View source for Mood disorder

{{short description|Mental disorder affecting the mood of an individual or person, over a long period of time}}
{{Use dmy dates|date=December 2019}}
{{Infobox medical condition (new)
| name = Mood disorder
| synonyms = mental disorder
| image = A depressive man standing by a country pond in the pouring r Wellcome V0011388.jpg
| caption = A depressive man standing by a country pond in the pouring rain
| pronounce = 
| field = [[Neuropsychiatry|Neuro]][[psychiatry]]
| symptoms = 
| complications = 
| onset = 
| duration = 
| types = [[Bipolar disorder]], [[cyclothymia]], [[disruptive mood dysregulation disorder]], [[dysthymia]], [[major depressive disorder]], [[premenstrual dysphoric disorder]], [[seasonal affective disorder]]
| causes = Family history, previous diagnosis of a mood disorder, trauma, stress or major life changes in the case of depression, physical illness or use of certain medications. Depression has been linked to major diseases such as cancer, diabetes, Parkinson's disease and heart disease, Brain structure and function in the case of bipolar disorder.<ref name="clevelandclinic">{{cite web |title=Mood Disorders |url=https://my.clevelandclinic.org/health/diseases/17843-mood-disorders |publisher=Cleveland Clinic |access-date=2022-06-09}}</ref>
| risks = 
| diagnosis = 
| differential = 
| prevention = 
| treatment = 
| medication = Antidepressants, mood stabilizers, antipsychotics<ref name="clevelandclinic" />
| prognosis = 
| frequency = 
| deaths = 
}}

A '''mood disorder''', also known as an '''affective disorder''', is any of a group of conditions of [[mental disorder|mental]] and [[Abnormal behavior|behavioral]] [[Disorder (medicine)|disorder]]{{sfn|Sartorius|1993|pp=91–93}} where the main underlying characteristic is a disturbance in the person's [[mood (psychology)|mood]].{{sfn | Sadock | Sadock | 2002| p = 534}} The classification is in the ''[[Diagnostic and Statistical Manual of Mental Disorders]]'' (DSM) and [[International Statistical Classification of Diseases and Related Health Problems|International Classification of Diseases]] (ICD).

Mood disorders fall into seven groups,{{sfn|Sartorius|1993|pp=91–93}} including; abnormally elevated mood, such as [[mania]] or [[hypomania]]; depressed mood, of which the best-known and most researched is [[major depressive disorder]] (MDD) (alternatively known as clinical depression, unipolar depression, or major depression); and moods which cycle between mania and depression, known as [[bipolar disorder]] (BD) (formerly known as manic depression). There are several subtypes of depressive disorders or psychiatric syndromes featuring less severe symptoms such as [[dysthymic]] disorder (similar to MDD, but longer lasting and more persistent, though often milder) and [[cyclothymic]] disorder (similar to but milder than BD).{{sfn|Carlson|Heth|2007|p={{page needed|date=November 2013}}}}

In some cases, more than one mood disorder can be present in an individual, like bipolar disorder and depressive disorder.<ref>{{Cite web |title=Bipolar Disorder - National Institute of Mental Health (NIMH) |url=https://www.nimh.nih.gov/health/publications/bipolar-disorder |access-date=2025-04-10 |website=www.nimh.nih.gov |language=en}}</ref> Mood disorders may also be substance induced, or occur in response to a [[medical condition]].

English [[psychiatrist]] [[Henry Maudsley]] proposed an overarching category of ''affective disorder''.<ref name="Lewis1934">{{cite journal |last=Lewis |first=AJ |year=1934 |title=Melancholia: A Historical Review |journal=Journal of Mental Science |volume=80 |issue=328 |pages=1–42 |doi=10.1192/bjp.80.328.1 |doi-access=free |url=http://bjp.rcpsych.org/cgi/content/citation/80/328/1 |url-status=live |archive-url=https://web.archive.org/web/20081215051726/http://bjp.rcpsych.org/cgi/content/citation/80/328/1 |archive-date=15 December 2008}}</ref> The term was then replaced by ''mood disorder'', as the latter refers to the underlying or longitudinal emotional state,<ref>{{cite journal |doi=10.1017/S0033291700004980 |last1=Berrios |first1=GE |year=1985 |title=The Psychopathology of Affectivity: Conceptual and Historical Aspects |journal=Psychological Medicine |volume=15 |issue=4| pages=745–758 |pmid=3909185|s2cid=26603488 }}</ref> whereas the former refers to the external expression observed by others.{{sfn | Sadock | Sadock | 2002| p = 534}}
{{TOC limit|3}}

== Classification ==

=== Depressive disorders ===
* [[Major depressive disorder]] (MDD), commonly called major depression, unipolar depression, or clinical depression, wherein a person has one or more [[major depressive episode]]s. After a single episode, Major Depressive Disorder (single episode) would be diagnosed. After more than one episode, the diagnosis becomes Major Depressive Disorder (Recurrent). Depression without periods of mania is sometimes referred to as ''unipolar depression'' because the mood remains at the bottom "pole" and does not climb to the higher, [[mania|manic]] "pole" as in bipolar disorder.{{sfn|Parker|Hadzi-Pavlovic|Eyers|1996|p=173}}

:Individuals with a major depressive episode or major depressive disorder are at increased risk for [[suicide]]. [[Suicide prevention|Seeking help]] and treatment from a health professional dramatically reduces the individual's risk for suicide. Studies have demonstrated that asking if a depressed friend or family member has thought of committing suicide is an effective way of identifying those at risk, and it does not "plant" the idea or increase an individual's risk for suicide in any way.{{sfn|Sartorius|1993|p={{page needed|date=October 2021}}}} Epidemiological studies carried out in Europe suggest that, at this moment, roughly 8.5 percent of the world's population have a depressive disorder. No age group seems to be exempt from depression, and studies have found that depression appears in infants as young as 6 months old who have been separated from their mothers.<ref>{{cite journal | author = Ayuso-Mateos J.L.| year = 2001 | title = Depressive Disorders in Europe: Prevalence figures from the ODIN study | journal = British Journal of Psychiatry | volume = 179 | issue = 4| pages = 308–316 | doi=10.1192/bjp.179.4.308| pmid = 11581110 |display-authors=etal| doi-access = free }}</ref> However, there may be differences between cultures in prevalence of MDD due to cultural influences that "challenge the definition and diagnosis of psychiatric disorders", as seen in a study by Parker et al. that researched MDD in Chinese individuals.<ref>{{Cite journal |last=Parker |first=Gordon |last2=Gladstone |first2=Gemma |last3=Chee |first3=Kuan Tsee |date=June 2001 |title=Depression in the Planet's Largest Ethnic Group: The Chinese |url=http://psychiatryonline.org/doi/abs/10.1176/appi.ajp.158.6.857 |journal=American Journal of Psychiatry |language=en |volume=158 |issue=6 |pages=857–864 |doi=10.1176/appi.ajp.158.6.857 |doi-access=free |url-status=live |archive-url=https://web.archive.org/web/20240703190756/https://ajp.psychiatryonline.org/doi/pdf/10.1176/appi.ajp.158.6.857?download=true |archive-date= Jul 3, 2024 |url-access=subscription }}</ref> [[Depressive Disorder Not Otherwise Specified|Depressive disorder]] (also known as [[Depression (mood)|depression]]) is a common mental disorder. It involves a depressed mood or loss of pleasure or interest in activities for long periods of time. Depression is different from regular mood changes and feelings about everyday life. It can affect all aspects of life. Depression can happen to anyone. People who have lived through abuse, severe losses, or other stressful events are more likely to develop depression.<ref>{{Cite web |title=Depressive disorder (depression) |url=https://www.who.int/news-room/fact-sheets/detail/depression |access-date=2024-03-11 |website=World Health Organization |date= 31 March 2023  |language=en}}</ref>
* Depressive disorder is frequent in primary care and general hospital practice but is often undetected.  Unrecognized depressive disorder may slow recovery and worsen prognosis in physical illness, therefore it is important that all doctors be able to recognize the condition, treat the less severe cases, and identify those requiring specialist care.<ref>Gelder & Mayou, Geddes (2005). Psychiatry: Page 170. New York, NY; Oxford University Press Inc.</ref>

: Diagnosticians recognize several subtypes or course specifiers:

