Psychology

Mood disorders comprises of a group of mental disorders that are characterized by depression periods which sometimes alternate with durations where the mood is elevated (Dinsmoor, 2010). Majority of the people do experience mood swings from time to time where one moment they feel sad and the next moment their moods are elevated (National Center for Health and Wellness, 2002). However, for people with mood disorders their state of mood is usually very severe or so prolonged such that it disrupts their daily lives. The major mood disorders include dysthymia, bipolar disorder and major depressive disorder (Dinsmoor, 2010). In order to diagnose and classify mood disorders, the doctors usually first determine if it is bipolar or unipolar. Unipolar is a condition of mood disorder characterized by presence of only one extreme mood.

Major depression involves one period of severe depression. That is usually characterized by thoughts of hopelessness and physical problems such as fatigue. Some of the patients with major depressive disorder experience infrequent periods of depression while some experience very frequent periods of depression. There are five subtypes of this mood disorder that are known as specifiers which include seasonal affective disorder, melancholic depression, postpartum disorder, catatonic depression as well as atypical depression.

Bipolar disorder on the other hand is a condition where the patients who are affected experience two extreme moods (Ghaemi, 2008). It is also known as manic depression or bipolar depression. Patients with this condition alternate between episodes of high mood (mania) and episodes of low mood (depression). These episodes of mania are usually very intense and have a debilitating effect on the patient. There are four types of bipolar disorders which includes bipolar I disorder, bipolar II disorder, bipolar not-otherwise specified and cyclothymia (Ghaemi, 2008). Patients with bipolar one I disorder exhibit episodes of manic where the patient is high. This period of manic is usually followed by a depression period. Some patients with this disorder also do exhibit mixed states where both depressive and manic symptoms occur together. Bipolar II disorder is usually characterized by periods of major depression which alternate with periods of hypomania. This form of bipolar disorder is hard to distinguish from unipolar depression. Cyclothymia is characterized by a cyclic pattern of depression and hypomania but these do not reach the levels of major depression (Ghaemi, 2008). The category of bipolar disorder known as not-otherwise specified comprises of states of bipolar that do not fit into any of the other categories.

Dysthymia condition is characterized lengthy or recurrent depression and this can last a lifetime (Ghaemi, 2008). Its characteristics are similar to those of major depressive disorder. The only difference is that dysthymia is long-lasting, mild, chronic, and persistent. In some rare cases, patients experience both dysthymia and major depressive episodes together. This condition is usually known as double depression.

There are several theories that seek to explain the etiology of mood disorders. These include psychoanalytic theory, interpersonal theory, existential theory, cognitive theory and biological theory (Barlow  Durand, 2005). Cognitive theory seeks to explain how the patterns of thought are related to mood disorders. Under cognitive theories is Becks theory which says that depression is caused by interplay of habits of negativity, a pessimistic character as well as erroneous thinking (Barlow  Durand, 2005). These erroneous thought patterns include overgeneralization of issues, selective abstraction as well as minimization and magnification of issues. According to Becks theory, people who are depressed show a cognitive bias in their thought patterns. This theory is not causal it is correlational. Other theories under cognitive theories include learned helplessness theory, hopelessness theory and attributional reformulation theory. Learned helplessness theory says that mood disorders result from patients perceived lack of environmental control. Attributional reformulation theory says that the causes of mood disorders in humans are problematic attributions which can be permanent e.g. no one will ever love me, universal e.g. nobody likes me or internal e.g. everything is my fault(Barlow  Durand, 2005). These attributions lead to depression and helplessness. Hopelessness theory says that lack of hope predisposes to low esteem which leads to mood disorders. This lack of hope is usually brought about by an uncontrollable adverse event which leads to a sense of hopelessness (Health Grades International, 2010).

Interpersonal theory focuses on rejection as a cause of mood disorder. Factors such as reduced interpersonal support of whatever kind can lead to depression (Barlow  Durand, 2005). Another factor under this theory is experiences of rejection. The sources of rejection can be elicited by the patient for example following comments made by their friends, can be due to lack of good social skills and so the patient is unable to seek reassurance which leads to mood disorders. Another source of rejection is the social structure where the patients are disliked by others or have social networks that are inadequate and this leads to development of mood disorders as a response to this.

