Understanding Mood Disorders

General Course Information

Lectures: Two per week.
Tutorials: One per week (Tuesday or Wednesday).
Assessments: Two online tests.
Final Exam: One.
Information Source: Course guide on iKamva.
Communication: All enquiries via email to psy3queries@[Link], clearly indicating PSY311
in the subject line.

General Learning Objectives

Understand and distinguish mood disorders from other disorders.
Formulate an aetiological model of mood disorders.
Recount the history of mood disorders.
Understand the challenges in the nosology (classification) of mood disorders.
Describe a major depressive episode.
Describe a manic episode.
Understand Persistent Depressive Disorder (PDD) and its alternative names.
Identify cross-cultural and South African variations in mood disorder presentation.
Critically engage with content, answering factual, conceptual, and application-based
questions (e.g., case studies).

Chapter 7: Mood Disorders Overview

Introduction to Mood Disorders
Mood Disorders (MDs): Also known as affective disorders.
Mood: Defined as "any short-lived emotional state, usually of low intensity (e.g., a cheerful
mood, an irritable mood)" or "a disposition to respond emotionally in a particular way that
may last for hours, days, or even weeks, perhaps at a low level and without the person
knowing what prompted the state."
Impact: MDs affect how a person thinks, feels, and functions in daily life, potentially
impacting personal and family functioning.
Distinction between Mood and Emotion: While often used interchangeably in everyday
language, "mood" and "emotion" refer to different aspects in psychology and medicine.
Emotion: A reaction to a meaningful stimulus.
Feeling: An experience of emotion that influences behavior.
Affect: The outward expression of an emotional state.
Mood: A sustained emotional state (the overall affective state).

History of Mood Disorders

1798 (Phillipe Pinel): Categorized mental illness into four types, including melancholia and
mania.
1851 (Jean-Pierre Falret): Introduced the concept of "circular insanity."
Late 1800s (Emil Kraepelin): Differentiated between manic-depressive insanity and dementia
 praecox.
First half of 1900s (Karl Kleist): Proposed the distinction between unipolar and bipolar mood
disorders.
1980 (DSM-III): Formally introduced "Bipolar disorder" as a diagnostic category.

Epidemiology of Mood Disorders

Prevalence: Mood disorders are highly prevalent globally.
Burden: The World Health Organization (WHO) identifies depressive and bipolar illnesses as
the most burdensome and disabling medical conditions worldwide.
Treatment Gap: Over 75% of individuals with MDs in low- to middle-income countries do not
receive treatment.
Disabling Disorders: Depression and anxiety are ranked among the top 25 leading causes of
global burden.
United States Statistics: An estimated 21% of adults experience a mood disorder at some
point in their lives.
South African Context:
Prevalent symptoms of depression and anxiety are observed in specific demographic
groups.
Higher prevalence noted in individuals aged 65 years or older (39% showing signs of
probable depression).
Other groups with higher prevalence include those who were widowed, divorced, or
separated (32.6%), had only primary school education (32.1%), were retired (30.6%),
resided in metropolitan areas (27.0%), were women (26.7%), and had lower household
assets (26.4%).

Aetiology of Mood Disorders

Mood disorders are understood to result from the interaction of multiple risk factors:

Environmental Factors:
Environmental stressors are significant precipitating factors for Major Depressive Disorder
(MDD).
Examples include financial difficulties, separation/divorce, health problems, job loss, and
significant life events.
The COVID-19 pandemic is cited as an example of an environmental stressor with adverse
mental health effects.
Individuals react differently to stressors due to their unique biological and psychological
adaptations.

Biological Factors (Neurotransmitters):

Multiple interconnected neurotransmitter circuits are implicated in mood disorders.
Specific neurotransmitters regulate crucial functions like sleep, appetite, sexual function,
endocrine function, arousal, and emotional states.
Monoamine Hypothesis: Disruption in monoamine signaling (e.g., serotonin, dopamine,
norepinephrine) is linked to mood disorders.
Selective Serotonin Reuptake Inhibitors (SSRIs): These medications work by inhibiting the
reuptake of serotonin, increasing its levels in the synapse and enhancing
neurotransmission. This also applies to dopamine and norepinephrine with some SSRIs.
Altered Biological Rhythms: Disruption in circadian rhythms is also associated with mood
disorders. "Wake therapy" is a treatment strategy that capitalizes on this.
 Genetic Factors:
Genetic risk factors contribute to the onset of mood disorders, particularly in young
people.
A family history of mood disorders in a first-degree relative increases the risk.
The estimated heritability of MDD is a significant factor. Individuals who experience one
major depressive episode are more vulnerable to recurrent episodes.