:* ''[[Atypical depression]]'' (''AD'') is characterized by mood reactivity (paradoxical anhedonia) and positivity,{{Clarify | date = November 2019 | reason = What's the difference between mood reactivity and positivity?  "Mood reactivity" itself is explained in the Atypical depression article, but not "mood positivity."  Perhaps just drop the mood positivity and elaborate more on mood reactivity.}}  significant [[weight gain]] or increased appetite ("comfort eating"), excessive sleep or somnolence ([[hypersomnia]]), a sensation of heaviness in limbs known as leaden paralysis, and significant social impairment as a consequence of hypersensitivity to perceived [[social rejection|interpersonal rejection]].{{sfn|American Psychiatric Association|2000| pp=421–422}} Difficulties in measuring this subtype have led to questions of its validity and prevalence.{{sfn|Sadock|Sadock|2002| p=548}}

:* ''[[Melancholic depression]]'' is characterized by a loss of pleasure ([[anhedonia]]) in most or all activities, a failure of reactivity to pleasurable [[Stimulus (physiology)|stimuli]], a quality of depressed mood more pronounced than that of [[grief]] or loss, a worsening of symptoms in the morning hours, early-morning waking, [[psychomotor retardation]], excessive weight loss (not to be confused with [[anorexia nervosa]]), or excessive guilt.{{sfn|American Psychiatric Association|2000| pp=419–420}}

:* ''[[Psychotic major depression]]'' (''PMD''), or simply psychotic depression, is the term for a major depressive episode, in particular of melancholic nature, wherein the patient experiences psychotic symptoms such as [[delusion]]s or, less commonly, [[hallucination]]s. These are most commonly mood-congruent (content coincident with depressive themes).{{sfn|American Psychiatric Association|2000| p=412}}

:* ''[[Catatonic depression]]'' is a rare and severe form of major depression involving disturbances of motor behavior and other symptoms. Here, the person is mute and almost stuporous, and either is immobile or exhibits purposeless or even bizarre movements. Catatonic symptoms can also occur in [[schizophrenia]] or a [[manic episode]], or can be due to [[neuroleptic malignant syndrome]].{{sfn|American Psychiatric Association|2000| pp=417–418}}

:* ''[[Postpartum depression]]'' (''PPD'') is listed as a course specifier in DSM-IV-TR; it refers to the intense, sustained and sometimes disabling depression experienced by women after giving birth. Postpartum depression, which affects 10–15% of women, typically sets in within three months of [[childbirth|labor]], and lasts as long as three months.<ref>{{cite web |author=Ruta M Nonacs |url=http://www.emedicine.com/med/topic3408.htm |website=eMedicine |title=Postpartum Depression |archive-url=https://web.archive.org/web/20081013205912/http://www.emedicine.com/med/topic3408.htm |archive-date=13 October 2008 }}</ref> It is quite common for women to experience a short-term feeling of tiredness and sadness in the first few weeks after giving birth; however, postpartum depression is different because it can cause significant hardship and impaired functioning at home, work, or school as well as, possibly, difficulty in relationships with family members, spouses, or friends, or even problems bonding with the newborn.<ref>O'Hara, Michael W. "Postpartum Depression: Causes and consequences." 1995.</ref> In the treatment of postpartum major depressive disorders and other unipolar depressions in women who are breastfeeding, [[nortriptyline]], [[paroxetine]] (Paxil), and [[sertraline]] (Zoloft) are in general considered to be the preferred medications.<ref>{{cite journal |volume=161 |issue=6 |title=Pooled analysis of antidepressant levels in lactating mothers, breast milk, and nursing infants |vauthors=Weissman AM, Levy BT, Hartz AJ, Bentler S, Donohue M, Ellingrod VL, Wisner KL |journal=Am J Psychiatry |pages=1066–1078 |year=2004 |pmid=15169695 |doi=10.1176/appi.ajp.161.6.1066}}</ref> Women with personal or family histories of mood disorders are at particularly high risk of developing postpartum depression.<ref>Parry, Barbara L. "Premenstrual and Postpartum Mood Disorders." Volume 9.1. 1996. pp=11–16</ref>

:* ''[[Premenstrual dysphoric disorder]]'' (''PMDD'') is a severe and disabling form of [[premenstrual syndrome]] affecting 3–8% of menstruating women.<ref name=Rapkin/> The disorder consists of a "cluster of affective, behavioral and somatic symptoms" that recur monthly during the [[luteal phase]] of the [[menstrual cycle]].<ref name=Rapkin>{{cite journal |last1=Rapkin |first1=AJ |last2=Lewis |first2=EI |title=Treatment of premenstrual dysphoric disorder |journal=Women's Health |volume=9 |issue=6 |pages=537–56 |date= November 2013 |pmid=24161307 |doi=10.2217/whe.13.62|doi-access=free }}</ref> PMDD was added to the list of depressive disorders in the ''[[Diagnostic and Statistical Manual of Mental Disorders]]'' in 2013. The exact pathogenesis of the disorder is still unclear and is an active research topic. Treatment of PMDD relies largely on antidepressants that modulate serotonin levels in the brain via serotonin reuptake inhibitors as well as ovulation suppression using contraception.<ref name=Rapkin/>{{sfn|American Psychiatric Association|2013|pp=[https://archive.org/details/diagnosticstatis0005unse/page/171 171–175]}}

:* ''[[Seasonal affective disorder]]'' (''SAD''), also known as "winter depression" or "winter blues", is a specifier. Some people have a seasonal pattern, with depressive episodes coming on in the autumn or winter, and resolving in spring. The diagnosis is made if at least two episodes have occurred in colder months with none at other times over a two-year period or longer.{{sfn|American Psychiatric Association|2000| p=425}} It is commonly hypothesised that people who live at higher latitudes tend to have less sunlight exposure in the winter and therefore experience higher rates of SAD, but the epidemiological support for this proposition is not strong (and latitude is not the only determinant of the amount of sunlight reaching the eyes in winter). It is said that this disorder can be treated by [[light therapy]].<ref>{{Cite journal|last=Rosenthal|first=N.E|date=1984|title=A Description of the syndrome and preliminary findings with Light Therapy|journal=Archives of General Psychiatry|volume=41|issue=1|pages=72–80|doi=10.1001/archpsyc.1984.01790120076010|pmid=6581756|pmc=2686645}}</ref> SAD is also more prevalent in people who are younger and typically affects more females than males.<ref>{{cite journal |author1=Lam, Raymond W. |author2=Levitan, Robert D. | year = 2000 | title = Pathophysiology of seasonal affective disorder: a review | journal = Journal of Psychiatry and Neuroscience | volume = 25 | issue = 5| pages = 469–480 | pmid = 11109298 | pmc = 1408021 }}</ref>

:* ''[[Dysthymia]]'' is a condition related to unipolar depression, where the same physical and cognitive problems are evident, but they are not as severe and tend to last longer (usually at least 2 years).{{sfn|Schacter |Gilbert |Wegner |2011|pp=564–565}} The treatment of dysthymia is largely the same as for major depression, including antidepressant medications and psychotherapy.{{sfn|Sartorius|1993|p={{page needed|date=October 2021}}}}

:* ''[[Double depression]]'' can be defined as a fairly depressed mood (dysthymia) that lasts for at least two years and is punctuated by periods of major depression.{{sfn|Schacter |Gilbert |Wegner |2011|pp=564–565}}

:*[[Unspecified depressive disorder|Unspecified Depressive Disorder]] is designated by the [[DSM-IV Codes|code]] ''311'' for depressive disorders. In the DSM-5, Unspecified Depressive Disorder encompasses symptoms that are characteristic of depressive disorders and cause significant impairment in functioning, but do not meet the criteria for the diagnosis of any specified depressive disorders. In the DSM-IV, this was called Depressive Disorder Not Otherwise Specified.

:*''[[Depressive personality disorder]]'' (DPD) is a controversial psychiatric diagnosis that denotes a personality disorder with depressive features. Originally included in the DSM-II, depressive personality disorder was removed from the DSM-III and DSM-III-R.<ref>{{cite web |last=Millon |first=T. |date=2006 |title=Personality subtypes |publisher=Institute for Advanced Studies in Personology and Psychopathology |url=http://millon.net/taxonomy/summary.htm |access-date=1 November 2010 |archive-url=https://web.archive.org/web/20131023055645/http://millon.net/taxonomy/summary.htm |archive-date=23 October 2013}}</ref> Recently, it has been reconsidered for reinstatement as a diagnosis. Depressive personality disorder is currently described in Appendix B in the DSM-IV-TR as worthy of further study.