Biological theories focus on how the genetic composition of an individual as well as how neurotransmitters serve to cause mood disorder (Barlow  Durand, 2005). They include brain chemistry theories, brain structure theories, neuroendocrine theories and genetic theories. The brain chemistry theories seek to explain the role played by serotonin and nor epinephrine in mood disorders. These are neurotransmitters and are the chemical messengers that enable the nerve cells to communicate with each other thus transmission of impulses. Mood disorders results from imbalance in the neurotransmitters. Causes of imbalances include failure of the neurotransmitters to bind to the receptors after release, release of inadequate neurotransmitters, and very fast absorption of the transmitter from the circulation system. Brain structure theory of mood disorder is usually used for only the major depressive disorder. Diagnostic scans using magnetic resonance imaging have shown that the brain structure of depressed individuals has several differences compared to those without depression. Research has shown that depressed people have smaller volumes of hippocampal as well as a higher number of hyper intensive lesions. Hippocampus is the centre for mood and memory and loss of neurons in this part has been found in some of the individuals who are depressed and is associated with dysthmic mood and impaired memory. The neuroendocrine theory of mood disorder says that mood disorders are caused by malfunction of the endocrine systems. Major depression has been shown to be caused by hyperactivity of the hypothalamic pituitary adrenal axis. Major depression is also caused following increases in the levels of cortisol as well as enlarged adrenal and pituitary glands. Genetic theory explains that the genetic composition of an individual may predispose them to mood disorders. This has been determined through research in molecular genetics which has revealed that when a gene which codes for a protein that is involved with the transport of serotonin mutates, an individual may not be able to cope with stressful situations and this may lead to mood disorders especially depression.

Another theory that tries to explain the causes of mood disorder is the existential theory (Barlow  Durand, 2005). This seeks to show how loss of meaning can lead to mood disorder. According to this theory, when people lack goals in life or when they no longer strive to attain self actualization, depression sets in. Behavioral theory of mood disorder says that learned hopelessnesshelplessness theory has a cognitive twist but it is a behavioral theory. It explains that people who are depressed usually take part in few events that give them pleasure. These individuals also usually lack skills that help to regulate moods which include self control skills, problem solving skills, occupational skills, social skills, recreational skills, and skills to learn the behavior of the environment.

Different methods are adopted to treat the various forms of mood disorders. Each disorder is treated differently after being diagnosed but the principles are basically the same. The treatments that are commonly used to treat depression include electroconvulsive therapy, psychotherapy and depression (Ghaemi, 2008). Psychotherapy is usually used to treat individuals under the age of 18 and yields good results. It is usually administered to groups or to individuals. If the form of depression is chronic and complex, psychotherapy should be combined with medication. There are three forms of psychological therapy which includes interpersonal therapy, cognitive behavioral therapy and family therapy. Psychotherapy is also effective in people who are older and if the therapy is successful, chances of depression recurrence are reduced. The most common form of depression psychotherapy is cognitive behavioral therapy and it is administered by teaching patients how to learn useful behavioral and cognitive skills. It works best when used in cases of moderate to severe depression and in adolescents who are depressed. Success of therapy is usually indicated by reduced hopelessness, increased levels of positive thoughts and less cognitive distortions. Interpersonal therapy is usually aimed at addressing the interpersonal and social factors that lead to depression. In this therapy the patients attend sessions that help them to be able to relate well with others. Logotherapy is a form of therapy that is used to treat mood disorders that are caused by existentialism (Ghaemi, 2008). It addresses feelings of loss of meaning in individuals by filling the extential vacuum. This therapy works well in adolescents who are older.

