthlessness, decreased ability to concentrate, and recurrent thoughts of death or suicide.
• Questions about the heterogeneity of MDD are raised.
• Persistent Depressive Disorder is a chronic but milder form of depression.
• The differences between personality traits and depressive disorders are discussed.

Bereavement Exclusion

• DSM-5 controversially removed the bereavement exclusion for major depressive disorder.
• The debate surrounding this decision includes the aggressive medicalization of symptoms and the implications of professional autonomy.
• The exclusion's removal could be seen as either more or less culturally sensitive, or as an attack on cultural expression.
• Another discussion point is if and/or how death should be viewed differently from other stressors.
• New diagnostic categories like persistent complex bereavement disorder continue to further complicate the debate.

Bereavement Exclusion II

• A key tension in diagnosing mental disorders is delineating between typical fluctuations in mood and symptoms of mental illness.
• Should all suffering be pathologized?
• What are the consequences of defining some experiences as "illness"? This raises the broader issue of what it means to be human, healthy, and normal.

Depression and Sadness

• Some argue depression and sadness are distinct phenomena, not just varying degrees of misery.
• Depression is characterized by pervasiveness, persistence, and lacking a clear cause or stimulus. Also shows impaired social and occupational functioning.
• The experience is described as being "consumed by a black cloud."
• A significant question is whether biomarkers for depression can definitively distinguish it from sadness.

Bipolar Disorder (BD)

• Bipolar disorder (BD) is characterized by cycling between periods of depression and mania, potentially with intervening periods of normality.
• Mania is defined by persistently elevated or irritable mood, unrealistic self-beliefs, gregariousness, impulsivity, reduced need for sleep, distractibility, and increased goal-oriented activity.
• Manic episodes can lead to excessive involvement in pleasurable activities which can result in negative consequences.
• Bipolar disorder could also involve severe psychotic symptoms.
• Issues around how to differentiate grandiose delusions from overly-confident expression of abilities and hypomania are discussed.

Benefits of Mood Disorders

• There are arguments that mood disorders, while often perceived negatively, may also hold some positive benefits or values that could be explored.
• One example is whether mania inspires creativity and greatness and does depression inspire contemplation or thoughtfulness.
• Others consider these proposals selective, unrealistic, and harmful.

Premenstrual Dysphoric Disorder (PMDD)

• PMDD is characterized by five or more symptoms during the week before menstruation in most menstrual cycles.
• PMDD symptoms include affective liability, interpersonal conflicts, depressed mood, hopelessness, anxiety, tension, decreased interest or enjoyment in activities, difficulty concentrating, and lethargy.
• Additional symptoms include changes in appetite, overeating or specific food cravings, sleep disturbances (hypersomnia or insomnia), and feeling overwhelmed or out of control.
• Physical issues like breast tenderness, swelling, joint or muscle pain, bloating, and weight gain can also be presented.

PMDD Controversies

• What constitutes the boundaries between PMDD and Premenstrual Syndrome (PMS)?
• What does it mean to label something naturally occurring (as part of the menstrual cycle) as a disorder?
• The listing of PMDD in the DSM was controversial and prompted debate and discussion, reflecting the difficulties in defining normality and abnormality or health and illness.

Disruptive Mood Dysregulation Disorder (DMDD)

• DMDD is a new diagnosis in DSM-5.
• It's characterized by recurrent temper outbursts that are disproportionate to the situation, with persistent irritability occurring between outbursts, mainly in children.
• Observations across multiple settings are important for diagnosis: observations should be made not only with parents but also with teachers, and peers.
• Children must be aged between 6 and 18, and symptoms must begin before age 10.

DMDD Controversies

• There's a broader trend of medicalizing childhood conditions, including significant increases in diagnoses of ADHD, autism, as well as childhood bipolar disorder since the 1990s.
• Concerns exist about whether DMDD is genuinely needed, as similar behaviour may already be covered by oppositional defiant disorder (ODD).
• The diagnosis is considered "untested," and members of the DSM group have voiced concerns about the diagnosis violating the Hippocratic oath.
• The broader questions regarding labelling behaviour as mental disorder, and the potential benefits and drawbacks of medicalization raise further discussion points.

The "Great Depression"

• Questions about the dramatic increase in the diagnosis of depression are addressed. The sharp increase in depression cases in recent decades raises questions about its causes.
• Possible elements to this increase include modernization, increased individualism, and social isolation, with the speculation that a cultural avoidance of negative feelings may be hindering the ability to overcome significant challenges or feelings of anguish.
• An alternative theory to this rise in diagnoses questions whether the increase is real or simply a result of changing diagnostic criteria or enhanced awareness.
• This theory posits that the increasing incidence is due to factors like increased awareness, reduced stigma, or the adapting to contemporary scientific discourse regarding emotional distress or psychological issues.