:* ''[[Recurrent brief depression]]'' (''RBD''), distinguished from major depressive disorder primarily by differences in duration. People with RBD have depressive episodes about once per month, with individual episodes lasting less than two weeks and typically less than 2–3 days. Diagnosis of RBD requires that the episodes occur over the span of at least one year and, in female patients, independently of the [[menstrual cycle]].{{sfn|American Psychiatric Association|2000| p=778}} People with clinical depression can develop RBD, and vice versa and both illnesses have similar risks.<ref>{{cite journal |author1=Carta, Mauro Giovanni |author2=Altamura, Alberto Carlo |author3=Hardoy, Maria Carolina |year=2003|title=Is recurrent brief depression an expression of mood spectrum disorders in young people? |journal=European Archives of Psychiatry and Clinical Neuroscience |volume=253 |issue=3 |pages=149–53 |doi=10.1007/s00406-003-0418-5 |pmid=12904979 |display-authors=etal|hdl=2434/521599 |s2cid=26860606 |hdl-access=free}}</ref>{{Clarify |date=November 2019 |reason=What kind of risks?  The second statement (from and both...) cannot be verified against the source.}}

:* ''[[Minor Depressive Disorder|Minor depressive disorder]]'', or simply minor depression, which refers to a depression that does not meet full criteria for major depression but in which at least two symptoms are present for two weeks.<ref>{{cite journal |vauthors=Rapaport MH, Judd LL, Schettler PJ, Yonkers KA, Thase ME, Kupfer DJ, Frank E, Plewes JM, Tollefson GD, Rush AJ |year=2002|title=A descriptive analysis of minor depression |journal=American Journal of Psychiatry |volume=159 |issue=4 |pages=637–43 |pmid=11925303 |doi=10.1176/appi.ajp.159.4.637 }}</ref>

=== Bipolar disorders ===
* [[Bipolar disorder]] (BD) (also called "manic depression" or "manic-depressive disorder"), an unstable emotional condition characterized by cycles of abnormal, persistent high mood ([[mania]]) and low mood ([[Clinical depression|depression]]),{{sfn|Schacter |Gilbert |Wegner |2011|pp=[https://archive.org/details/psychologysecond00dani/page/n601 570]}} which was formerly known as "manic depression" (and in some cases rapid cycling, mixed states, and [[psychosis|psychotic]] symptoms).<ref>{{cite web |author=Melissa Conrad Stöppler |title=Bipolar Disorder (cont.) |publisher=MedicineNet, Inc. |url=http://www.medicinenet.com/bipolar_disorder/page3.htm |access-date=27 October 2013 |archive-url=https://web.archive.org/web/20131018063559/http://www.medicinenet.com/bipolar_disorder/page3.htm |archive-date=18 October 2013 |url-status=live}}</ref> Subtypes include:

:* ''[[Bipolar I]]'' is distinguished by the presence or history of one or more [[manic episodes]] or [[mixed episodes]] with or without major depressive episodes. A depressive episode is not required for the diagnosis of Bipolar I Disorder, but depressive episodes are usually part of the course of the illness.
:* ''[[Bipolar II]]'' consisting of recurrent intermittent [[hypomania|hypomanic]] and depressive episodes or mixed episodes.
:* ''[[Cyclothymia]]'' is a form of bipolar disorder, consisting of recurrent hypomanic and [[dysthymia|dysthymic]] episodes, but no full manic episodes or full major depressive episodes.
:* ''[[Bipolar disorder not otherwise specified]]'' (''BD-NOS''), sometimes called "sub-threshold" bipolar, indicates that the patient has some symptoms in the bipolar spectrum (e.g., manic and depressive symptoms) but does not fully qualify for any of the three formal bipolar DSM-IV diagnoses mentioned above.
:It is estimated that roughly 1% of the adult population has bipolar I, a further 1% has bipolar II or cyclothymia, and somewhere between 2% and 5% percent have "sub-threshold" forms of bipolar disorder. Furthermore, the possibility of getting bipolar disorder when one parent is diagnosed with it is 15–30%. Risk, when both parents have it, is 50–75%. Also, while with bipolar siblings the risk is 15–25%, with identical twins it is about 70%.<ref>{{cite journal|last=Abell|first=S.|author2=Ey, J. L.|title=Bipolar Disorder|journal=Clinical Pediatrics|date=4 June 2009|volume=48|issue=6|pages=693–694|pmid=19498214 |doi=10.1177/0009922808316663 |s2cid=46493183 }}</ref>

=== Substance-induced ===

A mood disorder can be classified as substance-induced if its etiology can be traced to the direct physiologic effects of a [[psychoactive drug]] or other chemical substance, or if the development of the mood disorder occurred contemporaneously with [[substance intoxication]] or [[Drug withdrawal|withdrawal]]. Also, an individual may have a mood disorder coexisting with a [[substance abuse]] disorder. Substance-induced mood disorders can have features of a manic, hypomanic, mixed, or depressive episode. Most substances can induce a variety of mood disorders. For example, [[stimulant]]s such as [[amphetamine]], [[methamphetamine]], and [[cocaine]] can cause manic, hypomanic, mixed, and depressive episodes.<ref>{{cite web | url=http://www.faqs.org/patents/app/20120321644#b | title=Methods for Diagnosing Mood Disorders | publisher=faqs.org | access-date=26 November 2013 | url-status=live | archive-url=https://web.archive.org/web/20131203062559/http://www.faqs.org/patents/app/20120321644#b | archive-date=3 December 2013}}</ref>{{unreliable source?|date=November 2013}}

==== Alcohol-induced ====

High rates of major depressive disorder occur in heavy drinkers and those with [[alcoholism]]. Controversy has previously surrounded whether those who abused alcohol and developed depression were self-medicating their pre-existing depression. Recent research has concluded that, while this may be true in some cases, alcohol misuse directly causes the development of depression in a significant number of heavy drinkers. Participants studied were also assessed during stressful events in their lives and measured on a ''Feeling Bad Scale.'' Likewise, they were also assessed on their affiliation with '' deviant '' peers, unemployment, and their partner's substance use and criminal offending.<ref>{{cite journal |vauthors=Fergusson DM, Boden JM, Horwood LJ |title=Tests of causal links between alcohol abuse or dependence and major depression |journal=Arch. Gen. Psychiatry |volume=66 |issue=3 |pages=260–6 |date=March 2009 |doi=10.1001/archgenpsychiatry.2008.543 |pmid=19255375 |doi-access=free }}</ref><ref>{{cite journal |vauthors=Falk DE, Yi HY, Hilton ME |title=Age of Onset and Temporal Sequencing of Lifetime DSM-IV Alcohol Use Disorders Relative to Comorbid Mood and Anxiety Disorders |journal=Drug Alcohol Depend |volume=94 |issue=1–3 |pages=234–45 |date=April 2008 |pmid=18215474 |doi=10.1016/j.drugalcdep.2007.11.022 |pmc=2386955 }}</ref><ref name="Schuckit MA, Smith TL, Danko GP, et al 2007 805–12">{{cite journal |vauthors=Schuckit MA, Smith TL, Danko GP |title=A comparison of factors associated with substance-induced versus independent depressions |journal=J Stud Alcohol Drugs |volume=68 |issue=6 |pages=805–12 |date=November 2007 |pmid=17960298 |doi= 10.15288/jsad.2007.68.805|s2cid=17528609 |display-authors=etal}}</ref> High rates of suicide also occur in those who have alcohol-related problems.<ref>{{cite journal |vauthors=Chignon JM, Cortes MJ, Martin P, Chabannes JP |title=[Attempted suicide and alcohol dependence: results of an epidemiologic survey] |language=fr |journal=Encephale |volume=24 |issue=4 |pages=347–54 |year=1998 |pmid=9809240 }}</ref> It is usually possible to differentiate between alcohol-related depression and depression that is not related to [[alcohol (drug)|alcohol]] intake by taking a careful history of the patient.<ref name="Schuckit MA, Smith TL, Danko GP, et al 2007 805–12"/><ref name="pmid9210745">{{cite journal |vauthors=Schuckit MA, Tipp JE, Bergman M, Reich W, Hesselbrock VM, Smith TL |title=Comparison of induced and independent major depressive disorders in 2,945 alcoholics |journal=Am J Psychiatry |volume=154 |issue=7 |pages=948–57 |date=July 1997 |pmid=9210745 |doi= 10.1176/ajp.154.7.948|citeseerx=10.1.1.461.7953 }}</ref><ref>{{cite journal |vauthors=Schuckit MA, Tipp JE, Bucholz KK |title=The life-time rates of three major mood disorders and four major anxiety disorders in alcoholics and controls |journal=Addiction |volume=92 |issue=10 |pages=1289–304 |date=October 1997 |pmid=9489046 |doi= 10.1111/j.1360-0443.1997.tb02848.x|display-authors=etal}}</ref> Depression and other mental health problems associated with alcohol misuse may be due to distortion of brain chemistry, as they tend to improve on their own after a period of abstinence.<ref>{{cite journal |vauthors=Wetterling T, Junghanns K |date= December 2000 |title=Psychopathology of alcoholics during withdrawal and early abstinence|journal=Eur Psychiatry |volume=15 |issue=8 |pages=483–8 |pmid=11175926 |doi=10.1016/S0924-9338(00)00519-8 |s2cid= 24094651 }}</ref>