Antidepressants have the same effects as psychotherapy but are not as good as psychotherapy which has no side effects. To reduce the side effects of these drugs, dosages are adjusted and sometimes it is necessary to use different types of antidepressants in combination. Use of antidepressants in patients who are depressed is usually continued for sometime after the patient has recovered to prevent cases of recurrence. In case of chronic depression, individuals are required to take the drugs indefinitely to prevent cases of relapse. The primary antidepressant medications are selective serotonin reuptake inhibitors which include fluoxetine, sertraline, citalopram, escitalopram and paroxetine (Shah, Einsner, Farell and Raeder, 1999). These are good since their side effects are mild they are effective and are not as toxic as other antidepressants in cases of overdose. Patients are usually put on one type of selective serotonin reuptake inhibitors and when they do not improve they are switched to another (Shah et al., 1999). In adolescents who are depressed, escitalopram and fluoxetine are the drugs which are recommended. Monoamine oxidase inhibitors are another group of antidepressants. However, they are only rarely used as their interaction with food and other drugs is life-threatening.

Another form of therapy is electroconvulsive therapy which uses two electrodes to send electricity pulses through the brain. In this procedure, the patient is usually put under general anesthesia for a short period during which the electrodes are placed on the temples to induce a seizure (Ghaemi, 2008). This method is usually used to treat severe cases of major depression that have failed to respond to psychotherapy, antidepressant medication and supportive interventions. This form of therapy yields immediate results and is useful in emergency cases where the patient is very suicidal or where the depression has led the patient to stop drinking and eating. In the short term this method yields good results compared to pharmacotherapy but cases of relapse are high following electrocompulsive therapy. Common side effects of this method include long term and short term loss of memory, headache and disorientation.

Other somatic treatment methods of depression include the repetitive transcranial magnetic stimulation method and vagus nerve stimulation (Mind Care Centers, 2010). Repetitive transcranial magnetic stimulation is a therapy technique in which strong magnetic fields are applied on the head to reach the brain. It is used to treat depression that does not respond to treatment as well as uncomplicated depression (Ghaemi, 2008). The technique of stimulating vagus nerve is also another therapy for drug resistant depression.

To treat bipolar mood disorders, the same therapies that are used to treat depression are used. The most recommended treatment plans for treating bipolar disorder is counseling and psychotherapy. Psychotherapy for this mood disorder is administered to both the patients and their family members to enable them to lower the risk of suicide as well as help them adjust. Chinese herbs are another form of therapy that is used on patients with bipolar disorders and helps to stabilize moods. Biofeedback is another therapy that is used on these kinds of patients and is effective in controlling the patients symptoms for example racing thoughts, irritability, sleep problems and lack of self control. In this technique a diet that is low in vanadium and with a high level of vitamin C is used to reduce depression in the patients (Ghaemi, 2008). Allopathic method uses medication to treat bipolar disorder. It usually comprises of a combination of agents of stabilizing moods and antipsychotics, antidepressants and anticonvulsants. The agents that are used to stabilize mood includes lithium, valproate and carbamazepine. Lithium is used to regulate bipolar depression though it has side effects. Its long term use is not recommended as it can cause hyperthyroidism. Carbamazepine is used to treat cases that are resistant to lithium in combination with other agents of stabilizing moods. Valproate is used to treat patients who have mixed states and those with cycling bipolar that is rapid. It can be used alone or in combination with lithium or carbamazepine. Electrocompulsive therapy can also be used to treat bipolar conditions but only after other methods have failed (MGH hotline, 2006). If it is to be used, it is recommended that it be used in combination with drug therapy.

There are many case studies associated with mood disorders. A case study of a bipolar disorder is a girl aged eight who had been diagnosed with rapid cycling when she was three years (Elster, 2007). She tried many therapies but none was helping and that was when her parents sought other options. They adopted a supplement program that included minerals and vitamins and this improved her condition (Elster, 2007). A case study of the major depressive disorder is a case of Alex whose behavior had changed when his parents were getting a divorce (Kids Behavior, 2010). He had problems sleeping and was generally fussy. During treatment, Alex said that he was stupid and that he wished to die. His psychiatrist recommended both family and individual therapy and Alexs mood improved (Kids Behavior, 2010).