Depressive Disorders
Depressive disorders affect millions globally and have a pervasive impact on various life
domains. They are characterized by:

Affective symptoms (sadness, low mood).

Impaired cognitive functioning.
Neurovegetative symptoms (e.g., disturbed sleep, appetite changes).
Increased risk of suicidality.
The global estimated prevalence of depression is 5% of adults, approximately 280 million
people.

Major Depressive Disorder (MDD)

Clinical Syndrome: Characterized by a depressed mood or a loss of interest or pleasure in
nearly all activities.
Duration: Symptoms must be present for most of the day, nearly every day, for a minimum of
two weeks.
Symptoms: Can include cognitive, physical (somatic), behavioral, and perceptual changes.
Neurovegetative Symptoms: Disturbances in appetite and sleep are common.
Course: MDD is typically an episodic and lifelong disorder with potential for multiple
recurrences. The average interval between episodes is approximately 5 years. The course can
vary in chronicity and remission.

DSM-5 Criteria for a Major Depressive Episode (MDE)

Presence of five or more symptoms during the same two-week period, representing a change
from previous functioning.
At least one of the symptoms must be either:
Depressed mood.
Loss of interest or pleasure (anhedonia).
Other potential symptoms include:
Significant weight loss or gain (or decrease/increase in appetite).
Insomnia or hypersomnia.
Psychomotor agitation or retardation.
Fatigue or loss of energy.
Feelings of worthlessness or excessive guilt.
Diminished ability to think or concentrate, or indecisiveness.
Recurrent thoughts of death or suicide ideation.

Grief vs. Major Depressive Episode (MDE)

While grief can share symptoms with MDE, key distinctions exist:

Dysphoria:
Grief: Dysphoria is often tied to thoughts of the deceased and may involve periods of
positive affect.
MDE: Dysphoria is more persistent and pervasive, affecting all aspects of life.
Self-Esteem:
Grief: Self-esteem is usually preserved.
MDE: Feelings of worthlessness are prominent.
Thoughts of Death:
Grief: Thoughts of death are typically related to a longing for the deceased.
MDE: Thoughts of death are more often associated with suicide ideation.

Persistent Depressive Disorder (PDD) / Dysthymia

Characteristics: A type of depressive disorder characterized by mild but persistent
symptoms.
Severity: Symptoms are generally less severe than MDD but can last for years, significantly
impacting the individual.
Historical Terms: Previously considered a "depressed personality state." Also known as
dysthymia, recurrent major depressive disorder, chronic major depressive disorder, and dual
depression.
In Children and Adolescents: The mood can be irritable, and the duration must be at least one
year.
Other Symptoms: Changes in appetite, sleeping patterns, low energy, low self-esteem, poor
concentration, difficulty with decision-making, and feelings of hopelessness.
Severity Spectrum: PDD can present as mild, moderate, or severe.
"Double Depression": Occurs when PDD and MDD coexist in the same individual.

Premenstrual Dysphoric Disorder (PMDD)

Affected Population: Commonly affects women of reproductive age.
Timing: Characterized by mood and somatic (physical) symptoms that typically occur in the
final week before the start of the menstrual cycle and resolve in the week after.
Severity: A more extreme form of premenstrual syndrome (PMS).
Impact: Causes significant distress and impairment in daily functioning, productivity, and
quality of life.
Key Symptoms:
Mood swings, feelings of hopelessness, suicidal thoughts, bouts of extreme sadness,
decreased interest in usual activities, depression.
Anxiety, irritability, bouts of rage.
Other Potential Symptoms: Headaches, joint/muscle pain, hot flushes, insomnia, extreme
fatigue, appetite changes (decrease/increase), difficulty concentrating, cramps/bloating,
breast tenderness.