==== Benzodiazepine-induced ====
[[Benzodiazepine]]s, such as [[alprazolam]], [[clonazepam]], [[lorazepam]] and [[diazepam]], can cause both depression and mania.{{sfn|American Psychiatric Association|2013|p={{page needed|date=October 2021}}}}

Benzodiazepines are a class of medication commonly used to treat anxiety, panic attacks and insomnia, and are also [[Substance abuse|commonly misused and abused]]. Those with anxiety, panic and sleep problems commonly have negative emotions and thoughts, depression, suicidal ideations, and often have comorbid depressive disorders. While the [[anxiolytic]] and [[hypnotic]] effects of benzodiazepines may disappear as [[Drug tolerance|tolerance]] develops, depression and impulsivity with high suicidal risk commonly persist.<ref name=":0">{{Cite journal|title = Long-term use of benzodiazepines: tolerance, dependence and clinical problems in anxiety and mood disorders|journal = Pharmacopsychiatry|date = July 1996|issn = 0176-3679|pmid = 8858711|pages = 127–134|volume = 29|issue = 4|doi = 10.1055/s-2007-979558|first1 = S.|last1 = Michelini|first2 = G. B.|last2 = Cassano|first3 = F.|last3 = Frare|first4 = G.|last4 = Perugi| s2cid=19145509 }}</ref> These symptoms are "often interpreted as an exacerbation or as a natural evolution of previous disorders and the chronic use of sedatives is overlooked".<ref name=":0" /> Benzodiazepines do not prevent the development of depression, can exacerbate preexisting depression, can cause depression in those with no history of it, and can lead to suicide attempts.<ref name=":0" /><ref>{{Cite journal|title = Recent developments in the psychopharmacology of anxiety disorders|journal = Journal of Consulting and Clinical Psychology|date = August 1996|issn = 0022-006X|pmid = 8803355|pages = 660–668|volume = 64|issue = 4|first1 = R. B.|last1 = Lydiard|first2 = O.|last2 = Brawman-Mintzer|first3 = J. C.|last3 = Ballenger|doi=10.1037/0022-006x.64.4.660}}</ref><ref>{{Cite journal|title = Evidence-based guidelines for the pharmacological treatment of anxiety disorders: recommendations from the British Association for Psychopharmacology|journal = Journal of Psychopharmacology|date = November 2005|issn = 0269-8811|pmid = 16272179|pages = 567–596|volume = 19|issue = 6|doi = 10.1177/0269881105059253|first1 = David S.|last1 = Baldwin|first2 = Ian M.|last2 = Anderson|first3 = David J.|last3 = Nutt|first4 = Borwin|last4 = Bandelow|first5 = A.|last5 = Bond|first6 = Jonathan R. T.|last6 = Davidson|first7 = J. A.|last7 = den Boer|first8 = Naomi A.|last8 = Fineberg|first9 = Martin|last9 = Knapp|s2cid = 15685770|url = http://tud.qucosa.de/api/qucosa%3A26469/attachment/ATT-0/|access-date = 5 July 2019|archive-date = 30 April 2019|archive-url = https://web.archive.org/web/20190430005347/http://tud.qucosa.de/api/qucosa%3A26469/attachment/ATT-0/}}</ref><ref name=Ashton1987>{{Cite journal |title=Benzodiazepine withdrawal: outcome in 50 patients|journal=British Journal of Addiction|date=June 1987|issn=0952-0481|pmid=2886145|pages=665–671|volume=82|issue=6|first=C. H.|last=Ashton|doi=10.1111/j.1360-0443.1987.tb01529.x |url=http://www.benzo.org.uk/ashbzoc.htm|url-access=subscription}}</ref><ref>{{Cite journal|title=Treatment of recent trauma survivors with benzodiazepines: a prospective study|journal=The Journal of Clinical Psychiatry|date=September 1996|issn=0160-6689|pmid=9746445|pages=390–394|volume=57|issue=9|first1=E. |last1=Gelpin|first2=O.|last2=Bonne|first3=T.|last3=Peri|first4=D.|last4=Brandes|first5=A. Y.|last5=Shalev}}</ref> Risk factors for suicide and suicide attempts while using benzodiazepines include high dose prescriptions (even in those not misusing the medications), benzodiazepine intoxication, and underlying depression.{{sfn|American Psychiatric Association|2013|p={{page needed|date=October 2021}}}}<ref>{{Cite journal |title=Prevalence and trends of benzodiazepine use among Veterans Affairs patients with posttraumatic stress disorder, 2003–2010|journal=Drug and Alcohol Dependence|date=July 2012|issn=1879-0046|pages=154–161 |volume=124|issue=1–2|first1=Eric J. |last1=Hawkins|first2=Carol A.|last2=Malte|first3=Zac E.|last3=Imel |first4=Andrew J.|last4=Saxon|first5=Daniel R.|last5=Kivlahan|doi=10.1016/j.drugalcdep.2012.01.003 |pmid=22305658 |url=https://zenodo.org/record/1258903}}</ref><ref>{{Cite journal|title=Comorbid Anxiety as a Suicide Risk Factor Among Depressed Veterans|journal=Depression and Anxiety|date=January 2009|issn=1091-4269|pmc=2935592|pmid=19544314 |pages=752–757|volume=26|issue=8|doi=10.1002/da.20583|first1=Paul N. |last1=Pfeiffer|first2=Dara|last2=Ganoczy|first3=Mark|last3=Ilgen|first4=Kara|last4=Zivin|first5=Marcia |last5=Valenstein}}</ref>

The long-term use of benzodiazepines may have a similar effect on the brain as [[alcoholic beverage|alcohol]], and are also implicated in depression.{{sfn|Semple|Smyth|Burns|Darjee|2007|p=540}} As with alcohol, the effects of benzodiazepine on neurochemistry, such as decreased levels of [[serotonin]] and [[norepinephrine]], are believed to be responsible for the increased depression.{{sfn|Collier|Longmore|2003|p=366}}<ref>{{cite web | author= Professor Heather Ashton | year= 2002 | url= http://www.benzo.org.uk/manual/bzcha03.htm | title= Benzodiazepines: How They Work and How to Withdraw}}</ref><ref>{{cite journal |vauthors=Lydiard RB, Laraia MT, Ballenger JC, Howell EF |title=Emergence of depressive symptoms in patients receiving alprazolam for panic disorder |journal=Am J Psychiatry |volume=144 |issue=5 |pages=664–665 |date=May 1987 |pmid=3578580 |doi=10.1176/ajp.144.5.664}}</ref><ref>{{cite journal |vauthors=Nathan RG, Robinson D, Cherek DR, Davison S, Sebastian S, Hack M |date=January 1985 |title=Long-term benzodiazepine use and depression |journal=Am J Psychiatry |volume=142 |issue=1 |pages=144–145 |pmid=2857068 |doi=10.1176/ajp.142.1.144-b |url=http://ajp.psychiatryonline.org/cgi/reprint/142/1/144a |access-date=21 March 2009 |archive-date=16 May 2008 |archive-url=https://web.archive.org/web/20080516053102/http://ajp.psychiatryonline.org/cgi/reprint/142/1/144a |url-access=subscription }}</ref><ref>{{Cite journal|title = Addiction: Part I. Benzodiazepines—side effects, abuse risk and alternatives|journal = American Family Physician|date = April 2000|issn = 0002-838X|pmid = 10779253|pages = 2121–2128|volume = 61|issue = 7|first1 = L. P.|last1 = Longo|first2 = B.|last2 = Johnson}}</ref><ref>{{Cite book |title = Psychiatry, third edition |veditors=Tasman A, Kay J, Lieberman JA |publisher = John Wiley & Sons|year = 2008|location = Chichester, England|pages = 2603–2615}}</ref> Additionally, benzodiazepines can indirectly worsen mood by worsening sleep (i.e., benzodiazepine-induced sleep disorder). Like alcohol, benzodiazepines can put people to sleep but, while asleep, they disrupt sleep architecture: decreasing sleep time, delaying time to [[REM sleep]], and decreasing [[Slow-wave sleep|deep sleep]] (the most restorative part of sleep for both energy and mood).<ref>{{Cite journal|title = The diagnosis and management of benzodiazepine dependence|journal = Current Opinion in Psychiatry |date = May 2005|issn = 0951-7367|pmid = 16639148|pages = 249–255|volume = 18|issue = 3|doi = 10.1097/01.yco.0000165594.60434.84|first = Heather|last = Ashton|s2cid = 1709063 }}</ref><ref name=brt05>{{Cite journal|title = Long-term outcome after discontinuation of benzodiazepines for insomnia: a survival analysis of relapse|journal = Behaviour Research and Therapy|date = January 2005|issn = 0005-7967|pmid = 15531349|pages = 1–14|volume = 43|issue = 1|doi = 10.1016/j.brat.2003.12.002|first1 = Charles M.|last1 = Morin|first2 = Lynda|last2 = Bélanger|first3 = Célyne|last3 = Bastien|first4 = Annie|last4 = Vallières}}</ref><ref name=jpr04>{{Cite journal|title = Chronic benzodiazepine usage and withdrawal in insomnia patients|journal = Journal of Psychiatric Research|date = June 2004|issn = 0022-3956|pmid = 15003439|pages = 327–334|volume = 38|issue = 3|doi = 10.1016/j.jpsychires.2003.10.003|first1 = Dalva|last1 = Poyares|first2 = Christian|last2 = Guilleminault|first3 = Maurice M.|last3 = Ohayon|first4 = Sergio|last4 = Tufik}}</ref> Just as some antidepressants can cause or worsen anxiety in some patients due to being activating, benzodiazepines can cause or worsen depression due to being a [[central nervous system]] depressant—worsening thinking, concentration and problem solving (i.e., benzodiazepine-induced neurocognitive disorder).{{sfn|American Psychiatric Association|2013|p={{page needed|date=October 2021}}}} However, unlike antidepressants, in which the activating effects usually improve with continued treatment, benzodiazepine-induced depression is unlikely to improve until after stopping the medication.<ref name=brt05 /><ref name=jpr04 />

