Mood disorders: what they are and what problems they cause

By Cristiano Antonino On Feb 6, 2023

Mood disorders are psychopathological syndromes characterised by an alteration of the physiological mechanisms of mood oscillation that normally allow the individual to adapt his or her reactions to the conditions of the environment surrounding him or her

In the case of mood disorders, changes in mood often occur spontaneously, are of excessive magnitude and are accompanied by a wide range of symptoms that lead to the individual no longer being able to maintain normal daily functioning.

Mood disorders are usually divided into depressive disorders (‘unipolar depression’) and bipolar disorders

The former are characterised by depressed mood with

feelings of deep sadness, guilt and apprehension,
feeling that nothing has value any more,
tendency to isolation and apathy,
loss of interest and pleasure in daily activities,
sleep or appetite disturbances,
poor sexual desire.

These mood disorder symptoms may present as acute episodes (lasting at least two weeks in order to speak of major depressive disorder) or as long periods of depressed mood but without the other depressive symptoms being particularly marked or numerous (lasting at least two years in order to diagnose dysthymic disorder).

These disorders share a characteristic that distinguishes them from bipolar disorders: the absence of manic, mixed or hypomanic episodes, either present or past.

Bipolar mood disorders, on the other hand, are characterised by alternating depressive episodes with phases of markedly euphoric or irritable mood, associated with

increased activity level in the work, social or sexual sphere,
unusual talkativeness or rapid speech,
subjective impression that thoughts follow one another quickly,
decreased need for sleep,
high self-esteem,
easy distractibility,
excessive involvement in potentially harmful pleasurable activities.

Among mood disorders, bipolar II disorder differs from bipolar I in the presence of hypomanic symptoms, thus less severe and intense, with reduced social and work impairment of the subject.

Finally, cyclothymic disorder is characterised by the presence, for at least two years, of a rapid and continuous alternation of depressive and hypomanic symptoms of moderate intensity.

Mood disorders are a widespread pathology in the general population and, especially depression, a frequent reason for consulting the general practitioner.

It is estimated that 20% of the population will experience depressive or manic episodes during their lifetime, with a 1:3 ratio between bipolar and unipolar forms.

In Western countries, the prevalence of major depression is 2.2 per cent within a month and 5.8 per cent over the course of a lifetime, with women being approximately twice as frequent as men.

The age of onset varies greatly between unipolar and bipolar mood disorders: in the former the typical age of onset varies between 30 and 40 years, while in bipolar forms between 15 and 30 years.

The attention paid to mood disorders by the scientific world is justified not only by their high prevalence, but also by the serious complications associated with them, such as the impairment of social, working and emotional life, alcohol or drug abuse and finally suicide.

The hypotheses that attempt to explain the factors that contribute to mood disorders are divided into biological and psychological hypotheses

The former support the idea that in some subjects there is a particular vulnerability of biochemical systems on a genetic basis or in relation to neurotransmitter alterations, in particular of the noradrenergic and serotonergic systems; this vulnerability, driven by environmental factors, would give rise to depressive, manic or mixed clinical pictures.

Psychological causal models of mood disorders have instead emphasised the central role of the ‘negative’ mental representations that the individual has of himself, others and the world and that guide his thoughts and behaviour (cognitive hypothesis) or have related depression to experiences of loss in childhood (psychoanalytic hypothesis).

Whereas in the past the treatment of mood disorders, especially severe ones, was associated almost exclusively with the use of drugs, in recent decades cognitive-behavioural psychotherapy has been recognised as a particularly effective treatment, especially when combined with drug therapy.

The patient can benefit from cognitive-behavioural psychotherapy not only in the acute phase but also in the prevention of relapses and, in bipolar forms, as a preventive intervention in the inter-critical phase.

Other forms of psychotherapy have no particular scientific evidence of efficacy for the treatment of mood disorders.

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