Bipolar and Related Disorders

Manic Episode
 Definition (DSM-5): A distinct period of abnormally and persistently increased activity or
energy.
Characteristics:
A change from usual functioning.
Increased energy.
Engaging in risky behaviors.

Bipolar Disorders
Bipolar I Disorder: Characterized by at least one manic episode. Major depressive episodes
are common but not required for diagnosis.
Bipolar II Disorder: Characterized by at least one hypomanic episode and at least one major
depressive episode. There have never been any manic episodes.
Hypomania: A less severe form of mania, characterized by a distinct period of abnormally
elevated, expansive, or irritable mood and increased activity or energy, lasting at least 4
consecutive days. The episode is associated with an unequivocal change in functioning
that is uncharacteristic of the individual when not symptomatic. The disturbance in mood
and the change in functioning are observable by others. The episode is not severe enough
to cause marked impairment in social or occupational functioning or to necessitate
hospitalization.
Cyclothymic Disorder: Characterized by at least two years (one year in children and
adolescents) of numerous periods with hypomanic symptoms that do not meet criteria for a
hypomanic episode and numerous periods with depressive symptoms that do not meet
criteria for a major depressive episode.

Treatment of Bipolar Disorder

Pharmacological Options:
Lithium carbonate.
Antipsychotics.
Mood stabilizers.
Combined Approach: Most treatments involve a combination of psychotherapy and
medication.

Key Terms
Affect: Outward expression of emotion.
Bipolar I Disorder: Manic episodes, often with depressive episodes.
Bipolar II Disorder: Hypomanic episodes and major depressive episodes.
Circadian Rhythms: Biological cycles that regulate sleep-wake patterns, often disrupted in
mood disorders.
Cyclothymic Disorder: Chronic, fluctuating mood with periods of hypomanic and depressive
symptoms that do not meet full diagnostic criteria.
Depression: A mood state characterized by sadness, low energy, and loss of interest.
Disruptive Mood Dysregulation Disorder: A childhood disorder characterized by persistent
irritability and frequent temper outbursts.
Dysthymia: Another term for Persistent Depressive Disorder (PDD).
Dysphoria: A state of unease or dissatisfaction; unhappiness.
Emotion: A reaction to a stimulus.
Environmental Stressors: Life events or conditions that trigger distress.
Epidemiology: The study of the distribution and determinants of health-related states or
 events in specified populations.
Feeling: The subjective experience of an emotion.
Grief: A natural response to loss, distinct from a major depressive episode.
Heritability: The proportion of variation in a trait attributable to genetic factors.
Hypomania: A less severe form of mania.
Major Depressive Episode (MDE): A period characterized by at least five depressive
symptoms, including depressed mood or loss of interest/pleasure.
Major Depressive Disorder (MDD): A clinical syndrome characterized by one or more major
depressive episodes.
Melancholia: An older term often associated with severe depression.
Mood: A sustained emotional state.
Mood Disorders (MDs): Also known as affective disorders.
Neurotransmitters: Chemical messengers in the brain that play a role in mood regulation.
Nosology: The branch of medicine dealing with the classification of diseases.
Parasuicide: Non-fatal self-harming behavior.
Persistent Depressive Disorder (PDD): A chronic form of depression with milder but longer-
lasting symptoms.
Premenstrual Dysphoric Disorder (PMDD): A severe form of premenstrual symptoms
affecting mood and physical well-being.
Sadness: A common emotion, a component of depressive disorders.
Suicide: The act of intentionally causing one's own death.
Suicide Ideation: Thoughts about committing suicide.
Unipolar Depression: Depression without a history of manic or hypomanic episodes.

Self-Study Articles and Test Preparation

Required Reading: Thoroughly study pages 220-238 of "Understanding Psychopathology."
Self-Study Article: Marx, W., Penninx, B. W., Solmi, M., Furukawa, T. A., Firth, J., Carvalho, A. F.,
& Berk, M. (2023). Major depressive disorder. Nature Reviews Disease Primers, 9(1), 44.
Test 1 (March 3, 2026):
Content: Chapter 7 and self-study articles.
Format: 50 Multiple Choice Questions (MCQs).
15 conceptual questions.
15 application questions.
20 questions based on the two articles.