In a long-term follow-up study of patients dependent on benzodiazepines, it was found that 10 people (20%) had taken drug overdoses while on chronic benzodiazepine medication despite only two people ever having had any pre-existing depressive disorder. A year after a gradual withdrawal program, no patients had taken any further overdoses.<ref name=Ashton1987/>

Just as with intoxication and chronic use, [[benzodiazepine withdrawal syndrome|benzodiazepine withdrawal]] can also cause depression.<ref>{{cite journal |vauthors=Fyer AJ, Liebowitz MR, Gorman JM, Campeas R, Levin A, Davies SO, Goetz D, Klein DF |date=March 1987 | title = Discontinuation of Alprazolam Treatment in Panic Patients | journal = Am J Psychiatry | volume = 144 | issue = 3 | pages = 303–8 | pmid = 3826428| url = http://www.benzo.org.uk/alprazolam.htm | access-date = 10 December 2008 | doi=10.1176/ajp.144.3.303| url-access = subscription }}</ref><ref>{{cite journal | journal = Psychosomatics | date = March–April 1997 | volume = 38 | issue = 2 | pages = 160–1 | title = Protracted benzodiazepine withdrawal syndrome mimicking psychotic depression | author = Modell JG | pmid = 9063050 | url = http://psy.psychiatryonline.org/cgi/reprint/38/2/160.pdf | archive-url = https://wayback.archive-it.org/all/20080625161217/http://psy.psychiatryonline.org/cgi/reprint/38/2/160.pdf | archive-date = 25 June 2008 | doi = 10.1016/S0033-3182(97)71493-2 | access-date = 21 March 2009 }}</ref><ref>{{cite journal |author=Lader M |title=Anxiety or depression during withdrawal of hypnotic treatments |journal=J Psychosom Res |volume=38 |issue=Suppl 1 |pages=113–23; discussion 118–23 |year=1994 |pmid=7799243 |doi= 10.1016/0022-3999(94)90142-2}}</ref> While benzodiazepine-induced depressive disorder may be exacerbated immediately after discontinuation of benzodiazepines, evidence suggests that mood significantly improves after the acute withdrawal period to levels better than during use.<ref name=":0"/> Depression resulting from withdrawal from benzodiazepines usually subsides after a few months but in some cases may persist for 6–12 months.<ref>{{cite journal | journal = Psychiatric Annals |date=March 1995 | volume = 25 | issue = 3 | pages = 174–179 | title = Protracted Withdrawal From Benzodiazepines: The Post-Withdrawal Syndrome | author = Ashton CH | url = http://www.benzo.org.uk/pha-1.htm | doi=10.3928/0048-5713-19950301-11| url-access = subscription }}</ref><ref>{{cite web| author= Professor Heather Ashton| year= 2004| url=http://www.benzo.org.uk/pws04.htm| title= Protracted Withdrawal Symptoms From Benzodiazepines | publisher= Comprehensive Handbook of Drug & Alcohol Addiction}}</ref>

===Due to another medical condition===
"Mood disorder due to a general medical condition" is used to describe manic or depressive episodes which occur secondary to a medical condition.<ref name="APP textbook">Hales E and Yudofsky JA, eds, The American Psychiatric Press Textbook of Psychiatry, Washington, DC: American Psychiatric Publishing, Inc., 2003</ref> There are many medical conditions that can trigger mood episodes, including [[neurological disorder]]s (e.g. [[dementia]]s), [[hearing loss]] and associated disorders (e.g. [[tinnitus]] or [[hyperacusis]]), [[metabolic disorder]]s (e.g. electrolyte disturbances), [[gastrointestinal diseases]] (e.g. [[cirrhosis]]), [[endocrine disease]] (e.g. thyroid abnormalities), [[cardiovascular disease]] (e.g. [[heart attack]]), [[pulmonary disease]] (e.g. [[chronic obstructive pulmonary disease]]), [[cancer]],  [[autoimmune disease]]s (e.g. [[multiple sclerosis]]),<ref name="APP textbook"/> and pregnancy.

===Not otherwise specified===
{{See also|DSM-IV codes}}

Mood disorder not otherwise specified (MD-NOS) is a mood disorder that is impairing but does not fit in with any of the other officially specified diagnoses. In the [[DSM-IV]] MD-NOS is described as "any mood disorder that does not meet the criteria for a specific disorder."{{sfn|American Psychiatric Association|2000|p={{page needed|date=October 2021}}}} MD-NOS is not used as a clinical description but as a statistical concept for filing purposes.<ref name=Kaplan>{{cite web |last=Akiskal |first=Hagop S. |url=https://www.brown.edu/Courses/BI_278/Other/Teaching%20examples/Brain%20and%20Behavior/articles/mood.pdf |title=Mood Disorders: Clinical Features |date=2 November 2004 |publisher=Kaplan & Sadock's Comprehensive Textbook of Psychiatry |access-date=21 March 2013 |url-status=live |archive-url=https://web.archive.org/web/20150610220404/http://www.brown.edu/Courses/BI_278/Other/Teaching%20examples/Brain%20and%20Behavior/articles/mood.pdf |archive-date=10 June 2015}}</ref> The diagnosis of MD-NOS does not exist in the DSM-5, however the diagnoses of unspecified depressive disorder and unspecified bipolar disorder are in the DSM-5.<ref>{{Cite book|last=Force.|first=American Psychiatric Association. American Psychiatric Association. DSM-5 Task|title=Diagnostic and statistical manual of mental disorders: DSM-5.|date=2017|publisher=American Psychiatric Association|isbn=978-0-89042-554-1|oclc=1042815534}}</ref>

Most cases of MD-NOS represent hybrids between mood and anxiety disorders, such as [[mixed anxiety-depressive disorder]] or [[atypical depression]].<ref name = Kaplan/> An example of an instance of MD-NOS is being in minor depression frequently during various intervals, such as once every month or once in three days.{{sfn|American Psychiatric Association|2000|p={{page needed|date=October 2021}}}} There is a risk for MD-NOS not to get noticed, and for that reason not to get treated.<ref>{{cite journal |author1=Williams Daniel T. |author2=Hirsch Scott |author3=Coffey Barbara | year = 2007 | title = Mood and Anxiety Symptoms in An Adolescent with Pervasive Developmental Disorder Not Otherwise Specified and Moderate Mental Retardation| journal = Journal of Child and Adolescent Psychopharmacology | volume = 17 | issue = 5| pages = 721–726 | doi = 10.1089/cap.2007.17503 |pmid=17979592 }}</ref>

== Causes ==
Meta-analyses show that high scores on the personality domain [[neuroticism]] are a strong predictor for the development of mood disorders.<ref>{{cite journal |vauthors=Jeronimus BF, Kotov R, Riese H, Ormel J |year=2016 |title=Neuroticism's prospective association with mental disorders: A meta-analysis on 59 longitudinal/prospective studies with 443 313 participants |journal=Psychological Medicine |doi=10.1017/S0033291716001653 |pmid=27523506 |volume=46 |issue=14 |pages=2883–2906 |s2cid=23548727 |url=https://zenodo.org/record/895885}}</ref>

