Mood Disorders

Mood disorders such as major depression, dysthymia, bipolar disorder, and cyclothymia are common and very treatable forms of psychiatric problems. Depression is one of the most common conditions encountered in medical practice and affects up to 25 percent of women and 12 percent of men. Untreated depression can persist for two years or longer. Sixty percent of patients who receive treatment and recover will experience a recurrence of depression within three years. Fortunately, most episodes of major depression respond well to treatment.

For the diagnosis of major depression to be made, a depressed mood or loss of interest or pleasure in almost all activities must be present for at least two weeks and at least four of the following symptoms must be experienced: sleep disturbance (usually early morning awakening), fatigue or loss of energy, feelings of worthlessness or excessive guilt, diminished ability to concentrate or make decisions, agitation (anxiety or restlessness) or slowed movements, change in appetite with or without weight loss, and recurrent thoughts of death or suicide.

Dysthymia, or minor depression, is the presence of a depressed mood for most of the day for two years with no more than two months' freedom from symptoms. In addition at least two of the following symptoms must occur concurrently with the depression: disruption in eating habits--poor appetite or overeating; disturbed sleeping pattern--insomnia or hypersomnia; low energy or fatigue; low self-esteem; poor concentration or difficulty making decisions; and a feeling of hopelessness.

Bipolar disorder or manic depressive disorder is characterized by recurrent episodes of mania and major depression. Most of those who suffer from this condition (60 to 80 percent) initially manifest a manic phase, followed by depression. Manic symptoms consist of feelings of inflated self-esteem or grandiosity, a decreased need for sleep, unusual loquacity, and an unconnected flow of ideas, distractibility, or excessive involvement in pleasurable activities that have a high potential for painful consequences, such as buying sprees or sexual indiscretions. Lithium is an effective drug for controlling these symptoms, although additional medications such as a benzodiazepine are needed to counteract an acute manic phase, and other antidepressants are necessary to treat bouts of major depression.

Cyclothymia is a chronic mood disturbance and is a milder form of bipolar disorder. For this diagnosis to be made the patient will have exhibited at least two years of hypomania or moderate mania and numerous periods of depressed mood that do not meet the criteria for major