A depressed mood is a predictable response to certain types of life occurrences, such as loss of status, divorce, or death of a child or spouse. These are events that signal a loss of reproductive ability or potential, or that did so in humans' ancestral environment. A depressed mood can be seen as an adaptive response, in the sense that it causes an individual to turn away from the earlier (and reproductively unsuccessful) modes of behavior.{{citation needed|date=April 2022}}

A depressed mood is common during illnesses, such as [[influenza]]. It has been argued that this is an evolved mechanism that assists the individual in recovering by limiting their physical activity.{{sfn|Nesse|Williams|1994|p={{page needed|date=October 2021}}}} The occurrence of low-level depression during the winter months, or [[seasonal affective disorder]], may have been adaptive in the past, by limiting physical activity at times when food was scarce.{{sfn|Nesse|Williams|1994|p={{page needed|date=October 2021}}}} It is argued that humans have retained the instinct to experience low mood during the winter months, even if the availability of food is no longer determined by the weather.{{sfn|Nesse|Williams|1994|p={{page needed|date=October 2021}}}}

Much of what is known about the genetic influence of clinical depression is based upon research that has been done with identical twins. Identical twins have exactly the same genetic code. It has been found that when one identical twin becomes depressed the other will also develop clinical depression approximately 76% of the time. When identical twins are raised apart from each other, they will both become depressed about 67% of the time. Because both twins become depressed at such a high rate, the implication is that there is a strong genetic influence. If it happened that when one twin becomes clinically depressed the other always develops depression, then clinical depression would likely be entirely genetic.<ref>{{cite web |url=http://www.erissolver.com/sq/What-are-the-main-causes-of-depression-or-depressive-disorders-(psychology) |title=What are the main causes of depression or depressive disorders (psychology)? |publisher=Eris Consulting |access-date=10 June 2015 |archive-url=https://web.archive.org/web/20150610110247/http://www.erissolver.com/sq/What-are-the-main-causes-of-depression-or-depressive-disorders-(psychology) |archive-date=10 June 2015}}</ref>

[[Bipolar disorder]] is also considered a mood disorder and it is hypothesized that it might be caused by [[mitochondrial dysfunction]].<ref name="Pieczenik, Steve R 2006">{{cite journal |author1=Pieczenik, Steve R. |author2=Neustadt, John |title=Mitochondrial dysfunction and molecular pathways of disease |journal=Experimental and Molecular Pathology |volume=83 |issue=1 |pages=84–92 |year=2007 |pmid=17239370 |doi=10.1016/j.yexmp.2006.09.008}}</ref><ref>{{cite web |title=Mitochondrial dysfunction and bipolar disorder |date=29 September 2017 |url=https://bipolarnutrition.wordpress.com/2017/09/29/mitochondrial-dysfunction-and-bipolar-disorder/ |access-date=1 October 2017 |url-status=live |archive-url= https://web.archive.org/web/20171001165713/https://bipolarnutrition.wordpress.com/2017/09/29/mitochondrial-dysfunction-and-bipolar-disorder/ |archive-date=1 October 2017}}</ref><ref>{{cite journal |vauthors=Scainiab, Giselli, Rezinc, Gislaine, Carvalhod, Andre, Streckb, Emilio L, Berkef, Michael, Quevedo, João |title=Mitochondrial dysfunction in bipolar disorder: Evidence, pathophysiology and translational implications |journal=Neurosci Biobehav Rev |volume=68 |pages=694–713 |year=2016 |doi=10.1016/j.neubiorev.2016.06.040 |pmid=27377693|s2cid=207092957 }}</ref>

===Sex differences===
Mood disorders, specifically stress-related mood disorders such as anxiety and depression, have been shown to have differing rates of diagnosis based on sex. In the United States, women are two times more likely than men to be diagnosed with a stress-related mood disorder.<ref name="Sex-dependent effects of chronic va">{{cite journal |last1=Rosinger |first1=Zachary |title=Sex-dependent effects of chronic variable stress on discrete corticotropin-releasing factor receptor 1 cell populations |journal=Physiology & Behavior |date=2020|volume=219 |article-number=112847 |doi=10.1016/j.physbeh.2020.112847 |pmid=32081812 |pmc=7540729 }}</ref><ref>{{cite journal |last1=Blume |first1=Shannon |title=Disruptive effects of repeated stress on basolateral amygdala neurons and fear behavior across the estrous cycle in rats |journal=Scientific Reports |date=23 August 2019 |volume=9 |issue=1 |page=12292 |doi=10.1038/s41598-019-48683-3|pmid=31444385 |pmc=6707149 |bibcode=2019NatSR...912292B |doi-access=free }}</ref> Underlying these sex differences, studies have shown a dysregulation of stress-responsive neuroendocrine function causing an increase in the likelihood of developing these affective disorders.<ref>{{cite journal |last1=Weiser |first1=Michael |title=Androgen regulation of corticotropin-releasing hormone receptor 2 (CRHR2) mRNA expression and receptor binding in the rat brain |journal=Experimental Neurology |date=26 July 2008 |volume=214 |issue=1 |pages=62–68 |doi=10.1016/j.expneurol.2008.07.013 |pmid=18706413|pmc=2891365 }}</ref> Overactivation of the hypothalamic-pituitary-adrenal (HPA) axis could provide potential insight into how these sex differences arise. Neuropeptide corticotropin-releasing factor (CRF) is released from the paraventricular nucleus (PVN) of the hypothalamus, stimulating adrenocorticotropic hormone (ACTH) release into the blood stream. From here ACTH triggers the release of glucocorticoids such as cortisol from the adrenal cortex. Cortisol, known as the main stress hormone, creates a negative feedback loop back to the hypothalamus to deactivate the stress response.<ref>{{cite journal |last1=Ramot |first1=Assaf |title=Hypothalamic CRFR1 is essential for HPA axis regulation following chronic stress |journal=Nature Neuroscience |date=March 2017 |volume=20 |issue=3 |pages=385–388 |doi=10.1038/nn.4491 |pmid=28135239|s2cid=5017743 }}</ref> When a constant stressor is present, the HPA axis remains overactivated and cortisol is constantly produced. This chronic stress is associated with sustained CRF release, resulting in the increased production of anxiety- and depressive-like behaviors and serving as a potential mechanism for differences in prevalence between men and women.<ref name="Sex-dependent effects of chronic va"/>

==Diagnosis==

===''DSM-5''===
The ''DSM-5'', released in May 2013, separates the mood disorder chapter from the ''DSM-IV-TR'' into two sections: Depressive and related disorders and bipolar and related disorders. Bipolar disorders fall in between depressive disorders and schizophrenia spectrum and related disorders "in recognition of their place as a bridge between the two diagnostic classes in terms of symptomatology, family history and genetics" (Ref. 1, p 123).{{sfn|American Psychiatric Association|2013|p={{page needed|date=October 2021}}}} Bipolar disorders underwent a few changes in the ''DSM-5'', most notably the addition of more specific symptomology related to hypomanic and mixed manic states. Depressive disorders underwent the most changes, the addition of three new disorders: disruptive mood dysregulation disorder, persistent depressive disorder (previously dysthymia), and premenstrual dysphoric disorder (previously in appendix B, the section for disorders needing further research). Disruptive mood dysregulation disorder is meant as a diagnosis for children and adolescents who would normally be diagnosed with bipolar disorder as a way to limit the bipolar diagnosis in this age cohort. Major depressive disorder (MDD) also underwent a notable change, in that the bereavement clause has been removed. Those previously exempt from a diagnosis of MDD due to bereavement are now candidates for the MDD diagnosis.<ref>{{cite journal|last1=Parker|first1=George|title=DSM-5 and Psychotic and Mood Disorders|journal=Journal of the American Academy of Psychiatry and the Law|date=2014|volume=42|issue=2 |pages=182–190|pmid=24986345}}</ref>

==Treatment==
There are different types of treatments available for mood disorders, such as therapy and medications. [[Behaviour therapy]], [[cognitive behaviour therapy]] and [[interpersonal psychotherapy|interpersonal therapy]] have all shown to be potentially beneficial in depression.{{sfn|Nolen-Hoeksema|2013|p=203}}<ref>{{cite journal|last1=Weston|first1=Drew|last2=Morrison|first2=Kate|title=A multidimensional meta-analysis of treatments for depression, panic, and generalized anxiety disorder: An empirical examination of the status of empirically supported therapies|journal=Journal of Consulting and Clinical Psychology|date=2001 |volume=69|issue=6|pages=875–899|doi=10.1037/0022-006X.69.6.875 |pmid=11777114 |citeseerx=10.1.1.200.7241}}</ref> Major depressive disorder medications usually include [[antidepressant]]s; a combination of antidepressants and [[cognitive behavioral therapy]] has shown to be more effective than one treatment alone.<ref>{{Cite journal |last1=Karyotaki|first1=E.|last2=Smit|first2=Y.|last3=Holdt Henningsen|first3=K.|last4=Huibers|first4=M.J.H. |last5=Robays|first5=J.|last6=de Beurs|first6=D.|last7=Cuijpers|first7=P.|date=2016 |title=Combining pharmacotherapy and psychotherapy or monotherapy for major depression? A meta-analysis on the long-term effects|journal=Journal of Affective Disorders|volume=194 |pages=144–152|doi=10.1016/j.jad.2016.01.036|pmid=26826534 |issn=0165-0327|hdl=1871.1/adac41b1-0b2a-449f-a4df-b8e9baebddde |hdl-access=free}}</ref> Bipolar disorder medications can consist of [[antipsychotics]], [[mood stabilizers]], [[anticonvulsant]]s<ref>{{cite journal|last1=Keck|first1=Paul E. Jr.|last2=McElroy |first2=Susan L. |author2-link=Susan McElroy |last3=Strakowski|first3=Stephen M.|title=Anticonvulsants and antipsychotics in the treatment of bipolar disorder|journal=The Journal of Clinical Psychiatry |date=1998|volume=59|issue=Suppl 6 |pages=74–82|pmid=9674940}}</ref> and/or [[lithium (medication)|lithium]]. Lithium specifically has been proven to reduce suicide and all causes of mortality in people with mood disorders.<ref>{{Cite journal |last=Cipriani|first=A|year=2013|title=Lithium in the prevention of suicide in mood disorders: updated systematic review and meta-analysis|journal=BMJ|volume=346|page=1|pmid=23814104 |doi=10.1136/bmj.f3646|doi-access=free}}</ref> If mitochondrial dysfunction or [[mitochondrial diseases]] are the cause of mood disorders like bipolar disorder,<ref name="Pieczenik, Steve R 2006"/> then it has been hypothesized that N-acetyl-cysteine (NAC), acetyl-L-carnitine (ALCAR), S-adenosylmethionine (SAMe), coenzyme Q10 (CoQ10), alpha-lipoic acid (ALA), creatine monohydrate (CM), and melatonin could be potential treatment options.<ref>{{cite journal |vauthors=Nierenberg, Andrew A, Kansky, Christine, Brennan, Brian P, Shelton, Richard C, Perlis, Roy, Iosifescu, Dan V |title=Mitochondrial modulators for bipolar disorder: A pathophysiologically informed paradigm for new drug development|journal=Australian & New Zealand Journal of Psychiatry |volume=47 |issue=1 |pages=26–42 |year=2012 |doi=10.1177/0004867412449303|pmid=22711881 |s2cid=22983555 }}</ref> In determining treatment, there are many types of depression scales that are used. One of the depression scales is a self-report scale called Beck Depression Inventory (BDI). Another scale is the Hamilton Depression Rating Scale (HAMD). HAMD is a clinical rating scale in which the patient is rated based on clinician observation.<ref>{{Cite journal|last1=Kim|first1=Eun Young|last2=Hwang|first2=Samuel Suk-Hyun |last3=Lee|first3=Nam Young|last4=Kim|first4=Se Hyun|last5=Lee|first5=Hyun Jeong|last6=Kim|first6=Yong Sik |last7=Ahn |first7=Yong Min |date=June 2013|title=Intelligence, temperament, and personality are related to over- or under-reporting of affective symptoms by patients with euthymic mood disorder|journal=Journal of Affective Disorders |volume=148|issue=2–3 |pages=235–242|doi=10.1016/j.jad.2012.11.065|pmid=23270973 |issn=0165-0327}}</ref> The Center for Epidemiologic Studies Depression Scale (CES-D) is a scale for depression symptoms that applies to the general population. This scale is typically used in research and not for self-reports. The PHQ-9 which stands for Patient-Health Questionnaire-9 questions, is a self-report as well. Finally, the Mood Disorder Questionnaire (MDQ) evaluates bipolar disorder.<ref>{{Cite journal |last1=Choi|first1=Seung W.|last2=Schalet|first2=Benjamin|last3=Cook|first3=Karon F.|last4=Cella|first4=David |date=2014|title=Establishing a common metric for depressive symptoms: Linking the BDI-II, CES-D, and PHQ-9 to PROMIS Depression.|journal=Psychological Assessment|volume=26|issue=2|pages=513–527|doi=10.1037/a0035768 |pmid=24548149|pmc=5515387|issn=1939-134X}}</ref>

==Epidemiology==

According to a substantial number of epidemiology studies conducted, women are twice as likely to develop certain mood disorders, such as major depression.  Although there is an equal number of men and women diagnosed with bipolar II disorder, women have a slightly higher frequency of the disorder.<ref>Bauer, M., Pfenning, A. (2005). Epidemiology of Bipolar Disorders. Epilepsia, 46(s4), 8–13.</ref>

In 2011, mood disorders were the most common reason for hospitalization among children aged 1–17 years in the United States, with approximately 112,000 stays.<ref>{{cite journal |vauthors=Pfuntner A, Wier LM, Stocks C |title=Most Frequent Conditions in U.S. Hospitals, 2011 |work=HCUP Statistical Brief |issue=162 |date=September 2013 |publisher=Agency for Healthcare Research and Quality |place=Rockville, MD. |url=http://www.hcup-us.ahrq.gov/reports/statbriefs/sb162.jsp |access-date=9 February 2016 |url-status=live |archive-url=https://web.archive.org/web/20160304032807/http://www.hcup-us.ahrq.gov/reports/statbriefs/sb162.jsp |archive-date=4 March 2016}}</ref> Mood disorders were top principal diagnosis for Medicaid super-utilizers in the United States in 2012.<ref>{{cite journal |vauthors=Jiang HJ, Barrett ML, Sheng M |title=Characteristics of Hospital Stays for Nonelderly Medicaid Super-Utilizers, 2012 |journal=HCUP Statistical Brief |issue=184 |publisher=Agency for Healthcare Research and Quality |location=Rockville, MD |date=November 2014 |pmid=25590126 |url=https://www.hcup-us.ahrq.gov/reports/statbriefs/sb184-Hospital-Stays-Medicaid-Super-Utilizers-2012.jsp |access-date=6 April 2015 |archive-url=https://web.archive.org/web/20150411224657/https://www.hcup-us.ahrq.gov/reports/statbriefs/sb184-Hospital-Stays-Medicaid-Super-Utilizers-2012.jsp |archive-date=11 April 2015}}</ref> Further, a study of 18 states found that mood disorders accounted for the highest number of hospital readmissions among Medicaid patients and the uninsured, with 41,600 Medicaid patients and 12,200 uninsured patients being readmitted within 30 days of their index stay—a readmission rate of 19.8 per 100 admissions and 12.7 per 100 admissions, respectively.<ref>{{cite journal |vauthors=Hines AL, Barrett ML, Jiang HJ, Steiner CA |title=Conditions With the Largest Number of Adult Hospital Readmissions by Payer, 2011 |journal=HCUP Statistical Brief |issue=172 |publisher=Agency for Healthcare Research and Quality |location=Rockville, MD |date=April 2014 |pmid=24901179 |url=http://hcup-us.ahrq.gov/reports/statbriefs/sb172-Conditions-Readmissions-Payer.jsp |url-status=live |archive-url=https://web.archive.org/web/20160304052719/http://hcup-us.ahrq.gov/reports/statbriefs/sb172-Conditions-Readmissions-Payer.jsp |archive-date=4 March 2016}}</ref> In 2012, mood and other behavioral health disorders were the most common diagnoses for Medicaid-covered and uninsured hospital stays in the United States (6.1% of Medicaid stays and 5.2% of uninsured stays).<ref>{{cite journal |vauthors=Lopez-Gonzalez L, Pickens GT, Washington R, Weiss AJ |title=Characteristics of Medicaid and Uninsured Hospitalizations, 2012 |journal=HCUP Statistical Brief |issue=183 |publisher=Agency for Healthcare Research and Quality |location=Rockville, MD |date=October 2014 |pmid=25535644 |url=https://www.hcup-us.ahrq.gov/reports/statbriefs/sb182-Medicaid-Uninsured-Hospitalizations-2012.jsp |url-status=live |archive-url=https://web.archive.org/web/20141129104408/https://www.hcup-us.ahrq.gov/reports/statbriefs/sb182-Medicaid-Uninsured-Hospitalizations-2012.jsp |archive-date=29 November 2014}}</ref>

A study conducted in 1988 to 1994 amongst young American adults involved a selection of demographic and health characteristics. A population-based sample of 8,602 men and women ages 17–39 years participated. Lifetime prevalence were estimated based on six mood measures:
* major depressive episode (MDE) 8.6%,
* major depressive disorder with severity (MDE-s) 7.7%,
* dysthymia 6.2%,
* MDE-s with dysthymia 3.4%,
* any bipolar disorder 1.6%, and
* any mood disorder 11.5%.<ref name=":17">Nesse, Randolphe M.; Williams, George C. (1994). ''Why We Get Sick: The New Science of Darwinian Medicine''. Vintage Books. {{ISBN|0-8129-2224-7}}</ref>

== Research ==
{{See also|List of investigational antidepressants}}

[[Kay Redfield Jamison]] and others have explored the possible links between mood disorders – especially bipolar disorder – and [[creativity]]. It has been proposed that a "ruminating personality type may contribute to both [mood disorders] and art."<ref>{{cite news |url=http://www.cnn.com/2008/HEALTH/conditions/10/07/creativity.depression/index.html |access-date=13 May 2010 |work=CNN |title=Experts ponder link between creativity, mood disorders |date=2 April 2009 |archive-url=https://web.archive.org/web/20100327185226/http://www.cnn.com/2008/HEALTH/conditions/10/07/creativity.depression/index.html |archive-date=27 March 2010 |url-status=live}}</ref>

Jane Collingwood notes an Oregon State University study that:<blockquote>looked at the occupational status of a large group of typical patients and found that 'those with bipolar illness appear to be disproportionately concentrated in the most creative occupational category.' They also found that the likelihood of 'engaging in creative activities on the job' is significantly higher for bipolar than nonbipolar workers.<ref>{{cite web |last=Collingwood |first=Jane |date=2010 |title=The Link Between Bipolar Disorder and Creativity |website=Psych Central |url=http://psychcentral.com/lib/2010/the-link-between-bipolar-disorder-and-creativity/ |access-date=19 November 2011 |archive-url=https://web.archive.org/web/20111022082308/http://psychcentral.com/lib/2010/the-link-between-bipolar-disorder-and-creativity/ |archive-date=22 October 2011}}</ref></blockquote>In Liz Paterek's article "Bipolar Disorder and the Creative Mind" she wrote:<blockquote>Memory and creativity are related to mania. Clinical studies have shown that those in a manic state will rhyme, find synonyms, and use [[alliteration]] more than controls. This mental fluidity could contribute to an increase in creativity. Moreover, mania creates increases in productivity and energy. Those in a manic state are more emotionally sensitive and show less inhibition about attitudes, which could create greater expression. Studies performed at Harvard looked into the amount of original thinking in solving creative tasks. Bipolar individuals, whose disorder was not severe, tended to show greater degrees of creativity.<ref>{{cite web |last=Paterek |first=Liz |title=Bipolar Disorder and the Creative Mind |website=Serendip |date=2006 |url=https://serendipstudio.org/bb/neuro/neuro06/web2/lpaterek.html}}</ref></blockquote>The relationship between depression and creativity appears to be especially strong among [[poet]]s.<ref>{{cite journal | last = Kaufman | first = JC | title = The Sylvia Plath effect: Mental illness in eminent creative writers | journal = Journal of Creative Behavior | volume = 35 | issue = 1 | pages = 37–50 | year = 2001 | url = http://creativeeducation.metapress.com/content/p1t4563378366t55/fulltext.pdf | issn = 0022-0175 | doi = 10.1002/j.2162-6057.2001.tb01220.x | archive-url = https://web.archive.org/web/20120302025608/http://creativeeducation.metapress.com/content/p1t4563378366t55/fulltext.pdf | archive-date = 2 March 2012}}</ref><ref>{{cite journal | last = Bailey | first = DS | title = Considering Creativity: The 'Sylvia Plath' effect | journal = Monitor on Psychology | volume = 34 | issue = 10 | page = 42 | year = 2003 | url = http://www.apa.org/monitor/nov03/plath.html | url-status = live | archive-url = https://web.archive.org/web/20081020181540/http://www.apa.org/monitor/nov03/plath.html | archive-date = 20 October 2008}}</ref>

==See also==
* [[Personality disorder]]
* [[Endorphins]]
* [[Bipolar Disorder]]
* [[Depression (mood)]]
* [[Dysthymia]]
* [[Hypomania]]
* [[Major depressive disorder]]
* [[Mania]]

== References ==
{{Reflist}}
;Cited texts
* {{Cite book |title=Diagnostic and statistical manual of mental disorders, Fourth Edition, Text Revision: DSM-IV-TR |author=American Psychiatric Association |publisher=American Psychiatric Publishing, Inc. |location=Washington, DC |year=2000 |isbn=978-0-89042-025-6}}
* {{cite book|author=American Psychiatric Association|year=2013|title=Diagnostic and statistical manual of mental disorders, Fifth Edition, Text Revision: DSM-5 |publisher=American Psychiatric Association, Inc. |location=Washington, DC |isbn=978-0-89042-554-1 |url=https://archive.org/details/diagnosticstatis0005unse}}
* {{Cite book|title=Psychology the science of behaviour|last1=Carlson|first1=Neil R.|first2=C. Donald |last2=Heth|year=2007|publisher=Pearson Education Inc.|edition=4th|isbn=978-0-205-64524-4|url-access=registration |url=https://archive.org/details/psychologyscienc0004unse}}
* {{cite book |last1=Collier |first1=Judith |last2=Longmore |first2=Murray |chapter=4 |editor-last=Scally |editor-first=Peter |title=Oxford Handbook of Clinical Specialties |edition=6th |year=2003 |publisher=Oxford University Press |isbn=978-0-19-852518-9}}
* {{cite book |last1=Nesse |first1=Randolphe M. |last2=Williams |first2=George C. |year=1994 |title=Why We Get Sick: The New Science of Darwinian Medicine |publisher=Vintage Books |isbn=0-8129-2224-7}}
* {{cite book|last1=Nolen-Hoeksema|first1=S|title=Abnormal Psychology|year=2013|publisher=McGraw-Hill Higher Education|isbn=978-0-07-749969-3|edition=6th |url=https://ufl.instructure.com/courses/207352/external_tools/11778 |access-date=5 December 2014}}
* {{Cite book |title=Melancholia: A disorder of movement and mood: a phenomenological and neurobiological review |last1=Parker |first1=Gordon |author-link=Gordon Parker (psychiatrist) |last2=Hadzi-Pavlovic |first2=Dusan |last3=Eyers |first3=Kerrie |year=1996 |publisher=Cambridge University Press |location=Cambridge |isbn=978-0-521-47275-3}}
* {{Cite book|title=Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry |last1=Sadock|first1=Benjamin J.|last2=Sadock|first2=Virginia A.|year=2002|publisher=Lippincott Williams & Wilkins|edition=9th |isbn=978-0-7817-3183-6}}
* {{cite book|last1=Semple|first1=David |last2=Smyth |first2=Roger |last3=Burns |first3=Jonathan |last4=Darjee |first4=Rajan |last5=McIntosh |first5=Andrew |year=2007 |orig-date=2005 |chapter=13 |title=Oxford Handbook of Psychiatry |publisher=Oxford University Press|isbn=978-0-19-852783-1}}
* {{cite web |last=Sartorius|first=Norman|author-link=Norman Sartorius |date=1993 |title=The ICD-10 Classification of Mental and Behavioural Disorders – Clinical descriptions and diagnostic guidelines |website=www.who.int |publisher=[[World Health Organization]] |url=https://www.who.int/classifications/icd/en/bluebook.pdf |access-date=3 July 2021 }}
* {{cite book|last1=Schacter|first1=Daniel L.|last2=Gilbert|first2=Daniel T.|last3=Wegner|first3=Daniel M. |year=2011|chapter=Chapter 14: Psychological Disorders|title=Psychology|edition=2nd|isbn=978-1-4292-3719-2 |publisher=Worth Publishers |url=https://archive.org/details/psychologysecond00dani |url-access=limited}}

==External links==
* {{Commons category-inline|Mood disorders}}
{{Medical resources
|  DiseasesDB     =
|  ICD10          = {{ICD10|F|30||f|30}}-{{ICD10|F|39||f|30}}
|  ICD9           = {{ICD9|296}}
|  ICDO           =
|  OMIM           =
|  MedlinePlus    =
|  eMedicineSubj  =
|  eMedicineTopic =
|  MeshID         = D019964
}}
{{Mental and behavioral disorders|selected = mood}}
{{Bipolar disorder}}

{{Authority control}}

[[Category:Mood disorders| ]]